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  2. Knox Preschool Play Scale

Knox Preschool Play Scale

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Purpose

The purpose of this assessment is to describe typical play behavior from birth to six years old. It analyzes four dimensions of play, including space management, material management, pretense/symbolic, and participation.

Acronym PPS, PPS-R. RKPSS or KPPSr

Area of Assessment

Infant & Child Development
Occupational Performance
Life Participation
Developmental
Language
Social Relationships
Behavior
General Health

Assessment Type

Observer

Cost

Not Free

Actual Cost

$75.16

Cost Description

The manual can obtained through purchasing, Play in Occupational Therapy for Children (2nd Ed.).

Populations

Pediatric Disorders
Non-Specific Patient Population

Key Descriptions

  • ● Assesses play in children, birth to six-years old
    ● Evaluates 12 items, which are divided into 4 dimensions
    ● Scores are obtained for each dimension
    ● Total play score is obtained from the mean of the 4 dimension scores
    ● Assessment completed in two observations, each 30-minutes long (one inside and one outside)

Number of Items

12

Equipment Required

  • 2 settings (indoor and outdoor)
  • Assortment of Toys
  • Peers

Time to Administer

60 minutes

2 observations, 30 minutes each (total time of 1 hour)

Required Training

No Training

Age Ranges

Infant

0 - 2

years

Preschool Children

2 - 6

years

Instrument Reviewers

Cassie Breshock, OTS, University of Illinois at Chicago

Megan Flaherty, OTS, University of Illinois at Chicago

Christina Scott, OTS, University of Illinois at Chicago

ICF Domain

Body Function
Activity
Participation

Measurement Domain

Cognition
General Health
Motor
Sensory

Considerations

  • Beneficial to use when the child cannot participate in a standardized test.
  • Correlates with developmental age, so chronological age may need to be adjusted.
  • Assesses natural behaviors

Pediatric Disorders

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Standard Error of Measurement (SEM)

Autism (Restall & Magill-Evans, 1994; n=9; mean age = 64.76 (SD= 11.3)  months)

  • SEM for entire group (n=9) based on dimension:
    • participation: 2.43
    • imitation: 1.59
    • space management: 7.35
    • material management: 2.08

Minimal Detectable Change (MDC)

Autism: (Restall & Magill-Evans,1994)

  • MDC for entire group (n=9) based on dimension and CI
    • Participation
      • 90% CI: 5.66
      • 95% CI: 6.74
      • 99% CI: 8.86
    • Imitation
      • 90% CI: 3.69
      • 95% CI: 4.40
      • 99% CI: 5.79
    • Space management 
      • 90% CI: 17.09
      • 95% CI: 20.36
      • 99% CI: 26.76
    • Material Management
      • 90% CI: 4.83
      • 95% CI: 5.75
      • 99% CI: 7.56

Normative Data

Autism: (Restall & Magill-Evans, 1994; scores obtained from the PPS in each dimension)

 

Dimension

Mean

Standard Deviation

Participation

44.00

12.37

Imitation

36.00

10.39

Space Management

44.00

16.97

Material Management

46.13

7.28

 

Test/Retest Reliability

Handicap Children: (Harrison and Kielhofner, 1986; n = 60, age range = 2 months - 5 years and 11 months)

  • Test-retest reliability for the Preschool Play Scale
    • Space management dimension: Adequate test-retest reliability (r = 0.73)
    • Material management dimension: Excellent test-retest reliability (r =  0.91)
    • Imitation dimension: Excellent test-retest reliability (r = 0.85)
    • Participation dimension: Excellent test-retest reliability (r = 0.87)
    • Play age: Excellent test-retest reliability (r = 0.91)

Autism: (Lee & Hinojosa, 2010; n = 61 preschoolers, age range = 3-5 years, mean age = 51 (SD = 7.08) months)
Revised version

  • Category scores: Adequate test-retest reliability(r=.67-.91)
  • Domains: Excellent test-retest reliability (r = .86-.96)
  • Overall play age: Excellent test-retest reliability (r = .96)

Interrater/Intrarater Reliability

Handicap children: (Harrison and Kielhofner, 1986)

  • Interrater reliability for Dimensions and Play Age
    • Space Management Dimension: Adequate interrater  reliability (ICC = 0.55)
    • Material management dimension: Excellent interrater reliability (ICC = 0.91)
    • Imitation dimension: Excellent interrater reliability (ICC = 0.77)
    • Participation dimension: Excellent interrater reliability (ICC = 0.88)
    • Play age: Excellent interrater reliability (ICC = 0.88)

Developmental Delay: (Fallon & MacComb, 2013; n = 5, age range = 3-6 years) 
Revised Version

  • Excellent interrater reliability (ICC = 0.83) for four of the cases
  • Adequate interrater reliability (ICC = 0.66) for one of the cases

Autism: 
Revised Version

  • Interrater reliability for total and dimension scores (Restall & Magill-Evans, 1994)
    • Total score: Excellent interrater reliability (ICC = 0.96)
    • Participation: Excellent interrater reliability (ICC = 0.84)
    • Imitation: Excellent interrater reliability (ICC = 1.00)
    • Space management: Adequate interrater reliability (ICC = 0.50)
    • Material management: Excellent interrater reliability (ICC = 0.94)
  • Interrater reliability for total and category scores, domains, and overall play age (Lee & Hinojosa, 2010)
    • Category scores:Excellent interrater reliability  (r=.89-.98)
    • Domains: Excellent interrater reliability(r=.97-.99)
    • Overall play age: Excellent interrater reliability (r=.99)
    • Total scores: Excellent interrater reliability (r=.94)

Criterion Validity (Predictive/Concurrent)

Concurrent validity:

Handicap children: (Harrison and Kielhofner, 1986)

  • Between the PPS and Lunzer's Scale With Play Age, Material Management, and Imitation Dimension Scores
    • Manipulation: Adequate concurrent validity (r = 0.53)
    • Construction: Adequate concurrent validity (r = 0.50)
    • Interest: Adequate concurrent validity (r = 0.58)
    • Purpose: Adequate concurrent validity (r = 0.58)
    • Attention: Adequate concurrent validity(r = 0.59)
    • Material management dimension: Adequate concurrent validity (r = 0.65)
    • Imitation: Adequate concurrent validity (r = 0.64)
    • Imagination: Excellent concurrent validity (r=0.89)
    • Dramatization: Excellent concurrent validity (r=0.76)
    • Imitation dimension: Adequate concurrent validity (r=0.69)
    • Play age total: Adequate concurrent validity  (r=0.59)

Autism: (Lee & Hinojosa, 2010)
Revised Version

  • Between PPS and Partens Social Play Hierarchy (r=.61 for typically developing children and r=.60 for children with disabilities): Adequate criterion validity
  • Between PPS and Lunzer’s Scale of Organization of Play Behavior (r=.64 for typically developing children and r=.59 for children with disabilities): Adequate criterion validity
  • Between the category and domain scores PPS-R and the total scores of the VABS (r=.52)
    • Category
      • Gross Motor: Poor concurrent validity (r = .24)
      • Interest: Poor concurrent validity (r = .26)
      • Manipulation: Adequate concurrent validity  (r = .53)
      • Construction: Adequate concurrent validity (r = .57)
      • Purpose: Poor concurrent validity (r = .18)
      • Attention: Adequate concurrent validity (r = .47)
      • Imitation: Adequate concurrent validity (r = .55)
      • Dramatization: Adequate concurrent validity (r = .50)
      • Type: Poor concurrent validity (r = .18)
      • Cooperation: Poor concurrent validity  (r = 0.04)
      • Humor: Poor concurrent validity (r = .08)
      • Language: Poor concurrent validity (r = .29)
    • Domains
      • Space management: Poor concurrent validity (r = 0.27)
      • material management: Adequate concurrent validity (r = 0.50)
      • Pretense/ symbolic: Adequate concurrent validity  (r = .055)
      • Participation: Adequate concurrent validity (r = 0.52)
    • Total score: Adequate concurrent validity (r = .52)
  • Between the domain scores of the PPS-R and the category and domain scores of the VABS

 

PPS-R (domains)

VABS (domains and categories)

Correlations (r)

Participation

Communication

0.24

Participation

Socialization

0.33

Participation

Communication

0.29

Space Management

Gross Motor

0.16

Material Management

Fine Motor

.01

Pretense/ Symbolic

Socialization

.57

Content Validity

Autism: (Lee & Hinojosa, 2010)
Revised Version

  • PPS scores were found to discriminate among chronological ages:
    • Typically developing children: Excellent content validity (r = .99)
    • Children with disabilities: Adequate content validity (r = .74)

Non-Specific Patient Population

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Test/Retest Reliability

Typically Developing Children; (Bledsoe & Shepard,1982; n = 90; age range =  4 months - 6 years)

  • Test-Retest Reliability for dimensions given by same rater
    • Space Management: Excellent test-retest reliability (r= 0.961)
    • Material Management: Excellent test-retest reliability (r= 0.941)
    • Imitation: Excellent test-retest reliability (r= 0.861)
    • Participation: Excellent test-retest reliability (r= 0.919)

Interrater/Intrarater Reliability

Typically Developing Children;

  • Inter-Rater Reliability for dimensions between two raters (Bledsoe & Shepard, 1982)
    • Space Management: Excellent interrater reliability (r= 0.993)
    • Material Management: Excellent interrater reliability (r= 0.991)
    • Imitation: Excellent interrater reliability (r= 0.976)
    • Participation: Excellent interrater reliability (r= 0.986)
  • Excellent interrater reliability (ICC = 0.86) (Jankovich, Mullen, Rinear, Tanta, & Dietz, 2008; n=38, age range = 36-72 months) Revised Version
  • Inter-Rater Reliability between two assessments of both examiners (r1 = First assessment, r 2= second assessment) (Pacciulio, Pfeiferand & Santos, 2010; n= 18; age range = 0 - 71 months and 29 days) 
    Revised Version
    • Space management:  Excellent interrater reliability (r1 = 0.91: r2 = 0.94)
    • Material management:  Excellent interrater reliability (r1 = 0.93 : r2 = 0.99)
    • Pretense/ symbolism:  Excellent interrater reliability (r1 = 0.78 : r2 = 0.95)
    • Participation:  Excellent interrater reliability (r1 = 0.92 : r2 = 0.92)
    • All:  Excellent interrater reliability(r1 = 0.92 : r2 = 0.95)
  • Intra-Rater Reliability between two assessments of each examiner  (r1= Examiner 1 : r2 = examiner 2) (Pacciulio, Pfeiferand & Santos, 2010; n= 18; age range = 0 - 71 months and 29 days)
    Revised Version
    • Space management: Excellent intra-rater reliability (r1 = 0.94 : r2 = 1.00)
    • Material management: Excellent intra-rater reliability  (r1 = 0.93 : r2 = 0.99)
    • Pretense/ symbolism: Excellent intra-rater reliability  (r1 = 0.87 : r2 = 0.99)
    • Participation: Excellent intra-rater reliability  (r1 = 0.94 : r2 = 1.00)
    • All: Excellent intra-rater reliability (r1 = 0.97 : r = 0.99)

Criterion Validity (Predictive/Concurrent)

Typically Developing Children (Bledsoe &  Shepard, 1982)

  • Comparisons with chronological age
    • Space Management: Excellent concurrent validity (r = 0.947)
    • Material Management: Excellent concurrent validity (r = 0.951)
    • Imitation: Excellent concurrent validity (r = 0.887)
    • Participation: Excellent concurrent validity (r = 0.913)
  • Comparisons of Social Parten Play Hierarchy scores with age and participation scores on PPS
    • Category
      • Type: Excellent concurrent validity (r = 0.618)
      • Cooperation: Excellent concurrent validity (r = 0.601)
      • Language: Excellent concurrent validity (r = 0.623)
    • Dimension
      • Participation: Excellent concurrent validity (r = 0.612)
    • Play age: Excellent concurrent validity (r = 0.614)
  • Comparisons of Lunzer Scale of Organization of Behavior scores with play age, material management, and imitation component scores of the PPS
    • Category
      • Manipulation: Excellent concurrent validity (r = 0.645)
      • Construction: Excellent concurrent validity (r = 0.689)
      • Interest: Excellent concurrent validity (r = 0.630)
      • Purpose: Excellent concurrent validity (r = 0.639)
      • Attention: Excellent concurrent validity (r = 0.660)
      • Imitation: Excellent concurrent validity (r = 0.633)
      • Imagination: Adequate concurrent validity (r = 0.577)
      • Dramatization: Excellent concurrent validity (r = 0.713)
      • Music: Adequate concurrent validity (r = 0.537)
      • Books: Adequate concurrent validity (r = 0.495)
    • Dimension
      • Material Management: Excellent concurrent validity (r = 0.632)
      • Imitation: Excellent concurrent validity (r = 0.637)
      • Play Age: Excellent concurrent validity (r = 0.640)

Construct Validity

Typically Developing Children: (Jankovich, Mullen, Rinear, Tanta, & Dietz, 2008)
Revised Version

 

The findings support the construct validity of the RKPPS because the vast majority of the overall play ages assigned by the two raters matched the children’s chronological ages.

 

Average Play Age Score (months)

 

36-47

48-59

60-72

 

n

%

n

%

n

%

Actual Age

(months)

8

57.1

5

35.7

1

7.1

36–47

(n = 14)

 

 

16

94.1

1

5.9

48–59

(n = 17)

 

 

 

 

1

5.9

60–72

(n = 7)

 

 

 

 

7

100.0

Bibliography

Bledsoe, N. P. & Shepard, J. H. (1982). A Study of Reliability and Validity of a Preschool Play Sale. The American Journal of Occupational Therapy, 36(12), 783-788. doi: 10.5014/ajot.36.12.783.

Fallon, J., MacCobb, S (2013). Free play time of children with learning disabilities in a noninclusive preschool setting: an analysis of play and nonplay behaviours. Special Irish Issue of British Journal of Learning Disabilities. 41, 212-219. doi:10.1111/bld.12052

Harrison, H., Kielhofner, G. (1986). Examining Reliability and Validity of the Preschool Play Scale With Handicapped Children. The American Journal of Occupational Therapy  40(3), 167-173.

Jankovich, M., Mullen, J., Rinear, E., Tanta, K., Dietz, J. (2008). Revised Knox Preschool Play Scale: Interrater Agreement and Construct Validity. The American Journal of Occupational Therapy, 62(2), 221-227.  

Lee, S. C., & Hinojosa, J. (2010) Inter-Rater Reliability and Concurrent Validity of the Preschool Play Scale with Preschool Children with Autism Spectrum Disorders. Journal of Occupational Therapy, Schools, & Early Intervention, 3(2), 154-167. doi:10.1080/19411243.2010.491015

Pacciulio, A.M., Pfeifer, L.I. and Santos, J.L.F. (2010). Preliminary Reliability and Repeatability of the Brazilian Version of the Revised Knox Preschool Play Scale. Occupational Therapy International, 17(2), 74-80. doi:10.1002/oti.289.

Restall, G., Magill-Evans, J. (1994). Play and Preschool Children with Autism. The American Journal of Occupational Therapy, 48(2), 113-120.
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