Oeeupational Therapy Rehavior in Pediatries
A Play Skil s nventory:
A Competency Monitoring Tool
for the 10 Year Old
(childhood, skills assessment, PSI)
Janith McCready Hurff
Occupational behavzor theory
provides gwdelines for current
occupational therapy practice.
This theory, based on the balance
of work and play activities, guided
the development of an evaluative
tool to mom tor the skill acqwsl­
tion of the lO-year-old child. This
article presents a conceptual
model of basIc chIldhood skIlls
and abilities reqwred for success­
ful transition into adolescence.
The model and princzples sup­
porting the evaluatwe tool are
used to demonstrate assessment of
critical skills required for compe­
tent role performance durzng the
latency period of life and the
child's readiness for the adolescent
struggle.
lay is an adaptive learning pro­
cess for acquiring the tools of
mastery. Occupational therapy is
a ble to promote health and adapt­
ability by teaching the skills of daily
living. Therapists who are knowl­
edgeable of the capabilities,
strengths, weaknesses, and deficits
of their young patients are particu­
larly mindful of the child's hard­
gained skill accomplishments.
These skills may be diminished
while therapy is directed to specific
medical concerns. Also, if develop­
ment in one skill area is progressing
at a greater rate and strength than
another, it may follow that the child
is dominated by a particular set of
P
Janith McCready Hurff, M.A.,
OTR, is Assistant Dirf'Ctor of
Occupational Therapy Trainzng,
University Affiliated Program,
Children's Hospital of Los
Angeles, California.
skills. Discrepancies in the rate of
skill acquisition between develop­
memal areas or significant devel­
opmental deviations in the progress
of a child's growth pattern are of
major concern to the occupational
therapist.
As a prelude to imervention, a
competency monitoring system was
developed to assess the status of skill
development in middle childhood.
The evaluation tool (1), which is
based on concepts from the occupa­
tional behavior theory, contains
play situations from which sensory,
motor, perception, and intellectual
behaviors can be observed and as­
sessed. These behaviors are the
foundation for skill maintenance
and developmen t. The ten-year-old
period (8- 12-year range) is chosen
as a key period for monitoring
competencies because it is a critical
period for the mastery of physical,
psychological, and social skills re­
quired for satisfactory future func­
tioning.
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651
Purpose
The purpose of this paper is to pre­
sent a conceptual model that identi­
fies the components of competency
development. Play and its relation­
ship to skill learning are discussed
and form the basis for the Play
Skills Inventory (PSI), a gross mon­
itoring tool of skill development
during middle hildhood. The use
of the tool is demonstra ted by case
iJiustrations.
Theoretical Framework
The theoretical framework of occu­
pational behavior developed under
the guidance of Reilly r vitalizes
the original life space and life style
concepts of early occupational ther­
apy practice proposed by Meyer (2).
Occupational behavior integrates
the concepts of competency, the
motivational aspects of competency,
life roles, and achievement into a
bio-social orgaOlzation within a de­
velopmental continuum of play
through work (3). The theory base
for occupational behavior theory is
drawn primarily from White (4),
Smith (5), Bruner (6), and Berlyne
(7). Others have contributed to the
knowledge base of occupational be­
havior and have emphasized the
importance of play for healthy
human growth and development.
Play is the arena in which compe­
tency is processed as the indi vidual
explores reality. Childhood explo­
ra tions teach the rules that allow
the child to process information
about his or her actions upon ob­
jects, space, and people within his
or her environment. From senso­
rimotor play in childhood, the
child moves into the symbolic play
of pre-adolescence to incorporate
the rules of winning and of losing.
Play activities involving craftsman­
ship and sportsmanship are the pre­
requisites for adult workmanship,
citizenship, and for successful adap­
652
tation to the rules of society (8).
What is learned during game play­
ing and the use of materials is
reflected in the llecisions made dur­
ing adolescence, the rules used to
make friends, whether the rules of
society are honored or broken, and
the nature of relationships with
others. In short, play experiences
are the building blocks for learning
and human adaptation. If one
assumes that human growth is a
developmental process and subject
to past and present influences, then
one can see that play experi nces,
arts and crafts, games, and chores
are the building blocks for work
skill' and the recreational and social
roles of later liff.
By age 10 the child should have
established a particular life style­
meaning a self-concept, an opinion
of others, and goals he or she sets for
him- or herself. Physical, psycholog­
ical. intellectual, and social skills
should be developing sufficiently to
free the child to explore the alterna­
tives of adolescence, the next stage
in the developmental process.
Havighurst describes the 10-year-old
stage as the time when the youth
moves physically into the world of
games, which gives practice to the
child's neuromuscular control;
when he has developed his mental
processes psychologically which
include symbolization, conceptual­
ization, and communication; and
when he has expanded his life space
socially from home group into
neighborhood group (9). The the­
ory of occupational behavior per­
mi ts the addi tion of role perfor­
mance as another parameter. The
roles assumed during childhood are
basic and influence those assumed
during later years. The encultura­
tion process begins within the fam­
il y where the child is able to acq uire
the socialized expectations associ­
ated with the roles of a sibling, an
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offspring, a neighbor, and a student.
In school the child becomes en­
trenched in the student role. In the
student role, the child tries to meet
the social expectancy of developing
competency in the skills of reading,
writing, reasoning, and problem
solving.
Erikson emphasizes the tool learn­
ing requirements of middle child­
hood in the stage he iden tifies as
industry versus inferiority. "His (the
child's) ego boundaries include his
tools and skills: the work principle
teaches him the pleasure of work
completion by steady allention and
persevering diligence." (10, p 259)
The child learns that he or she can
gain recognition by producing
things. As he explores and masters
the tool wotld of skills and tasks, he
gains the technological fundamen­
tals that will help IO his perfor­
mance of economic and social roles.
Erikson terms this period to be a
lull before the storm of puberty.
Latency is a relatively quiet period
for the chi ld to practice basic skills
and tool use, Providing opportuni­
ties for a variety, quali ty, and quan­
tity of play experiences will enable
the child to build a sense of industry
and efficacy for later life roles. With
a firm foundation in these critical
skills, the child moves into adoles­
cence with less likelihood of meet­
ing failure, frustration, and apathy
genera ted from a sense of inferiority.
Central in adolescence is The
Task of Occupational Choice de­
scribed by Ginzburg and others as a
developmental process spanning the
years of adolescence. Characteristic
of this process are choices tha t must
be made with regard to one's inter­
ests, capacities, and values as as­
sessed against the realities of the
work world. The extent to which
the child succeeds or fails in the
process of choosing a "satisfying"
occupation is dependent upon a
endurance, speed, flexibility, and
motor accuracy,
Perception-the ability to attend
selecti vely to a group of stimuli and
to recognize patterns (12).
Intellect-the ability to pull past
learnings from memory, to select
the best solution for the task at
hand, to adapt actions to meet the
task, and to reflect on the outcome
of one's actions (13).
Figure 1 Competency development model
PERCEPTION
SENSATION
baseline of prerequisite skills, The
need for a monitoring device to
assess these prereq uisi te ski lls for
the task of occupational choice in
adolescence prompted the design of
a Play Skills Inventory based on a
Competency Model of Skills De­
velopment.
The Competency Model
The importance of monitoring the
critical skills that are acquired over
the first decade of life seems a high
clinical priority, There are no com­
prehensi ve theories of ei ther devel­
opment or play to support testable
hypotheses that might identify and
measure skill acquisition of the 10­
year-old child to predict readiness
to move into adolescence, There are
standardized tests that assess mental
abilities (i,e" Wechsler Intelligence
Scales for children and Stanford­
Binet Intelligence Tests) and aca­
demic achievement (Wide-Range
Achievement Tests and Peabody In-
MOTOR
dividual Achievement Test), How­
ever, few methods are available to
assess basic playground skills so
important for peer acceptance, or
the feelings of self-worth and indus­
try emphasized by Erikson as criti­
cal requirements of the latency pe­
riod of the life cycle, The PSI
attempts to bridge this gap through
the use of a gross overview system to
assess learnings of the prerequisite
skills for occupational choice and
adaptation,
The process of competency de­
velopment and its components are
identified and ordered into a model
as seen in Figure I,
Competency development may be
described through the analysis of
the hierarchical domains of sensa­
tion, motor, perception, and intel­
lect. Components of the model are
defined as follows:
Sensation-the ability to detect
and identify stimulus change,
Motorability-physical strength,
These four components are seen
as hierarchical, prepotent, and in­
teractive-hierarchical because sen­
sation must precede perception;
perception must precede intellect
development-prepotent because
disruption or loss at a lower level of
the hierarchy may alter or prevent
functioning at the higher level of
competency development. Because
each component affects the others
through time, they are in teractive or
dynamic (I; 8, p 270).
Individuals move through these
stages in a circular fashion; that is,
as sensa tion and motor ski lis de­
velop, perception skills increase. Each
increase in perceptual-sensorimotor
skills permits organization, integra­
tion, and accommodation of new
learning within the individual.
Through this process, children learn
about themselves and their relation­
ship with their environment, build­
ing the social aspect of their
development.
Skills of sensation, motor, and
perception must become automatic
before the child is ready for success­
ful intellectual pursuits. Skill de­
velopment brings behavior to such
a degree of regulari ty that perfor­
mance no longer requires a major
investment of attention and motor
planning but becomes automatic.
This frees the child to problem­
solve and make decisions; he or she
can scan a situation, choose from
a vailable sol u tions, adapt his or her
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653
actions, and then benefit from feed­
back of his or her resulting actions.
Refinemem of sensation, motor, and
perceptual skills affects intellectual
functioning, which then facilitates
the child moving back into the
lower developmental sequences to
refine, expand, and perfect his or
her actions. Thus, the model is
interactive and cannot be conceptu­
alized in lineal sequemialterms (I).
Readiness implies that the child
has available the responses required
for the task. Growth and matura­
tion must have developed suffi­
ciently to allow him or her to refine
his or her gross and small muscula­
ture to permit more integrated, se­
quential actions. The Competency
Development Model in more de­
tailed form is presented in Figure 2.
As a developmental model, it en­
ables the user to examine and ques­
tion subcomponents.
The Play Skills Inventory
A Play Skills Inventory (PSI) of 20
play situations was developed to
detect gross deficit behaviors in sen­
sation, motor, perception, and
intellectual functioning. Play activ­
ities selected were considered repre­
sen ta ti ve of req uired skills and abil­
ities of middle childhood. Some
play situa tions tested one area of the
com petency model directl y, whereas
others tapped several areas simul­
taneously.
Many well-known tests used in
training or in educational institu­
tions were incorporated into the
PSI. Other play situations were
adapted to fit the Competency
Model components. Popular play­
ground games and commercial out­
door games or board games were
modified or adapted for assessment
and measurement (I, 14). Some of
the test si tuations or challenges were
specially constructed to produce an
interactional situation, such as
654
problem-solving tasks, social rela­
tionship in interplay, or special
physical challenges.
Tasks req uiring the child to detect
and identify stimuli change pro­
vided an indication of sensation
ability. Motor skills were tapped in
such acti vi ties as gross motor con­
trol (Kraus-Weber Physical Tests)
(15), fine motor control or dexterity
(Pick-Up Sticks or the game opera­
tion), and static plus dynamic bal­
ance tasks. Play exercises were
selected that challenged the ability
to attend to a group of stimuli and
to recognize patterns; this produced
a gross measurement of percep.tual
ability. Perceptual skills were sub­
divided into spatial, auditory, and
temporal judgments in such chal­
lenges as pa ttern recogni tion (hid­
den picture searches), reproducing
stick patterns and duplicating sound
patterns.
Social skills that include a sense
of responsibility to others were ob­
served in the child's conformity to
group rules, self-control for the
benefit of an end goal, empathy for
others, and cooperation. Many of
these beha viors were observa ble
through selected group game experi­
ences (team Lego Block construc­
tion) with a competitive focus.
Reasoning and thinking skills
were observed in learning and
problem-solving tasks (the games
Clue and Career). The ability to
comm unicate, to imagine, to attend,
and to concentrate are components
of intellectual functioning. Simple
com peti ti ve game elemen ts engaged
participants in decision making to
accom plish a predetermined end
goal. Important behavioral data can
be noted through observation of
play actions and interactions. Goal
setting, benefit from feedback, per­
sistence, willingness to take risks,
ability to overcome obstacles, trust
in own judgment, dependence ver­
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sus independence, perception of
own cause and effect actions are a
few of the observational yields. All
these tests were scored subjectively.
The pilot study on the PSI was
administered to 21 children, aged
10. Eleven boys and ten girls were
randomly selected from referrals
provided by elementary school
teachers, you th leaders, and recrea­
tional personnel. Since children
tested represented a population of
nonhandicapped children, this
would ascertain whether all test
situations in the PSI were well
within the range of the 10-year-old
child. Instructions were given in as
standard a form as possible in order
to collect objective data. Time re­
quirements to complete each test,
scoring procedures, ranked test per­
formances of all test subjects, min­
imal score recommendations, and
questions generated from individ­
ual test situations were recorded
(14). Only those items passed by all
21 test participants remained in the
PSI (20 of 26 test situations). Min­
imal scores were determined upon
the criterion of a score sufficiently
below the lowest ranked test per­
formance from the test group. The
PSI, test situations, suggested time
requiremems, and minimal perfor­
mance scores are described in Playas
Exploratory Learning (I).
There was no intent to standard­
ize the PSI. However, users may fol­
low the rationale and guidelines of
the Competency Model to substi­
tute or adapt appropriate play tasks
within the sequences presented.
Also, the model may be used to
develop test batteries for other age
ranges by overlaying the appropri­
a te developmental milestones char­
acteristic of a specific age range.
One might anticipate that chil­
dren with physical or emotional
problems would produce low scores
in specific areas of the PSI. This was
Figure 2 Competency model
A
I
reasoning
thinking
j
Transitional
tasks
between
categories
1
problem
SOIVin g
learning
\
INTELLEC~
_
self-concept
self­
esteem
identification
interpersonal
competence
personal
control
social
perception
role learning
fine motor
skills
belief-value system
PERCEPTION
recognition
of
visual
auditory
spatial
tactile
temporal
Transitional
tasks
between
categories
gross motor skills
locomotion
patterns
balance
selective attention
visual
kinesthetic
auditory
coordination
proprioceptive
motorlc
accuracy
tactile
gustatory
SENSATION
the finding when the inventory was
administered to a child with emo­
tional problems, to one with learn­
ing difficulties, and to several chil­
dren with developmental delays.
Case Illustrations
Two cases ill ustrate how the PSI can
be used to analyze play skill com­
petency and to formulate implica­
tions for clinical intervention. In
the first illustration, Gold used the
endurance
strength
flexibility
MOTOR
PSI to collect da ta on a IO-year-old
boy with problems of impulsivity,
aggressiveness, immaturity. and
learning problems (16). He was
diagnosed as having an adjustment
reaction of childhood and educa­
tional difficulties due to minimal
brain dysfunction. Minimal brain
dysfunction was described by Task
Force One of the National Project
of Minimal Brain Dysfunction
(MBD) in Children as:
... children of near average, aver­
age, or above average inteLLigence
with certain learning or behavioraL
dzsabilities ranging from miLd to
severe, which are associated with
deViations of function of the centraL
nervous system. The deviations may
manifest In various combinations
of impairment In perception, con­
ceptuaLizatzon, language, memory,
and control of allention, impulse,
or motor functzon. (17, pp 9-10)
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655
The subject demonstrated accept­
able performance in only one of the
four areas assessed-intellect. Gold
found this score compatible with
the definition of MBD that specified
normal intelligence,
Test results indicated deficits in
two of the three tactile tests, in three
of the seven motor tests, and in three
of the five perception tests (I), The
subject's play status was analyzed as
high risk because of having scored
at an acceptable level on only 12 of
the 20 tests administered, The PSI
was one of several play evaluative
tools that was useful in identifica­
tion of gross play defici ts, The in­
tervention plan designed provided
the subject with a program of play
experiences in his three areas of
deficiency-sensation, motor, and
perception, Gold emphasized the
use of the chi Id's intact areas of skill
to ease learning in the deficient
areas, She protected his hard-gained
skill accomplishments while attend­
ing to intervention concerns,
The second illustration is of an
amiable 11.4-year-old boy with a
reading disability, He knew his
alphabet but was unable to read,
although he was in the 6th grade,
Gross motor coordination and
balancing tasks on the PSI were
passed with ease, Fine motor coor­
dination was intact. Two areas on
the perception tests were unaccept­
ably performed. These were a fig­
ure ground task and a space-dot
task. The subject demonstra ted that
he had adequate mental processing
in his performance scores involving
transformation, ordering, and ego­
centric conceptualization, which are
components of the intellect area of
the inventory. Clinical planning in­
cluded prevocational exploration
and training to develop feelings of
competency, a play program focus­
ing on perceptual motor experi­
ences, and further evaluation using
656
the Southern California Sensory In­
tegration Tests,
Summary
The importance of play has been
identified as the arena for learning
childhood skills needed for work,
recreational, and social roles of later
life. A conceptual model of compe­
tency representing three develop­
mental sequences guided the identi­
fication of certain critical skills and
beha viors required for competent
role performance during middle
childhood and for readiness to move
into adolescence. The model also
established the rationale for con­
struction of a gross moni toring tool
to assess the presence or absence of
these identified skills. A variety of
play situations were selected, con­
structed, and adapted to formulate
an assessment instrument. The Play
Skills Inventory has been useful to
some occupational therapists in
their observa tions and identi fica tion
of the child's strengths and weak­
nesses in varied developmental areas.
The Inventory was presented and
instances of its use were shared
through two case illustrations,
Acknowledgment
Sincere a ppreciation is extended to
Dr. Mary Reilly for her faith and
guidance, which enabled the com­
pletion of this pilot study.
This study was supported by a
grant from Maternal and Child
Health Services, U.S. Department
of Health, Education, and Welfare
#257.
This article is based upon a thesis
titled Protecting the Achievement
Behavior and Competency Devel­
opment of the Ten Year Old Child,
presented in partial fulfillment of
the requirements for the degree of
Master of Arts, Department of Oc­
cupational Therapy, University of
Southern California.
October 1980, Volume 34, No. 10
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Copies of the Play Skills Inven­
tory are not available; however, for
more detail, see Reilly M: Playas
Exploratory Learning (8),
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