SHELBY MERCER, SYNERGY EDUCATION TRUST, UK; MEd GRADUATE, UNIVERSITY OF BIRMINGHAM, UK
Introduction
Play is widely recognised as central to children’s development. All children can benefit from play with peers, which can contribute significantly to their social and emotional development (Chen et al., 2020). However, some studies (such as Smith, 2018) suggest that children with profound and multiple learning disabilities (PMLD) take part in little to no social play with their peers. This may be due to the ways in which teaching and support are typically structured, with adult involvement sometimes unintentionally reducing opportunities for peer interactions and play. This research aimed to explore how adults could instead support these interactions and what happens when children with PMLD are given opportunities to play and interact without a specific educational aim.
Methods
Although inclusive research principles have led to an increase in co‑research, where those with disabilities take on various roles within the research design, there remains a lack of research including those with PMLD (Gjermestad et al., 2023). Watson (2020) challenges a negative attitude, held by some, that views including those with PMLD directly in research as being too difficult or tokenistic. Boxall and Ralph (2010) highlight the difficulty in ascertaining the views and perspectives of those with PMLD. However, some researchers have begun to involve individuals with PMLD in research, ensuring that they are more than merely subjects of observation (Nind, 2014).
I aimed to explore the experiences of the children involved in a way that was sensitive and respectful. To do this, I used a case study approach with a qualitative methodology, drawing on sensory ethnography (Pink, 2015). Ethnographic research seeks to understand people’s experiences from their own perspectives. Sensory ethnography does this by using all the senses to closely observe, and in this case it was used to contribute to an understanding of how the children played and interacted.
I held four regular sessions with three members of my Early Years class who have PMLD. I collected data through participant observations, recorded using an unstructured diary and video recordings. I also collected data from conversations held with members of the pupils’ circles of support, which included their families, carers and other professionals who work closely with them, during semi‑structured interviews. Within the unstructured diary, I also recorded incidental observations. Vignettes were written using the video recordings.
Analysis
The data was analysed using an adaptation of the constant comparative method described by Thomas (2023) and interpretative phenomenological analysis (IPA), as described by Smith et al. (2022). Using these methods together involved examining the data in depth and continuously comparing emerging themes to identify patterns.
Results and considerations
Children with PMLD often communicate in highly individual ways, which are sometimes subtle, using facial expressions, vocalisations, gestures and touch. Throughout the study, each child showed their own distinctive style:
Daisy then rubs her thumb across her own lips, reaching out momentarily to lightly touch Isla’s lip with her little finger, before returning her thumb to her own mouth. Isla remains unresponsive at first, but then she stirs, raising her arm interwoven with Daisy’s and vocalises loudly, emitting an “ahhh” accompanied by a smile. Daisy appears to respond with a softer, almost-whispered “eh”. Isla’s lip-smacking continues until she lets out another, quieter “ah”, to which Daisy appears to reply with a slightly louder “eh”. Isla’s sounds morph into longer “errr” vocals as she rhythmically moves her head and eyes from side to side, while Daisy looks to be listening.
Excerpt from Vignette 3
Although these behaviours might seem simple, they can form meaningful exchanges. Practitioners should be cautious about assuming a lack of understanding. Even if children are not consciously interpreting each other’s actions, they may still be actively engaged and connected within the interaction.
Throughout the sessions, all the children demonstrated an ability to play, usually sensorimotor in nature, reflecting the earliest stage of development described by Piaget (1936), in which children use their senses to explore and learn through trial and error. At times, their play, although not typical, stretched into what could be identified as associative play, in which children begin to interact with others during play but without coordinated structure:
Olly’s right arm stretches out at a near right angle on the floor. Daisy shifts onto her side, facing Olly’s hand. One of her hands rests still on her own mouth while the other lightly touches Olly’s wrist. At first, Daisy’s fingers remain motionless as she gazes between them and Olly’s face. Then, she starts to tickle Olly’s wrist gently. Olly’s eyebrows flicker momentarily. Daisy pauses and holds Olly’s forearm. Olly moves his arm closer, his hand softly landing on Daisy’s cheek, although this appears accidental. He lets out a large yawn, his eyelids fluttering slightly. Daisy’s eyelashes brush Olly’s fingers as she glances between his head and arm. They lie there, silent and still, for almost a minute… Meanwhile, Daisy resumes playing with Olly’s hand, her fingers weaving in and out of his like she’s sprinkling glitter. Olly sporadically opens and closes his palm, occasionally raising his eyebrows. His gaze remains fixed on the ceiling throughout; one small smile appears across his face.
Excerpt from Vignette 5
Throughout the study, the children demonstrated stages of play younger than their biological age, or achieved typical stages in a more unique way. If we follow Sutton‑Smith’s (1997) description of play as a quality or attitude rather than a rigid stage, then we may identify more instances of play between peers. Suggested signs of playfulness for those with PMLD can often be characterised physically by a lift in mood, awareness, motivation or a general sense of fun (Watson, 2020).
There were also times of low activity. As the children experience the world mainly through their senses, some may require more intense or sustained stimulation to respond, which a peer with PMLD may not be able to provide. These sessions were held in a purposefully calm, low‑distraction environment, but practitioners could increase stimulation levels for those who require it – including through play with mainstream peers – to support engagement and inclusion, as demonstrated successfully by Simmons (2023).
Based on this case study, I offer the following recommendations to colleagues looking to increase opportunities for peer play and interaction for students with PMLD:
- Position students for connection: Thoughtful positioning can help to create ‘social spaces’ where children are more able to notice and respond to one another. Repositioning was sometimes necessary for comfort or to support interaction, but carried the risk of interrupting engagement.
- Ensure student wellbeing through boundaries: The study demonstrates the need for close supervision to ensure safety and wellbeing. There were instances where I had to interject – for example, ‘Daisy then let go and reached for Isla’s face… I gently interjected with the word “gentle”.’ Other examples included stopping hair-pulling and attempts to place hands in one another’s mouths. Although there were no near misses concerning feeding tubes or self‑injury, I had to remain conscious of these throughout.
- Balance your presence: As demonstrated here, the adult role can both support and distract, ultimately becoming a balancing act. It may feel unnatural for those of us used to actively leading, but practitioners should recognise that even a less active role can be valuable in enabling communication and relationships.
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