Vận dụng phương pháp PECS kết hợp với trò chơi để luyện phát âm cho trẻ 3 - 4 tuổi có rối loạn phổ tự kỷ

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Bài viết trình bày kết quả vận dụng phương pháp PECS kết hợp trò chơi để luyện phát âm cho trẻ 3 - 4 tuổi có rối loạn phổ tựkỉtạitrường mầm non hoà nhập. Phương pháp nghiên cứu chủ yếu được sử dụng trong bài viết là phương pháp nghiên cứu định lượng nhằm xác định khả năng phát âm của 4 trẻ có rối loạn phổ tự kỉ trước và sau khi tham gia luyện phát âm kéo dài 1 tháng.

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Nội dung Text: Vận dụng phương pháp PECS kết hợp với trò chơi để luyện phát âm cho trẻ 3 - 4 tuổi có rối loạn phổ tự kỷ

TẠP CHÍ KHOA HỌC QUẢN LÝ GIÁO DỤC SỐ 01(45), THÁNG 3 – 2025 VẬN DỤNG PHƯƠNG PHÁP PECS KẾT HỢP VỚI TRÒ CHƠI ĐỂ LUYỆN PHÁT ÂM CHO TRẺ 3 – 4 TUỔI CÓ RỐI LOẠN PHỔ TỰ KỈ APPLYING THE PECS METHOD IN COMBINATION WITH GAMES TO PRACTICE PRONUNCIATION FOR 3-4-YEAR-OLD CHILDREN WITH AUTISM SPECTRUM DISORDER PHAN THỊ HẰNG*, NGUYỄN THỊ HOÀI THU** , DƯ THỐNG NHẤT***, nhatdt@hcmue.edu.vn * Khoa Giáo dục Đặc biệt, trường Đại học Sư phạm TP. Hồ Chí Minh ** Trường Mầm non Hòa Nhập Hướng Dương, TP. Thủ Đức *** Khoa khoa học giáo dục, trường Đại học Sư phạm TP. Hồ Chí Minh. THÔNG TIN TÓM TẮT Ngày nhận: 17/02/2025 Bài viết trình bày kết quả vận dụng phương pháp PECS kết hợp trò Ngày nhận lại: 15/03/2025 chơi để luyện phát âm cho trẻ 3 - 4 tuổi có rối loạn phổ tự kỉ tại trường Duyệt đăng: 18/03/2025 mầm non hoà nhập. Phương pháp nghiên cứu chủ yếu được sử dụng Mã số: TCKH-S01T03-2025-B12 trong bài viết là phương pháp nghiên cứu định lượng nhằm xác định ISSN: 2354 - 0788 khả năng phát âm của 4 trẻ có rối loạn phổ tự kỉ trước và sau khi tham gia luyện phát âm kéo dài 1 tháng. Kết quả nghiên cứu cho thấy cả 4 trẻ đã có những tiến bộ đáng kể về mặt phát âm, thể hiện qua khả năng tự phát âm đúng các từ một cách rõ ràng hơn, với mức độ phát âm cải thiện từ mức độ 4 lên mức độ 3 theo thang đo đánh giá. Nghiên cứu này khẳng định hiệu quả của việc kết hợp phương pháp PECS với trò chơi trong việc luyện phát âm đối với trẻ rối loạn phổ tự kỉ. Việc kết hợp này không chỉ giúp trẻ hứng thú hơn trong quá trình học tập mà còn góp phần nâng cao đáng kể khả năng phát âm, giúp trẻ phát âm rõ ràng, trôi chảy và dễ dàng hơn trong giao tiếp với bạn bè. Phương pháp PECS kết hợp trò chơi giáo dục nên được tích hợp vào giáo dục mầm non, đào tạo giáo viên và hỗ trợ cha mẹ học sinh. Nghiên cứu tiếp theo cần mở rộng quy mô, theo dõi tác động dài hạn, tối ưu hóa trò chơi và so sánh với phương pháp truyền thống. Từ khóa: ABSTRACT Luyện phát âm, rối loạn phổ tự kỉ, This article presents the results of applying the Picture Exchange giáo dục hoà nhập, trò chơi học Communication System (PECS) method in combination with tập. games to practice pronunciation for 3–4-year-old children with Keywords: autism spectrum disorder at an inclusive preschool. The main Pronunciation training, autism research method utilized in this study is the quantitative research spectrum disorder, inclusive method, aiming to determine the pronunciation capabilities of four education, educational games. children with autism spectrum disorder before and after participating in one month of pronunciation training. The research results indicate that all four children showed significant progress in pronunciation, as evidenced by their ability to independently articulate words more clearly, with their pronunciation level improving from level 4 to level 3 based on the evaluation scale. This study underscores the effectiveness of combining the PECS method with games in pronunciation training for children with autism spectrum disorder. This integration not only enhances the children’s interest in the learning process but also significantly contributes to improving their pronunciation ability, enabling them to articulate clearly, fluently, and more easily engage in communication with peers. The PECS method combined with educational games should be integrated into early childhood 111
PHAN THỊ HẰNG - NGUYỄN THỊ HOÀI THU - DƯ THỐNG NHẤT education, teacher training, and parental support. Future research should expand in scale, assess long-term effects, optimize games, and compare with traditional methods. 1. Introduction cooperative activities with peers. Therefore, Autism Spectrum Disorder (ASD) has been incorporating structured play-based a subject of interest and research among interventions not only fosters social interaction scientists since the 1940s. In 1943, American but also provides educators with opportunities to psychiatrist Leo Kanner provided specific encourage more natural, enthusiastic, and descriptions of autism and children with ASD effective verbal expression in children with (Le Minh Cong and Ngo Xuan Diep, 2012). ASD. As inclusive education continues to gain ASD is characterized by deficits in social importance, applying this method can communication and a preference for repetitive, significantly enhance early intervention efforts stereotyped behaviors, which consequently lead and provide a strong foundation for children’s to delays in children’s language development long-term development. (Vu Thi Thuy Dung, Nguyen Thi Tan, Do Thi According to the Law on Persons with Hao, 2024). ASD is a developmental disability Disabilities, the “rights and responsibilities of that persists throughout life, often appearing persons with disabilities are the obligations of the within the first three years of life. Key state, family, and society” (National Assembly of characteristics of ASD include impairments in the Socialist Republic of Vietnam, 2010). Children social interaction, verbal, and non-verbal with Autism Spectrum Disorder (ASD) also have communication. Most children with ASD face the right to study, dream, play, and engage in significant challenges in verbal expression activities like their peers. Inclusive education (IE) compared to typically developing children. is defined as “an educational approach for all Additionally, these children often exhibit restricted children, including those with special educational interests and repetitive, unchanging activities over needs, within regular classrooms of mainstream time (Nguyen Xuan Hai, 2010). Research findings schools” (Nguyen Xuan Hai, Le Thi Thuy Hang, on 15 children with ASD in Hanoi indicate that all Tran Thi Thiep, 2008, p. 15). This is an inevitable three-year-old children had spoken language, and trend adopted by most countries worldwide to their vocabulary size increased annually. ensure the fundamental rights of all children, as However, the rate of language development varied stated in the International Convention on the among children, depending on the severity of the Rights of the Child. In inclusive preschools, disorder and the language training they received children with ASD often face difficulties in (Nguyen Thi Giang, 2024). playing and interacting with their classmates. Speech therapy for children with ASD aged The role of teachers in organizing activities to 3 to 4 is crucial for fostering language encourage children with ASD to integrate into development and improving communication peer groups, imitate, and learn from their peers skills. Gameplay serves as an effective method, is extremely important. However, current IE as it not only captivates children’s interest but practices reveal that training speech also enhances their overall learning experience. development for children with ASD through Given the challenges children with Autism play activities has not been adequately Spectrum Disorder (ASD) face in pronunciation prioritized. Many classroom play activities and social interaction, integrating the PECS remain generic and lack specific goals tailored method with educational games creates a for children with ASD, failing to address their structured yet engaging environment that individual characteristics such as tendencies to promotes active participation and builds play alone, limited sharing or communication confidence in speech practice. This approach with peers, disputes over toys, mechanical or strengthens both language acquisition and social stereotyped play, minimal use of verbal integration, making it a valuable tool in early communication while playing, or a tendency to intervention. Research on play activities in distance themselves and display indifference preschoolers has affirmed that play is a toward others (Dao Thi Thu Thuy, 2016). Children fundamental aspect of early childhood and with ASD need appropriate support while serves as the primary means of learning at this participating in play activities to help them stage (Nguyen Thi Hoa, 2011). Young children communicate more effectively and gradually naturally acquire knowledge through play, yet integrate with their peers. Developing methods to those with ASD often engage in solitary or organize play activities suitable to the observational play and rarely participate in developmental characteristics of these children not 112
TẠP CHÍ KHOA HỌC QUẢN LÝ GIÁO DỤC SỐ 01(45), THÁNG 3 – 2025 only enhances their engagement but also creates an them to pronounce words clearly and correctly enabling environment for natural language according to phonetic rules. Additionally, development and social skills acquisition. children are trained in adjusting their voice to be In 2014, the National Professional expressive and suitable for different Development Center on Autism Spectrum communication contexts, which includes Disorders (NPDC) in the United States modulating voice intensity (loud or soft), speech recognized the Picture Exchange Communication tempo (fast or slow), rhythm (pausing System (PECS) as one of 27 evidence-based appropriately), and conveying emotional educational intervention methods for children nuances in speech (Vo Thi Dieu Hong, 2023). with autism spectrum disorders (ASD) (Vu Thi Furthermore, practicing pronunciation not only Thuy Dung et al., 2024). Numerous studies enhances children’s listening abilities but also globally have confirmed the role of PECS in supports the flexible coordination of speech supporting communication for children with ASD. organs such as lips, tongue, palate, and jaw, Researchers such as Ganz and Simpson (2004) thereby helping them develop precise articulation conducted studies analyzing the practical skills (Nguyen Thi Phuong Nga, 2006). For application of this method. In Vietnam, there are children aged 3-4 years with ASD, learning a few studies related to the use of PECS in pronunciation poses greater challenges vocabulary development for children with ASD, compared to typically developing children due such as: “The Status of Using PECS Card Systems to limitations in communication skills, language in Language Therapy for Children with Autism in cognition, and motor coordination abilities. The Hanoi” (Nguyen Thieu Da Huong, 2015) and process of pronunciation practice requires “Applying the PECS Method to Develop patience and adjustments tailored to each child Vocabulary for 3-4-Year-Old Children with Autism based on the severity of their disorder. Initially, Spectrum Disorders at the Special Em’s Education children should be guided to correctly Center” (Vu Thi Thuy Dung et al., 2024, p. 236). pronounce words containing basic sounds, However, there is a lack of studies detailing how gradually increasing complexity to compound to combine the PECS method with games to words or short phrases. Once children can improve pronunciation for children with ASD. accurately articulate some individual words, This combination not only helps enhance they should be encouraged to use simple children’s pronunciation abilities but also vocabulary in daily communication to enhance creates opportunities for them to participate in their language abilities, while also creating a group activities in an enthusiastic, flexible natural communication environment for regular manner while being tailored to their individual practice. Repeated pronunciation exercises characteristics. As such, researching and incorporated into contexts of play and experimenting with the integration of PECS and interaction can enable children to acquire games may open a more effective approach to language more effectively, thereby improving supporting children with ASD in developing communication skills and social integration language and social communication skills. This (Phan Thi Hang, Nguyen Thi Hue, 2024). study presents experimental results on the In this study, we focus on training children application of the PECS method combined with aged 3-4 years with ASD to clearly and accurately games to practice pronunciation for 3-4-year-old pronounce individual words. We will assess the children with ASD at Huong Duong ability to pronounce correctly 30 words from the Kindergarten, Thu Duc City. Through this, the theme “Self,” which includes basic sounds such as research assesses the effectiveness of this b, p, t, k, m. These sounds are selected for their method in improving pronunciation skills and simplicity and ease of articulation for children in enhancing communication abilities in children this age group, as well as for their potential to with ASD, contributing to proposing suitable evaluate the level of control over speech organs intervention solutions in inclusive education. such as lips, tongue, palate, and jaw. The choice of 2. Literature Review the theme “Self” is not only appropriate for the 2.1. Practicing Pronunciation for 3-4-Year-Old children’s cognitive capabilities but also enables Children with ASD Through the PECS Method them to relate to familiar objects and events from Combined with Educational Games daily life. According to Dinh Hong Thai (2008), 2.1.1. Practicing Pronunciation for 3-4-Year- organizing words into specific thematic categories Old Children with ASD aids children in systematizing the acquisition and Practicing pronunciation for children retention of language, thereby improving their involves guiding them to accurately articulate pronunciation and communication skills naturally. the sounds of their native language, enabling During the experimental process, we will observe 113
PHAN THỊ HẰNG - NGUYỄN THỊ HOÀI THU - DƯ THỐNG NHẤT and document the accuracy of each child’s will contribute toward proposing effective pronunciation for individual words, as well as pronunciation practice methods designed to support assess their ability to adjust their pronunciation children with ASD in enhancing their pronunciation following guidance. The findings of this research and communication skills more efficiently. Table 1. 30 words containing basic sounds within the theme “Self” No. Sound “b” No. Sound “p” No. Sound “t” No. Sound “m” No. Sound “k” 1 Bụng/Stomach 7 Phổi/Lungs 13 Tay/Hands 19 Mắt/Eyes 25 Kéo/Scissors 2 Bé/Child 8 Phao/Buoy 14 Tim/Heart 20 Môi/Lips 26 Khớp/Joints 3 Buồn/Sad 9 Phấn/Chalk 15 Tai/Ears 21 Má/Cheeks 27 Khóc/Crying 4 Bút/Pen 10 Phải/Right 16 Tóc/Hair 22 Mũi/Nose 28 Khăn/Towel 5 Bảng/Board 11 Phồng/Swollen 17 Trán/Forehead 23 Miệng/Mouth 29 Không/No 6 Balô/Backpack 12 Phim/Film 18 Thận/Kidneys 24 Mí/Eyelids 30 Kính/Glasses (Source: The authors (compiled)) Levels for evaluating children’s ability to desires, or ideas, thereby developing pronounce correctly according to Dinh Hong communication skills in a more active and Thai (2008): Level 1: children pronounce effective manner (Flippin et al., 2010). correctly 24 - 30 words; Level 2: children - Enhancing independence: PECS helps pronounce correctly 17 - 23 words; Level 3: children become independent in communication children pronounce correctly 8 - 16 words; Level by using pictures to express their desires, 4: children pronounce correctly 7 - 0 words. reducing their dependence on adult assistance. 2.1.2. PECS Method - Supporting comprehension and language PECS is a communication system using development: PECS aids children in learning to pictures, belonging to the group of augmentative associate words with real-world objects, thereby and alternative communication (AAC) methods. enhancing their vocabulary and communication This method was developed in 1985 by skills (Ganz & Simpson, 2004). psychologist Andrew Bondy and speech-language - Aligning with learning characteristics of therapist Lori Frost within the Delaware Autism children with ASD: Since children with ASD Program (Vu Thi Thuy Dung et al., 2024). PECS tend to process information better through visual is designed to support individuals who face means, PECS leverages this strength to make the difficulties in verbal communication, learning process more engaging and effective particularly children with ASD, helping them (Ganz & Simpson, 2004; Flippin et al., 2010). develop the ability to express needs, desires, and - Assisting with speech articulation practice: ideas through pictures. When educators use a dynamic, clear, and PECS users are taught how to exchange a comprehensible picture communication system, picture of an object or action they desire. According children are encouraged to articulate words to studies Flippin et al. (2010), this method not only associated with the images, hence improving their helps children develop communication skills but speech abilities. also fosters the ability to initiate communication PECS is divided into six stages, ranging (i.e., the ability to communicate spontaneously). from simple to complex, designed to Additionally, PECS trains important social skills systematically develop communication and such as approaching and interacting with others, language skills (Vu Thi Thuy Dung at al., 2024): expressing needs and thoughts clearly through Stage 1 - Picture exchange: Children learn selecting and distinguishing images. to use a picture to exchange with others in order According to results from the Delaware to receive the item they desire. The goal is to Autism Program, up to 76% of children help children proactively initiate independent applied with the PECS method began to use communication. speech and significantly improved their Stage 2 - Distance and persistence: Children communication skills. The outstanding learn to bring the picture to another person to benefits of PECS in practicing pronunciation effectively communicate, even when the and supporting communication for children communication partner is not nearby. with ASD include: Stage 3 - Picture discrimination: Children - Encouraging active communication: PECS learn to differentiate and select the correct helps children proactively initiate the exchange of picture to express their desires, rather than information through images to express needs, relying on a single recurring image. 114
TẠP CHÍ KHOA HỌC QUẢN LÝ GIÁO DỤC SỐ 01(45), THÁNG 3 – 2025 Stage 4 - Sentence structure: Children begin form for developing independence and positive to arrange pictures into a simple sentence, such as thinking, as reflected in the following a sentence starting with “I want...” accompanied characteristics: 1) Freedom, voluntariness, and by an image of the desired object. independence - Children actively participate in Stage 5 - Answering questions: Children games without being coerced; 2) Self-regulation learn to use PECS to respond to questions, such as - Children can control and adjust the process of “What do you want?”, enhancing their ability to playing based on their preferences; 3) Creativity engage in two-way communication. - Children are not confined to rigid templates and Stage 6 - Commenting: Children expand their can innovate in their style of play; 4) Socio- communication abilities from merely requesting emotional traits - Games allow children to items to commenting on events, activities, express emotions and develop relationships with emotions, and personal thoughts. peers and their surroundings. Each stage of PECS is designed from Games are categorized in various ways. In the simple to complex, enabling users to develop current preschool education curriculum, games are autonomy in communication and social typically divided into three main groups: 1) interaction. Creative games: role-playing thematic games, In this study, we primarily apply the first dramatization games, construction-assembly two stages of PECS (stages 1 and 2) in games; 2) Games with fixed content and rules: combination with learning games to support 3- educational games and physical games; 3) Folk 4-year-old children with ASD in practicing games: traditional games of the nation. speech articulation. Before initiating articulation In this study, we focus on educational practice, educators need to: 1) Clearly introduce games to organize and guide children to play the pictures and how to use the cards; 2) Utilize with interest, thereby supporting accurate engaging games to encourage children to pronunciation practice for children with ASD. interact and articulate words related to the Educational games are a type of game with images; 3) Adjust the use of cards and the clear educational objectives, wherein children organization of games to align with the solve learning tasks in a lighthearted, individual capabilities and needs of each child. comfortable manner through play. When The integration of PECS with games not only participating in educational games, children helps children practice pronunciation naturally but perceive intellectual tasks as enjoyable, free, and also stimulates interest, enhances initiative, and voluntary play, helping them achieve learning supports children in integrating into goals without feeling pressured. Educational communication activities. The results of this study games are characterized by being organized by will contribute to providing a scientific foundation adults, with a variety of content and gameplay for the application of the PECS method in rules. Each educational game not only offers inclusive education and supporting language entertainment but also helps children develop development for children with ASD. cognitive skills. The cognitive tasks within these 2.1.3. Games games require children to actively engage their Play is an activity where its motivation lies intellect, enabling them to learn observation, in the process rather than the outcome. The comparison, analysis, and information retention actions within play stimulate children to skills. An effective educational game must continue playing and maintain their interest. combine both cognitive and humorous elements During play, relationships between humans and to capture children’s attention. The humorous nature as well as society are simulated, helping component makes children feel excited and children develop cognition and social skills. unafraid of challenges, encouraging them to Play brings children a joyful, enthusiastic, and overcome difficulties within the game. comfortable mental state, primarily satisfying Educational games have a distinct structure their need for play without aiming to produce compared to ordinary games. According to specific products (Dinh Van Vang, 2016). Nguyen Thi Hoa (2011), an educational game Games are autonomous activities in which must encompass three main components: 1) children have the freedom to choose games, Cognitive task - Children must perform a playmates, and seek resources to execute their specific task related to learning, such as play intentions. Children can also actively expand identifying sounds, correctly articulating the theme of the games in various directions, sounds, arranging words, or matching letters; 2) applying existing knowledge and skills to solve Play actions - Children must carry out tasks within the games (Nguyen Thi Hoa, 2011). interactive activities within the game, such as Games for preschool children are considered a matching cards, finding objects, or expressing 115
PHAN THỊ HẰNG - NGUYỄN THỊ HOÀI THU - DƯ THỐNG NHẤT themselves through language; 3) Game rules - and accurately. This process also includes The game must have clear rules to guide linguistic levels: practicing articulation, auditory children on how to play correctly and achieve its exercises, practicing words and sentences, and educational purpose. These three components voice training (Tran Nguyen Nguyen Han, 2003). are closely interconnected; the absence of any - Ensuring appeal: Teachers utilize diverse one of these elements renders the game either toys and illustrations, combined with organizing unplayable or ineffective in achieving the engaging and enjoyable games that align with desired educational outcomes. the interests and preferences of 3-4-year-old In this study, we utilized educational games children (Ton Nu Dieu Hang, 2014). as a method to support pronunciation practice When organizing pronunciation practice for 3-4-year-old children with Speech and activities that combine the PECS method and Language Development Disorders (SLDD). The learning games, teachers need to design games games were designed to: 1) Stimulate children to suitable for each pronunciation practice level articulate naturally and without coercion; 2) while incorporating illustrated cards to support Integrate recognition and pronunciation tasks the children. Teachers can flexibly organize within a lively context; 3) Encourage children to pronunciation practice activities either participate in simple communication scenarios, individually or for the whole class. providing opportunities to practice language in a Organizing pronunciation practice games cheerful environment. within intentional class activities in inclusive Before organizing the games, educators need settings increases children’s interest, enhances to: 1) Clearly introduce the game’s content for communication motivation, and continuously children to understand the task; 2) Adjust the game’s improves pronunciation skills. Below are six difficulty level according to each child’s linguistic games designed to help 3-4-year-old children capabilities; 3) Encourage children to use language with speech and language disorders practice during gameplay while providing timely support if clear pronunciation: they encounter difficulties in pronunciation. Game 1: “Finding the Way Home” 2.1.4. Combining the PECS method and games Objective: To enhance articulation and for pronunciation practice in 3-4-year-old listening skills. children with SLDD Instructions: The teacher prepares five According to the preschool education picture cards and five corresponding houses. Each curriculum of 2021, some expected outcomes for child takes turns sitting next to the teacher, who the pronunciation of 3-4-year-old children include: guides them in pronouncing the words associated (1) Children articulate words clearly; (2) Children with the picture cards. During this process, mimic the voices of characters in stories; (3) children are encouraged to observe mouth Children adjust their tone of voice appropriately to movements, listen carefully to the pronunciation, the context when reminded; (4) Children speak and repeat the words after the teacher. Once audibly without mumbling (Moet, 2021). familiar with the words, the child receives a picture To practice pronunciation for 3-4-year-old card and is asked to exchange it for a preferred children with speech and language disorders, we object. Subsequently, the child must find the house have developed pronunciation practice games displaying the corresponding picture card of the based on the following principles: newly acquired object (Dinh Van Vang, 2016; - Ensuring appropriateness: The games are Nguyen Thieu Da Huong, 2015). designed systematically and structured to align Note: The teacher should not only help with the pronunciation practice activities children focus on listening to sounds but also suitable for preschool children (Do Thi Kim guide them in strengthening the flexibility of Cuong & Tran Thi Hue, 2021). articulatory organs such as the lips, tongue, - Ensuring effectiveness: The teaching palate, and jaw to ensure accurate pronunciation. process should flexibly integrate learning and Game 2: “The Secret Gift Box” playing, as preschool children learn through play Objective: To enable children to pronounce and play through learning (Dinh Van Vang, 2008). words correctly and independently. - Ensuring developmental relevance: Games Instructions: The teacher prepares a gift box are designed based on the developmental levels of containing seven picture cards. Each turn, a child children’s pronunciation skills, progressing from is invited to sit next to the teacher and randomly imitating model pronunciations, to pronouncing draw a picture card from the box without looking based on teacher guidance, and eventually inside. The teacher then provides guidance on achieving the ability to pronounce independently pronouncing the corresponding word. After 116
TẠP CHÍ KHOA HỌC QUẢN LÝ GIÁO DỤC SỐ 01(45), THÁNG 3 – 2025 pronouncing the word, the child may exchange the teacher assists them in pronouncing the picture card with the teacher for a preferred card. corresponding words. Upon completing all They then continue practicing pronunciation with stations, the child reaches the “treasure” and the newly exchanged card (Dinh Hong Thai, 2010; obtains a key. They then return to the starting point Dinh Van Vang, 2008). to exchange the key for a preferred object with the Note: During the activity, the teacher teacher (Dinh Hong Thai, 2010). should closely observe the child’s mouth Note: The teacher should assess each child’s movements and provide corrections to ensure pronunciation ability to select appropriate picture precise pronunciation. cards. Additionally, children should be Game 2: “Target Toss” encouraged to play multiple times and practice Objective: To help children recognize and speaking loudly and clearly to build confidence. correct pronunciation errors. Game 6: “Super-Speed Racing” Instructions: The teacher prepares eight Objective: To help children correct difficult baskets and eight picture cards, each basket pronunciations (previously mispronounced containing one card. Each child takes turns words from games 1, 2, 3, 4, and 5) and develop sitting next to the teacher and throwing a small perseverance in pronunciation practice. sandbag into a basket. Depending on which Instructions: The teacher prepares a toy car, basket the sandbag lands in, the teacher guides the four designated stop points, and ten picture cards child in pronouncing the corresponding word. containing words that most children struggle to After pronunciation practice, the child exchanges pronounce. Each child takes turns driving the the picture card with the teacher for a preferred toy car to different stop points, where the teacher object and then pronounces the word associated provides two to three picture cards for with the new object (Dinh Hong Thai, 2010). pronunciation practice. After completing all Note: The teacher should select picture cards stations, the child receives a picture card and that contain phonetically similar words. Special returns to the starting point to exchange it for a attention should be given to helping children preferred object (Dinh Hong Thai, 2010). distinguish between subtle pronunciation differences. Note: The teacher should adopt a flexible Game 4: “Jumping Through Boxes” approach in guiding correct pronunciation, Objective: To help children accurately ensuring clarity and engagement. Adjustments pronounce words and develop perseverance in should be made according to each child’s ability pronunciation practice. to maximize learning effectiveness. Instructions: The teacher prepares ten Games 1, 2, 3 are combined with phase 1 of picture cards and draws four squares on the floor, PECS to help children practice flexibility of each containing five picture cards. Children take speech organs, listening comprehension skills, turns jumping into each square, where they are pronunciation of simple words, and proactive guided in pronouncing the words corresponding communication. Children are continuously to the cards. After completing all squares, each encouraged without requiring accurate child receives a picture card, which they can pronunciation initially to avoid putting exchange with the teacher for a preferred object unnecessary pressure on them. Games 4, 5, 6 are (Dinh Hong Thai, 2010). combined with phase 2 of PECS (distance and Note: The teacher should ensure correct persistence). The goal is to help children achieve pronunciation while encouraging and motivating more accurate pronunciation, reduce children to articulate as much as possible. If a child pronunciation errors, and encourage perseverance. mispronounces a word, they should be given the Notes on organizing pronunciation practice opportunity to revisit and correct their games in inclusive kindergarten classes: When pronunciation through repeated practice. organizing pronunciation practice games in Game 5: “Treasure Hunt” inclusive kindergarten classes, teachers should Objective: To help children independently flexibly adjust requirements and levels of correct difficult pronunciations and develop support to suit the abilities of each child. perseverance in pronunciation practice. Teachers should encourage, remind, and create Instructions: The teacher prepares ten picture opportunities for children to support one another cards for each child, specifically targeting words during the games, thereby enhancing interaction they have previously mispronounced. In the and cooperation among them. Children need to classroom, the teacher draws directional arrows participate voluntarily and enthusiastically to leading to four different stations, each containing foster a sense of comfort and to avoid pressure two to three picture cards. Each child takes turns while practicing pronunciation. Additionally, following the arrows to the stations, where the teachers should prepare vibrant and visually 117
PHAN THỊ HẰNG - NGUYỄN THỊ HOÀI THU - DƯ THỐNG NHẤT appealing picture cards to attract the children’s developing language abilities in a natural way, attention and stimulate their interest in the improving interaction with their surroundings, and games, thereby contributing to the effectiveness achieving the goals of inclusive education. of pronunciation practice activities. 3. Materials and Methods Practicing pronunciation through games not 3.1. Research Subjects only helps children pronounce words correctly but The research subjects are four children also expands their vocabulary, enabling more aged 3-4 years with DSLSD, selected using flexible communication. Moreover, this method convenience sampling. These children are stimulates interest, boosts confidence in currently attending inclusive classes at Hoa communication, supports children with Nhap Huong Duong Kindergarten in Thu Duc developmental speech-language disorders City. All four children exhibit mild-to-moderate (DSLSD) in joining group activities, and enhances autism (scores ranging from 31 to 36) according social skills (Truong Thanh Loan, 2017). This to the Childhood Autism Rating Scale - CARS approach aids children with DSLSD in gradually (Nguyen Thi Hoang Yen, 2013). Table 2. Information on Experimental Subjects Child Gender Year of CARS Level of No. Code Birth Score Autism Child Characteristics 1 Child1 Female 8/2020 36 Moderate Limited eye contact, lack of focus. 2 Limited eye contact, lack of focus, frequently Child2 Female 5/2020 35 Moderate speaks English. 3 Limited eye contact, lack of focus, speaks in Child3 Male 2/2020 30 Mild short breathy sentences, speaks softly. 4 Child4 Male 4/2020 32 Moderate Slightly shy, lacks focus, poor eye contact. (Source: The authors (compiled)) 3.2. Instruments classrooms, clearly detailing evaluation criteria for To ensure a comprehensive and systematic skills based on the skill scale (Dave, 1970). investigation, multiple research methods were Teachers evaluated the pronunciation levels of employed in this study. four children with Autism Spectrum Disorder - Theoretical research method: This involved (ASD) within the theme “Myself” using 30 picture reviewing relevant literature on pronunciation cards containing 30 words of basic phonemes practice for children aged 3-4 years with DSLSD (Table 1). The children’s level of spontaneous through play-based activities in inclusive pronunciation was assessed using the framework kindergarten classes. Data were collected, of Đinh Hồng Thái (2008). synthesized, and summarized using analytical and - Experimental pedagogical method: synthesizing techniques, as well as classification and + Purpose of the experiment: The pedagogical systematization of theoretical information, to build experiment was conducted to verify the feasibility the theoretical foundation for the research issue. of the proposed measures for pronunciation training - Interview method: Interviews were for 3-4 year-old children with autism through play conducted with eight teachers from 3-4-year-old activities at MNHN School, as well as to evaluate classes at Huong Duong Inclusive Preschool the positive impacts of these measures. using convenience sampling. The teachers, + Experiment content: The experiment coded as T1 to T8, participated in sessions held involved organizing 6 games aimed at practicing from 4:30 PM to 6:00 PM on October 17, 2024, pronunciation for children. The experiment was in the school’s meeting room, each lasting 5-10 carried out as follows: Organizing the experiment in minutes. The interviews explored children’s the 3-4 year-old inclusive class; Applying the participation and engagement in pronunciation developed games to practice pronunciation; practice through games, with key questions Evaluating the progress in the pronunciation skills of including: 1) How do children participate when children with autism attending this inclusive class. games are integrated into pronunciation practice? + Experiment duration and location: The 2) How engaged are they in these activities? experiment was conducted from November 15, - Observation method: Observing the 2024, to December 15, 2024. Experiment location: pronunciation skills of children with ASD during Huong Duong Inclusive Preschool, Thu Duc City. pronunciation practice sessions and play activities + Experiment subjects: 4 children with autism in the 3-4 year-old inclusive class. We distributed aged 3-4 years studying in the inclusive class at observation sheets to teachers in inclusive preschool Huong Duong Inclusive Preschool, Thu Duc City. 118
TẠP CHÍ KHOA HỌC QUẢN LÝ GIÁO DỤC SỐ 01(45), THÁNG 3 – 2025 + Conducting the pedagogical experiment: 4.1. Current status of correct pronunciation The experimental process consisted of three practice for 3-4 year-old children with autism at main steps. Step 1: Initial survey, assessing the Huong Duong inclusive preschool, Thu Duc City. current situation to identify the children’s 4.1.1. Pronunciation Levels of 3-4 Year-Old baseline pronunciation skills. Step 2: Formative Children with Autism Studying in Inclusive Classes. experiment, organizing pronunciation practice The evaluation feedback was compiled, and the for children through the 6 proposed games. Step following results were obtained, as presented in 3: Final survey, using Dave’s (1970) skill scale Table 3. The results indicate that the skill of clear and with five levels (passive imitation, following accurate self-pronunciation of basic phonemes instructions, performing correctly, successful among all four children with ASD is not good, with articulation, proficient operation) to assess the most at Level 4. Child1 struggles to accurately progress of 4 children with ASD in the inclusive pronounce the picture cards containing the phonemes class after one month of experimentation, to “b, p, k,” managing to clearly self-pronounce only 4 verify the feasibility of the proposed measures picture cards containing the phoneme “t.” Child2 (cited from Bui Thi Viet, 2016). speaks quietly and often mispronounces the 3.3. Data Analysis phonemes “p, m, k,” managing to accurately Statistical calculations such as frequency, pronounce only 5 picture cards containing the percentage (%), standard deviation (SD), and the phoneme “t.” Child3 demonstrates the best Paired Samples Test were used to analyze data. pronunciation among the group, achieving Level 3 SPSS 22.0 software was utilized to perform but still has difficulty with picture cards containing mathematical statistical methods, serving as a the phonemes “t, p,” while accurately pronouncing 8 basis for analyzing and processing the data picture cards containing the phonemes “b, k.” Child4 collected in the study, ensuring the objectivity accurately pronounces 6 picture cards containing the and reliability of the results. phoneme “t” but fails to accurately pronounce picture 4. Results and Discussion cards containing the phonemes “b, p.” Table 3. Results of clear and accurate self-pronunciation among four children with Autism Spectrum Disorder aged 3-4 within the theme “Myself.” No. Child Code No. of words % Level 1 Child1 4/30 13.3 4 2 Child2 5/30 16.7 4 3 Child3 8/30 26.7 3 4 Child4 6/30 20.0 4 (Source: The authors (compiled)) 4.1.2. Interest of Children with Autism Spectrum Overall, integrating games into pronunciation Disorder Aged 3-4 Years in Participating in Games practice was highly regarded, though adjustments Interviews with eight teachers revealed that may be needed to support children with lower most children with autism aged 3-4 actively participation levels. participated in games when integrated into 4.2. Experimental Results of Practicing pronunciation practice. Seven out of eight teachers Pronunciation for Children with Autism (T1, T2, T4, T5, T6, T7, T8) reported that children Spectrum Disorder Aged 3-4 Years at Huong engaged willingly, while one child participated Duong Inclusive Preschool only occasionally (T3), and no cases of complete 4.2.1. Process of Practicing Pronunciation for refusal were observed. Games not only created a Children Through Six Games fun learning environment but also enhanced We organized six games aimed at training children’s cooperation and interaction during children’s pronunciation. In the first four games pronunciation practice. Regarding engagement, (Games 1, 2, 3, and 4), children were guided to seven out of eight teachers (T1, T3, T4, T5, T6, T7, pronounce a total of 30 words related to the T8) noted that children showed high enthusiasm, theme “Self.” In the subsequent two games indicating that games effectively captured their (Games 5 and 6), the incorrectly pronounced attention and motivation. However, one case (T2) words from the previous 30 were selected for reported occasional participation, possibly further guidance and practice. The results obtained influenced by individual or environmental factors. are as follows (Nguyen Thi Thu Hoai, 2024): 119
PHAN THỊ HẰNG - NGUYỄN THỊ HOÀI THU - DƯ THỐNG NHẤT Table 5. Summary of the pronunciation training process for children through six games No. of Child1 Child2 Child3 Child4 No. Game sessions n (%) n (%) n (%) n (%) Game 1: “Finding Home” - training 1 0/5 0/5 1/5 0/5 1 children to pronounce 5 words (0.0) (0.0) (20.0) (0.0) Game 2: “Secret Gift Box” - training 2 1/7 1/7 2/7 1/7 2 children to pronounce 7 words (14.3) (14.3) (28.6) (14.3) Game 3: “Hit the Target” - training 2 1/8 2/8 2/8 1/8 3 children to pronounce 8 words (12.5) (25) (25) (12.5) Game 4: “Hopscotch Across the 2 2/10 2/10 3/10 3/10 4 Squares” - training children to (20.0) (20.0) (30.0) (30.0) pronounce 10 words Game 5: “Treasure Hunt” - training 2 3/10 3/10 4/10 3/10 5 children to pronounce 10 words (30.0) (30.0) (40.0) (30.0) Game 6: “Super Speed Race” - training 2 3/10 3/10 4/10 4/10 6 children to pronounce 10 words (30.0) (30.0) (40.0) (40.0) 11 10/30 11/30 16/30 12/30 Total (33.3) (36.7) (53.3) (40) Note: n= Number of words. (Source: The authors (compiled)) The experimental findings presented in exhibited a lack of confidence in pronunciation Table 5 highlight a significant improvement in and occasional distraction during instruction, an the pronunciation abilities of children aged 3–4 issue commonly reported in studies on attention with speech and language disorders after and executive function deficits in children with engaging in pronunciation training games using ASD (Kuhl, 2004). Despite these challenges, the the PECS method. This improvement aligns child still showed steady progress, correctly with previous research demonstrating the pronouncing 11 words by the end of the effectiveness of structured, play-based sessions. The observed hesitation in interventions in enhancing language pronouncing /p/ suggests that phonemic development among children with Autism awareness and oral-motor coordination should Spectrum Disorder (ASD) (Kasari et al., 2014; be reinforced through additional guided Wong et al., 2015). Play-based learning has been exercises, as recommended by Gillon (2004). widely recognized as a crucial approach in early Child 3’s performance further reinforces the childhood education, particularly for children effectiveness of the PECS method combined with ASD, as it fosters engagement, motivation, with educational games, as this child and language acquisition in a natural and demonstrated superior pronunciation skills interactive manner (Lifter et al., 2011). Each compared to the others, achieving 16 correctly child’s progress followed a pattern of gradual pronounced words. However, the child still improvement, confirming findings from prior exhibited a tendency to speak in a very soft tone, studies that emphasize the importance of indicating the need for further interventions repetition and structured reinforcement in targeting vocal projection and speech clarity. speech therapy (Paul & Norbury, 2012). For Prior research suggests that children with ASD instance, Child 1, despite initial difficulties in often struggle with prosody and voice pronouncing any words correctly in Game 1, modulation, which can impact intelligibility and demonstrated gradual improvement across social communication (McCann & Peppé, multiple sessions, culminating in the correct 2003). Implementing additional activities such pronunciation of 10 words after 11 sessions. as rhythmic speech exercises or prosody- However, specific phonemes such as /b/ and /p/ focused games could be beneficial in addressing remained challenging, a difficulty that is well- this issue. Notably, Child 4’s enthusiastic documented in phonological studies on speech participation in the training further supports the development in ASD children (Edeal & notion that gamification enhances motivation Gildersleeve-Neumann, 2011). The confusion and engagement in children with ASD between these bilabial stops highlights the need (Pennefather et al., 2018). By Game 6, the child for targeted phonetic interventions to address had correctly pronounced 16 words, articulation difficulties. Similarly, Child 2 demonstrating significant improvement in 120
TẠP CHÍ KHOA HỌC QUẢN LÝ GIÁO DỤC SỐ 01(45), THÁNG 3 – 2025 pronunciation accuracy and speech confidence. need for ongoing targeted support. Future This result is consistent with studies indicating that studies should explore refining this approach by positive reinforcement and interactive learning incorporating phonetic cueing strategies, environments contribute to language gains in ASD prosody training, and digital game-based children (Tager-Flusberg et al., 2009). interventions to enhance pronunciation and Overall, the experimental findings affirm communication skills in ASD children. that integrating the PECS method with 4.2.2. Pronunciation Skills oF Children Post-Experiment educational games facilitates significant We conducted a reassessment of the pronunciation improvements in children with pronunciation skills of four children in ASD. The results are in line with existing articulating 30 words clearly from the theme literature highlighting the benefits of interactive “About Myself.” The evaluation was based on and play-based speech therapy interventions Dave’s (1970) skill measurement scale and the (Flippin et al., 2010). Challenges such as pronunciation accuracy scale by Dinh Hong articulating specific phonemes, reducing Thai (2008). The results are as follows (Nguyen mumbling, and maintaining focus indicate the Thi Thu Hoai, 2024): Table 6. Results of self-pronunciation skills of four 3-4-year-old children with autism spectrum disorders on the theme “About Myself” after the experiment. No. Child Code No. of words % Level 1 Child1 10/30 33,3 3 2 Child2 11/30 36,7 3 3 Child3 16/30 53,3 3 4 Child4 12/30 40,0 3 (Source: The authors (compiled)) As shown in Table 6, after the children pronunciation training games. These results affirm completed six pronunciation training games over that applying the PECS method in conjunction one month, we reassessed their ability to clearly with educational games not only effectively trains pronounce words. The results align with the pronunciation but also fosters communication cumulative outcomes presented in Table 5: Child1 motivation, enhancing interaction between correctly pronounced 10 words, Child2 children, teachers, and classmates. pronounced 11 words, Child3 pronounced 16 4.2.3. Comparison of Children’s Ability to Clearly words, and Child4 pronounced 12 words (Dave, Pronounce Words Before and After the Experiment 1970). All four children in the experiment We compared the results before and after achieved Level 3 on the pronunciation skill scale the experiment to assess the effectiveness of the (Dinh Hong Thai, 2008), demonstrating pronunciation training games. The findings are significant progress after participating in the as follows: Table 7. Comparison of children’s ability to clearly articulate words before and after the experiment No. Child Pre-experiment Post-experiment t-test results Code No. of words Ratio Level No. of words Ratio Level t (Sig.) 1 Child1 4/30 13,3 4 10/30 33,3 3 2 Child2 5/30 16,6 4 11/30 36,6 3 13.000 (
PHAN THỊ HẰNG - NGUYỄN THỊ HOÀI THU - DƯ THỐNG NHẤT with correctly articulated words increasing to aged 3-4, the approach can be adapted for older between 10 and 16. This substantial enhancement children (5-6 years) or those with in pronunciation ability highlights the efficacy of communication difficulties, requiring tailored integrating PECS with educational games in game content for different developmental speech interventions for young children, as groups. Continuous evaluation is necessary, similarly reported in studies on early with feedback mechanisms from teachers, communication interventions (Kasari et al., 2014; parents, and experts to refine and enhance Wong et al., 2015). The improvement in program effectiveness in fostering language and pronunciation accuracy is consistent with communication skills in children with SLI. research demonstrating that structured visual 5. Conclusions and Recommendations communication systems, such as PECS, provide Based on the aforementioned results, it can an effective framework for enhancing verbal be concluded that the integration of the PECS expression in children with communication method with educational games has difficulties (Bondy & Frost, 2001). Additionally, demonstrated its feasibility in improving the incorporation of gameplay in language pronunciation for 3–4-year-old children with interventions has been found to significantly SLI. The experimental findings indicate a increase engagement, reduce communication significant improvement in the children’s anxiety, and improve speech outcomes, particularly pronunciation abilities post-intervention among preschool children with ASD and SLI compared to pre-intervention. Most children (Lifter et al., 2011; Pennefather et al., 2018). exhibited enthusiasm and readiness to Beyond pronunciation accuracy, the intervention participate in the activities, showing agility, also contributed to increased communication boldness, and increased confidence during motivation, fostering confidence in language use pronunciation practice. Consequently, they were during everyday interactions. This aligns with able to articulate words more clearly, gradually prior research indicating that multimodal and overcoming pre-existing pronunciation interactive learning environments encourage challenges. This not only validates the spontaneous verbalization and enhance social effectiveness of the pronunciation games for communication skills in children with language children with SLI aged 3–4 but also confirms the impairments (Tager-Flusberg et al., 2009; feasibility of the designed games, opening up McLeod & Baker, 2017). The PECS new avenues for supporting children with SLI in methodology, combined with play-based developing their language and communication learning, appears to have facilitated a positive and skills through playful activities. engaging learning environment, allowing The research results indicate that the PECS children to practice pronunciation with greater methodology, coupled with educational games, enthusiasm and reduced hesitation. can be widely applied in educating children with Based on research on integrating the PECS SLI, particularly in inclusive kindergartens and with educational games to improve early intervention centers. Implementing this pronunciation in children aged 3-4 with SLI, method could involve its integration into preschool several key implications for educational education curricula, the design of teaching administrators can be drawn. Incorporating materials and guidebooks for educators, and the PECS into preschool curricula is essential, organization of training sessions to enhance particularly in inclusive classrooms and early teachers’ proficiency in utilizing PECS for intervention centers, requiring curriculum pronunciation practice. Additionally, parents adjustments to support language development. should be guided on how to support their Developing instructional materials and teacher children’s practice at home. Technology can be training programs is crucial, including guides, incorporated by developing software, mobile workshops, and specialized training on applications, or electronic PECS card systems to pronunciation techniques and PECS card usage. facilitate more flexible pronunciation practice for Supporting parents through consultation children. Moreover, this method is not restricted programs, instructional materials, and solely to children aged 3-4 but can also be adapted workshops can enhance speech practice at home. for children aged 5-6 or older who face Technology should be leveraged by developing communication challenges, with game content mobile applications or digital PECS systems to designed to align with developmental language facilitate flexible learning, with potential levels suited to each target group. collaboration between educators and tech Future research directions could focus on developers. While the study focuses on children scaling up the study by experimenting with 122
TẠP CHÍ KHOA HỌC QUẢN LÝ GIÁO DỤC SỐ 01(45), THÁNG 3 – 2025 larger sample groups across various educational adjusting rules according to each ASD level, and institutions to verify the effectiveness of the combining physical activity games with PECS method combined with educational linguistic games could enhance pronunciation games. Additionally, integrating other practice outcomes. Another important direction intervention methods such as animated is to compare the effectiveness of PECS with therapeutic techniques or artificial intelligence traditional pronunciation training methods to (AI) applications for pronunciation error identify the most effective approach for different recognition and correction could be considered. groups of children. Lastly, research should The research should also evaluate the long-term incorporate psychological studies and learning impact of the method, monitoring language motivation assessments, evaluating children’s development and social communication skills of interest levels, their ability to concentrate during children within six months to one year after educational games, and the impact of the application. Furthermore, optimizing learning environment on the language educational games by diversifying content, development process of children with ASD. REFERENCES Bondy, A., & Frost, L. (2001). The Picture Exchange Communication System. Behavior Modification, 25(5), 725-744. https://doi.org/10.1177/0145445501255004. Bui.T.V. (2016). Assessment in Early Childhood Education. Vietnam Education Publishing House. Charlop-Christy, M. H., Carpenter, M., Le, I., LeBlanc, L. A., & Kellet, K. (2002). Using the Picture Exchange Communication System (PECS) with children with autism: Assessment of PECS acquisition, speech, social-communicative behavior, and problem behavior. Journal of Applied Behavior Analysis, 35(3), 213–231. Dao.T.T.T. (2016). Children with Autism Spectrum Disorder and Support for Their Community Integration. Journal of Educational Science, Vietnam Institute of Educational Sciences, 132, 20-22. Dinh.H.T. (2008). Methods of developing children’s speech. Hanoi University of Education Publishing House. Dinh.H.T. (2010). Language development curriculum for preschool age. Hanoi University of Education Publishing House. Dinh.V.V. (2016). Organizing play activities for preschool children. Vietnam Education Publishing House. Dinh.V.V. (2008). Early Childhood Education Curriculum. Vietnam Education Publishing House. Do.T.K.C., & Tran.T.H. (2021). Developing pronunciation practice games on electronic applications for first-grade hearing-impaired children in inclusive classrooms. Journal of Education, 512(2), 35-41. Edeal, D. M., & Gildersleeve-Neumann, C. E. (2011). The importance of production frequency in therapy for childhood apraxia of speech. American Journal of Speech-Language Pathology, 20(2), 95-110. https://doi.org/10.1044/1058-0360(2011/09-0005). Flippin, M., Reszka, S., & Watson, L. R. (2010). Effectiveness of the Picture Exchange Communication System (PECS) on communication and speech for children with autism spectrum disorders: A meta-analysis. American Journal of Speech-Language Pathology, 19(2), 178-195. https://doi.org/10.1044/1058-0360(2010/09-0022) Ganz, J. B., & Simpson, R. L. (2004). Effects of PECS teaching to Phase III on communicative interaction between children with autism and their teachers. Journal of Autism and Developmental Disorders, 34(5), 395-409. Gillon, G. T. (2004). Phonological awareness: From research to practice. Guilford Press. Kasari, C., Gulsrud, A. C., Wong, C., Kwon, S., & Locke, J. (2014). Randomized controlled caregiver-mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders, 44(3), 540-553. https://doi.org/10.1007/s10803-013-1894-z. Kuhl, P. K. (2004). Early language acquisition: Cracking the speech code. Nature Reviews Neuroscience, 5(11), 831-843. https://doi.org/10.1038/nrn1533. Le Minh Cong, Ngo Xuan Diep. (2012). An experimental model for evaluation and early intervention for children with autism spectrum disorder in Bien Hoa City – Dong Nai. Specialization 1: Theoretical issues on autism, children with autism spectrum disorder, and causes leading to autism. Dong Nai Association for Psychological and Educational Sciences. Lifter, K., Sulzer-Azaroff, B., Anderson, S. R., & Cowdery, G. E. (2011). Teaching play to children with autism: Practical interventions using Identiplay. Jessica Kingsley Publishers. 123
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