Importance of Play in the Development of Language and Social Skills - A Case Study on Twins

Abstract

Play fosters language development in young children in which an effective language-learning environment is established to facilitate language. Language deficits in twins tend to persist through the early years of life. The present case study focussed on the relationship between language, social skills and play in a pair of twins diagnosed with language delay. A set of identical twins aged 3 years was evaluated for their speech and language skills. A detailed pre and post therapy evaluation was carried out formally and informally. Individual therapy and group therapy were provided to facilitate language through symbolic and associative play. A notable improvement was observed in language and social communication skills. Increased spontaneity of communication, social reciprocity, commenting, use of questions and use of linguistic markers were also observed. The study concludes that play facilitates language skills in children with language disorders.

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International Journal of Health Sciences & Research (www.ijhsr.org) 338
Vol.9; Issue: 4; April 2019
International Journal of Health Sciences and Research
www.ijhsr.org ISSN: 2249-9571
Case Study
Importance of Play in the Development of Language and Social Skills -
A Case Study on Twins
Ruth Deborah D1, Preethy Susan Reni2, Julie Sandra A3, Priyanka A4
1Assistant Professor, 3Clinical Supervisor, 4Intern BASLP,
Department of Audiology and Speech Language Pathology SRM Medical College Hospital and Research
Centre, SRM Institute of Science and Technology, Kattankulathur, Kancheepuram Dist, Tamilnadu-603203
2Speech Language Pathologist, National Institute of Speech and Hearing, NISH Road, Sreekariyam P.O,
Trivandrum, Kerala - 695017
Corresponding Author: Preethy Susan Reni
ABSTRACT
Play fosters language development in young children in which an effective language-learning
environment is established to facilitate language. Language deficits in twins tend to persist through
the early years of life. The present case study focussed on the relationship between language, social
skills and play in a pair of twins diagnosed with language delay. A set of identical twins aged 3 years
was evaluated for their speech and language skills. A detailed pre and post therapy evaluation was
carried out formally and informally. Individual therapy and group therapy were provided to facilitate
language through symbolic and associative play. A notable improvement was observed in language
and social communication skills. Increased spontaneity of communication, social reciprocity,
commenting, use of questions and use of linguistic markers were also observed. The study concludes
that play facilitates language skills in children with language disorders.
Keywords: Play, Twins, Language, Social skills
INTRODUCTION
Language is crucial for a child’s
development and is an essential key for
learning, communicating and building
relationships with others. Language
facilitation occurs when children interact
with adults and peers in a playful manner,
suggesting that play can make contributions
to some aspects of language development. [1]
According to Ginsburg (2007) play
enhances children’s development and
incorporates many social and cognitive
elements vital for language learning. [2]
Among children aged 1-6 years, those who
scored higher on a test of symbolic play
showed better receptive and expressive
language skills. [3] Play and linguistic
communication share a representational
character; hence play provides children with
opportunities to practice forming symbolic
relationships. [4] Play with adults and peers
bolsters language development because it
encourages greater language use. As the
symbolic play progresses, infants become
more capable of combining mental
representations of such relationships into
sequences or organizing them into a
hierarchical manner. Ferrera et.al (2011)
reported increased use of spatial language
while children and their parents played with
block in which parents scaffolded the
interaction where the child’s lead was
encouraged. [5] Language delay in twins
persists through early school years and has
been reported particularly in males. This
could lead to decreased academic
performance and less emotional well-being
as a long-term consequence. Earlier studies

Ruth Deborah D et.al. Importance of Play in the Development of Language and Social Skills –A Case Study on
Twins
International Journal of Health Sciences & Research (www.ijhsr.org) 339
Vol.9; Issue: 4; April 2019
reported by Luria & Yudovich (1971)
documented language delay in twins who
also presented with poor play and social
skills. [6] Language delay in twins is related
to social experiences in the child’s social
environment during the early years of life.
As language delay is evident in twins,
similar to a singleton with a language delay,
individual therapy program is required.
Long term therapy resulted in better verbal
communication skills, leading to better play
and social skills. [7]
The present case study has examined
the positive effects of play development on
language skills and social interaction. The
purpose of the present study was to study
the relationship between language, social
skills and play in a pair of twins diagnosed
with language delay.
MATERIALS AND METHODS
A pair of identical twins, Twin A
and Twin B aged 3 years old born of a
consanguineous marriage third degree were
brought by the parents with concerns
regarding their communication and social
interaction skills. No significant medical
history was reported.
The following tools were used during pre
and post-therapy evaluation to establish
baseline and for re-evaluation to document
the progress.
1. Communication-Developmental Eclectic
Approach to Language Learning (Com-
DEALL) Developmental checklist. [8]
2. A Scale for Assessing Children’s play.
[9]
3. Informal observation included free play-
sessions and semi-structured
observations. Both the twins were
diagnosed as having mixed receptive
and expressive language disorder.
The study was carried out in two phases. In
the first phase, emphasis was on semantic
language and to establish basic
communication skills. In the second phase,
emphasis was on pragmatic aspects of
language skills by incorporating symbolic
and associative play.
In the first phase a structured intervention
program was planned for 15 sessions once a
week and was followed up for a period of 6
months and the children were re-evaluated
at 3.9 years of age. The first two sessions
were used to set the baseline performance
for the goals (Table1). The play skills were
also assessed and the results are mentioned
in Table 2.
Table 1: Baseline performance of developmental skills using Com-DEALL Developmental checklist
Table 2: Baseline performance of play skills using Westby (2000): A Scale for Assessing Development of Children’s play
Child-centered approaches also
known as indirect language stimulation
approaches were used primarily for
language stimulation. In the second phase,
the children were rescheduled for individual
as well as group therapy once a week and
had attended 16 sessions totally. Focused
stimulation approaches and child directed
approaches were used. In order to facilitate
language through play, activities which
incorporated pre-symbolic schemes were
carried out to improve the child’s thematic
content to represent everyday activities,
short isolated schemas which include single
pretend actions, relating to self and others,
use of language for directive functions such
as requesting, commanding, and labeling.
Developmental Age in Months
Gross
motor
Fine
motor
Activities of
daily living
Receptive
language
Expressive
language
Cognitive
skills
Social
skills
Emotional
skills
Baseline- 3
years of age
Twin
A
Age adequate
18-24
12-18
24-30
18-24
18-24
Twin
B
18-24
12-18
24-30
18-24
18-24
Baseline-36 months of age
Twin A
Pre-symbolic level II: 13-17 months
Twin B
Pre-symbolic level II: 13-17 months

Ruth Deborah D et.al. Importance of Play in the Development of Language and Social Skills –A Case Study on
Twins
International Journal of Health Sciences & Research (www.ijhsr.org) 340
Vol.9; Issue: 4; April 2019
RESULTS AND DISCUSSION
The aim of the study was to facilitate
language skills through play in the
participants. The results of the study are
documented in two phases a) Phase 1 - the
focus was on to improve the semantic
aspects and early communication skills b)
Phase 2 – the focus was on to facilitate
pragmatic aspects of language including
social communication skills by
incorporating symbolic and associative play.
Phase 1 - To improve the semantic
aspects and early communication skills
Goals were targeted to improve
communication intent, pre-linguistic skills
such as eye contact during communication
acts, joint attention during play, imitation
skills (verbal and motor), use of vocabulary
in terms of needs and common objects of
use, and to facilitate use of two word
combinations for expressing needs.
An increase in frequency of
communication acts, consistent eye contact
during communication acts, social
referencing during joint attention acts,
increase in vocabulary and imitation skills,
and use of meaningful spontaneous 2 word
utterances to communicate needs were the
improvements observed in both twins. Due
to personal difficulties, the participants
could not continue with regular therapy,
hence home program was provided. The
results of the re-evaluation carried out at 3.9
years of age following 15 sessions of
therapy and home program is shown in table
3.
Table 3: Re-evaluation done at 3.9 years of age using Developmental checklist
Developmental Age in Months
Gross
motor
Fine
motor
Activities of
daily living
Receptive
language
Expressive
language
Cognitive
skills
Social
skills
Emotional
skills
Re-evaluation-
3years 9 months
of age
Twin
A
Age adequate
24-30
18-24
24-30
18-24
18-24
Twin
B
24-30
18-24
24-30
18-24
18-24
Phase 2 – To facilitate pragmatic
language including social communication
skills by incorporating symbolic and
associative play.
In the second phase, the children
were rescheduled for individual as well as
group therapy once a week and had attended
16 sessions totally. Primary focus was to
improve the pragmatic skills to improve
reciprocal communications and to use
language for various purposes. Both the
sessions primarily focused on improving
morpho-syntactic, semantic and pragmatic
aspects of language to improve the overall
communication abilities of the participants.
Group therapy was purposefully initiated to
improve sibling interaction among
themselves and also better social skills with
other children to achieve pragmatic
language skills such as greeting, requesting
and turn taking skills
Activities to improve morpho-
syntactic aspects such as use of tense
markers, pronouns, semantic aspects to
improve use of ‘wh’ questions (‘what’’and
‘where), pragmatic skills such as indirect
requesting, role play and narration skills
through pre-symbolic schemes, symbolic
play and associative play. Focused
stimulation approaches and child directed
approaches were used. In order to facilitate
language through play, activities which
incorporated pre-symbolic schemes were
carried out to improve the child’s thematic
content to represent everyday activities,
short isolated schemas which include single
pretend actions, relating to self and others,
use of language for directive functions such
as requesting, commanding and labeling. A
post therapy re-evaluation was done at 4.4
years of age and the results are given in
Table 4 and Table 5.

Ruth Deborah D et.al. Importance of Play in the Development of Language and Social Skills –A Case Study on
Twins
International Journal of Health Sciences & Research (www.ijhsr.org) 341
Vol.9; Issue: 4; April 2019
Table 4: Re-evaluation done at 4.4 years of age using Developmental checklist
Developmental Age in Months
Gross
motor
Fine
motor
Activities of
daily living
Receptive
language
Expressive
language
Cognitive
skills
Social
skills
Emotional
skills
Progress- Post
therapy Re-
evaluation
Twin
A
Age adequate
36-42
30-36
36-42
30-36
30-36
Twin
B
36-42
30-36
36-42
30-36
Table 5: Re-evaluation done at 4.4 years for play
The clinician interacted in a way to
scaffold learning skills initiated by the
children. The activities were primarily led
by the children based on their interests. A
post therapy re-evaluation was done at 4.4
years of age and the results
On formal evaluation, both children
showed an improvement in the overall
language skills. There was an increase in the
social interaction of these children and
improved spontaneity during
communication acts. The children were able
to use language for a variety of purposes
such as commenting, protesting, requesting,
sharing, using indirect requests, emergence
of role-play with each other, emerging of
narrative skills. They could also
intentionally interact and communicate with
various partners such as family members,
peers and also at school for a variety of
reasons. They could play and interact with
others for increasing periods of time, initiate
social interactions with peers and adults
spontaneously and also respond to the social
initiation of others, developed an expanding
interest in a variety of toys or objects. Use
of questions, pronouns, phrases were
observed.
Play constitutes a crucial component
in developing language, cognitive and social
skills Studies also reveal that the connection
between play and language development
may rely on the shared symbolic nature of
both activities and the social interaction
during the many types of play help in
language development. [10] Ojoundo (2015)
reported that when children are provided
with different types of play materials and
opportunities, they learn through
manipulation and are able to acquire skills
of speaking, listening and also reading and
writing. [11] Speech and language
intervention has enabled the children to
develop their communication skills
effectively as the clinician is able to
skillfully interact with the children more
purposefully and sensitively, thus providing
much precise models of effective language
use which is of prime importance for rapid
language learning.
CONCLUSION
The present study has shown that
incorporating play skills in speech and
language therapy will further enhance
language learning which is vital for
communication skills. This is an important
guideline especially during early
intervention of children who present with
language disorders. As language delay is
evident in twins, similar to a singleton with
a language delay, specialized individualized
program is required.
ACKNOWLEDGEMENTS
We would like to thank the children and the
family for their co-operation and active
participation in the intervention process.
Conflict Of Interest
The authors declare that there is no conflict of
interest.
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Progress- Post therapy Re-evaluation 16 sessions54months of age
Twin A
Symbolic level VI: 3to 3.6 years
Twin B
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How to cite this article: Deborah DR, Reni PS, Sandra AJ et.al. Importance of play in the
development of language and social skills - a case study on twins. Int J Health Sci Res. 2019;
9(4):338-342.