International Journal of Inclusive Education

ISSN: 1360-3116 (Print) 1464-5173 (Online) Journal homepage: https://www.tandfonline.com/loi/tied20

Children’s play behaviour, cognitive skills and

vocabulary in integrated early childhood special
education groups

Jonna Kesäläinen, Eira Suhonen, Alisa Alijoki & Nina Sajaniemi

To cite this article: Jonna Kesäläinen, Eira Suhonen, Alisa Alijoki & Nina Sajaniemi
(2019): Children’s play behaviour, cognitive skills and vocabulary in integrated early
childhood special education groups, International Journal of Inclusive Education, DOI:
10.1080/13603116.2019.1651410

To link to this article: https://doi.org/10.1080/13603116.2019.1651410

Published online: 08 Aug 2019.

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INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION
https://doi.org/10.1080/13603116.2019.1651410

Children’s play behaviour, cognitive skills and vocabulary in

integrated early childhood special education groups
Jonna Kesäläinen , Eira Suhonen, Alisa Alijoki and Nina Sajaniemi
Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland

ABSTRACT ARTICLE HISTORY

The aim of this research was to study how children’s play behaviour Received 9 September 2018
was related to their cognitive skills and vocabulary development in Accepted 28 July 2019
integrated early childhood special education (ECSE) groups. The
KEYWORDS
longitudinal study is part of the LASSO research project, which Special educational needs
concerns children’s stress regulation, learning and quality of early (SEN); early childhood special
childhood education, including special education. Children with education (ECSE); play
and without special needs should be supported according to their behaviour; cognitive skills;
diversity of individual needs as equal members of a learning vocabulary
community. The study aimed to discover how this was realised by
assessing children’s various learning paths. The data were
collected between 2012 and 2015 and involved 289 children,
including 121 with special educational needs (SEN). The children’s
cognitive skills and vocabulary were measured with standardised
psychological tools: the Wechsler Preschool and Primary Scale of
Intelligence (WPPSI) and the Developmental Neuropsychological
Assessment (NEPSY). Play behaviour was evaluated with the
Preschool Play Behaviour Scale (PPBS). In this study, we
hypothesised that progress in children’s social play boosts
cognitive functions and duly boosts learning. The results indicated
that all skills improved for all of the children during the research
period, although there were differences in results between
children’s status groups.

Introduction
Learning never occurs in a vacuum, and interaction with adults and peers as well as with the
physical environment is essential (Nummenmaa 2001; Haataja 2010; Sajaniemi and Mäkelä
2015). Children learn through play, which promotes academic abilities and predicts success
in school (Bergen 2002; Pellis and Pellis 2007). Although it has been argued that play exists
for its own sake and is an instinct in every child, children with special educational needs
(SEN) tend to play less than others (Missiuna and Pollock 1991; Anderson et al. 2004,
Miller and Almon 2009; Sheridan and Pramling Samuelsson 2013). An unskilled play reper-
toire may interfere with children’s ability to interact with peers or participate in classroom
activities. Limited experiences in joint play diminish the possibilities of acting in the zone of
proximal development (ZPD) and might arrest the development of language and cognitive
skills. Hence, there is an obvious need to find effective ways to promote play and learning in

CONTACT Jonna Kesäläinen jonna.kesalainen@helsinki.fi

© 2019 Informa UK Limited, trading as Taylor & Francis Group
2 J. KESÄLÄINEN ET AL.

young children who are at risk of experiencing learning difficulties (Anderson et al. 2003;
Alen and Kultti-Lavikainen 2015). In the present study, we set out to determine the
effects of an inclusive special education environment (integrated kindergarten groups) in
enabling play and learning among children with SEN. We monitored the changes in the chil-
dren’s play behaviour along with cognitive skills and the development of vocabulary during a
three-year period in integrated ECSE groups.
In Finland, approximately 7% of children (28% girls, 72% boys) have SEN (National Insti-
tute of Health and Welfare 2017). Children with SEN are largely mainstreamed or placed in
integrated special education groups according to the inclusive principles of the Finnish
National Curriculum for early childhood education (Suhonen and Nislin 2012). In integrated
groups, the inclusion is in accordance with the group structure, which consists of five children
with SEN and seven children without SEN. The aim in integrated SEN groups is to increase
social interaction and a sense of belonging by creating opportunities to engage in peer activi-
ties despite cognitive, language or behavioural difficulties, and with the support of an early
childhood special teacher (Koster et al. 2009). A sense of belonging has been defined as the
level at which an individual feels included, accepted and supported by others in social settings
(Pesonen 2016). Pedagogy in integrated groups is based on enhancing peer interactions in an
inclusive environment where children can learn from each other by playing together (Alijoki
et al. 2013). Our previous studies (Alijoki et al. 2013; Syrjämäki et al. 2017) have shown the
high quality of the groups involved in this study. High quality in this context means that
arrangements and functions in the group state were well designed and attention was paid
to the children’s individual needs. Interaction between adults and children was functioning
and the staff were committed to their work.
High-quality early childhood education seems to improve children’s well-being, social
and cognitive learning, and school readiness skills (Peisner-Feinberg et al. 2001; Reunamo
et al. 2012; Syrjämäki et al. 2016; Bakken, Brown, and Downing 2017). However, there are
no studies exploring the long-term effectiveness of Finnish integrated special education for
play activities and learning.
Statistics on special educational needs in the Helsinki Department of Early Education
and Care show that during this study (2012 and 2013) children with language difficulties
were the largest group to manifest SEN (approximately 35%) in early childhood education.
The other groups were delayed development (8%), socio-emotional difficulties (7%), intel-
lectual disabilities (3%) and attention difficulties (3%). Approximately 26%–30% of the
children with SEN did not have any diagnosis. However, the overarching feature of chil-
dren with SEN is difficulty in participating in joint activities with peers.
Learning is a dynamic social process in which play, language and cognitive actions are
intertwined. Cognitive skills include attention regulation, inhibitory control and cognitive
flexibility, as well as reasoning, problem-solving and planning (Golinkoff, Hirsh-Pasek,
and Singer 2010; Mackie, Van Dam, and Fan 2013). These functions enable children to
process information and to understand and make sense of the world together with
other children (Zelazo and Müller 2002; Närhi and Korhonen 2006).
Mounting evidence has shown that the above-mentioned cognitive skills can be affected
by a diverse range of cumulative learning difficulties (Diamond 2013; Farrant, Fletcher,
and Maybery 2014). Besides challenging learning, deficiencies in cognitive skills might
challenge flexible social relationships and hinder social play. Furthermore, co-operation
with peers is difficult if a child has insufficient language skills. Most children have achieved
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 3

basic language abilities, including phonetic, syntactical and morphological use and under-
standing of their native language by the time they reach school age. Even mild language
disorders can cause difficulty in communication between children, which may in turn
cause frustration, acting-out behaviour or withdrawal (Ketonen, Salmi, and Tuovinen
2004). Language skills are also essential for transmitting the social rules needed in play
(Määttä and Aro 2011; Aro 2011b).
Vygotsky proposed the concept of a zone of proximal development (ZPD), a zone deter-
mined by problem-solving under the guidance of adults or capable peers. He showed that
play is essential for the ZPD because it is a source of imagination and learning; he also noted
that children are more capable of engaging in play than of dealing with reality (Vygotsky
1978; Hännikäinen and Rasku-Puttonen 2001; Bodrova, Germeroth, and Leong 2013; Lil-
lemyr 2013; Jarvis, Brock, and Brown 2014). Play is a natural way to enhance self-regu-
lation, solve problems and express oneself; it helps children build a set of mental
representations of the world (Bodrova and Leong 2005; Pellis and Pellis 2007). It provides
a meaningful and dynamic context for learning and developing social relationships. It
breaks down barriers and is a universal tool with which all children can communicate.
Through play experiences, children acquire social and cognitive capabilities as well as a
sense of relatedness (Lillemyr 2013; Kilburn and Mills 2014; Syrjämäki et al. 2016). Accord-
ing to Vygotsky (Bodrova, Germeroth, and Leong 2013, 111–123), in the most useful form
of play, children create an imaginary situation. These situations with others always contain
rules and are meaningful for learning. Eventually this kind of play supports the develop-
ment of self-regulation. In the present study, we adopted the same perspective, although
we consider social play and its meaning for the ZPD in broader terms.
In light of its fundamental importance, play should be the main activity in early childhood
education (Singer et al. 2009; Brock 2014; Jarvis, Brock, and Brown 2014). After all, play
forms the context for a child’s own culture and is a field of learning. However, some
studies show that the amount of play in which today’s children engage is diminishing
(Singer et al. 2009; Jarvis, Brock, and Brown 2014). Knowledge about its importance is there-
fore crucial, and the evaluation of play behaviour should be systematic in an early childhood
education system (Lautamo 2012, 17; Brock 2014). Limited social play may indicate difficul-
ties in the learning process. Research indicates that children with SEN often engage in low
levels of play. Further, restricted play abilities diminish children’s opportunities to participate
and interact with others (Lautamo 2012; Kilburn and Mills 2014). Children who have fragile
peer relationships are at risk of subsequent emotional and psycho-social difficulties (Coplan
2000). Reunamo et al. (2013) Formatting … please wait found that children who engaged in
role play more frequently were more popular than other children. When a child has difficul-
ties in engaging in play, he or she may easily withdraw and be rejected by peers. For the most
part, this applies to children with severe disabilities because they may have their quality of
play compromised. This is a consequence of a limitation in a body structure or function
that prevents engagement in an activity. The environment can also have an effect on play.
Children with disabilities may be impacted by the attitudes of others or by a lack of support-
ing technology or environments (Allodi and Zappaterra 2017, 11).
Previous studies show that inclusive ECSE is one of the most effective ways of supporting
children with compromised development (Burger 2010). Diverging opinions have been
expressed about the significance of social play and inclusion when it is not realised in the
desired way. Sometimes inclusion policies and practices can mask forms of exclusion,
4 J. KESÄLÄINEN ET AL.

depending on whose needs are in question (Boldt and Valente 2014, 201–213). Watson
(2018) challenges the way in which social play is produced in the early childhood context.
From the perspective of the present study, we rely on the good quality of these integrated
kindergarten groups and consider the teacher’s role important in enhancing peer interaction
(Alijoki et al. 2013; Syrjämäki et al. 2017). In this study, we followed possible changes in chil-
dren’s play behaviour together with potential changes in cognitive skills and the development
of vocabulary during time spent in integrated special education groups. We were interested
in the interconnections between these skills and whether the children with SEN caught up
with the other children with regard to play behaviour, cognitive skills and vocabulary devel-
opment during three years in integrated special education groups.

Research questions
The study explored the following questions:

(1) What kind of changes occurred in the children’s play behaviour, cognitive skills and
vocabulary in integrated kindergarten groups between 2012 and 2015?
(2) Do possible changes in play behaviour explain the potential changes in cognitive skills
and vocabulary?

Materials and methods

Participants
This study is part of the Children’s Stress Regulation and Learning (LASSO) research
project at the University of Helsinki. All integrated early childhood special education
(ECSE) groups (n = 50) in Helsinki had the opportunity to participate in the research.
Twenty-four of these groups chose to participate. We collected data from 289 children
(167 boys and 122 girls) between the ages of three and seven (mean age: 56 months;
SD: 10.13). All of the parents gave their written consent for their children’s participation.
A total of 121 children with SEN and 168 children without SEN participated in the
study. The diagnoses were divided into eight different categories (Table 1). The distri-
bution was based on medical documents and the teachers’ descriptions of the children’s
difficulties and behaviour in the pedagogical environment. The category formulation
was based on an examination by a specialist in clinical neuropsychology. These categories
were subsequently narrowed down to three main categories: language disorders (n = 38;
13%), self-regulatory difficulties (n = 57; 19%), and severe disabilities (n = 26; 9%). In
the severe disabilities category, we included children with intellectual disabilities, children
with cerebral palsy, and children with autism spectrum disorders (ASD). Some children
had more than one of these difficulties. These categories and children without SEN are
henceforth referred to as status groups. When setting up the status groups, the child’s
primary need for support was carefully considered by a professor and a clinical neurop-
sychologist, who had extensive experience both in scientific and clinical work. The group-
ing was based on careful consideration and the overlap between groups was practically
nonexistent. For example, children with language disorders did not have any symptoms
of ASD. If children had clear difficulties in social communication (especially non-
verbal) and distinct signs of ASD, they were placed in the severe difficulties group.
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 5

Table 1. The categories of children’s special educational needs.

Severe Disabilities
Language Disorders (N = 38) Self-regulatory Difficulties (N = 57) (N = 26)
. Specific Language Impairment . Attention Deficits . Developmental
. Dyspraxia . Teacherś description about deficits in Disability
. Teacherś description about language behaviour, attention and impulse control . Developmental
disorders, no medical documents Disorder
. Autism Spectrum

Data collection
The data were collected from April 2012 to April 2015 in three waves (Table 2). The first sample
(n = 136) was collected in April 2012. In November 2012, we included the children who were
subsequently integrated into ECSE (n = 78). The third sample was collected in November 2013
(n = 75). Children in the third wave came to the ECSE groups in late autumn 2013; thus, they
had been participating for just a few months when we conducted measurements in the spring of
2014. Hence, we waited until spring 2015 to give them more time in early childhood education
before taking measurements, and we examined their development just twice.
The data consisted of demographic information about the children and their families. At
the beginning of the study, a family background questionnaire was distributed to the
parents. The questionnaire concerned family composition, occurrence of learning difficulties
among family members, and socio-economic status. The latter was based on the parental
education level and yearly income. Information about the participating children’s birth-
related factors, possible current medications and developmental concerns was also sought.
Measurements of the children’s play behaviour, cognitive skills and language skills were
taken three times during the research period by special education teachers (pre-measure-
ment, repeat measurement and post-measurement). A specialist in clinical neuropsychology
trained the teachers to use the assessments. Cognitive skills were evaluated with pen and
paper assignments. In order to examine language skills, the teachers interviewed the children
to see if they knew the meanings of selected words. The children’s play behaviour was eval-
uated with a form designed for early childhood special teachers to observe children.

Measurements
Play behaviour
The children’s play behaviour was assessed with the Preschool Play Behaviour Scale (PPBS,
Coplan and Rubin 1998). The PPBS is a widely-used evaluation method in early education
settings, which has 18 items scored on a 5-point Likert scale from ‘never’ to ‘very often’.
In this assessment tool, play is divided into five categories: reticent behaviour, solitary
play, outward directed solitary play, social play, and rough-and-tumble play. Solitary play

Table 2. Measurement schedule.

Spring 2012 Autumn 2012 Spring 2013 Autumn 2013 Spring 2014 Spring 2015
1. wave Pre- Repeat Post-
measurements measurements measurements
2. wave Pre- Repeat Post-
measurements measurements measurements
3. wave Pre- Post-
measurements measurements
6 J. KESÄLÄINEN ET AL.

can be lively and developmentally appropriate, or it can indicate difficulties in forming

peer relationships. Social play offers an opportunity to share and learn from others.
Rough-and-tumble play is another form of interactive play, which is physical, energised
and lively; it supports the development of emotional regulation and social co-ordination
(Pellis, Pellis, and Bell 2010). In this study, we had a special interest in social play because
of its importance for learning.

Cognitive skills
A composite of the children’s cognitive skills was assessed with various cognitive tasks
chosen from the Developmental Neuropsychological Assessment (NEPSY-II) and the
Wechsler Preschool and Primary Scale of Intelligence (WPPSI-III). The NEPSY-II
(Korkman, Kirk, and Kemp 2007) is a comprehensive, co-normed and multi-domain neu-
ropsychological battery designed for assessing neurocognitive abilities in pre-schoolers,
children and adolescents. It comprises a flexible battery of 32 subtests that permits the
administration of specific subtests, groups of subtests or the entire battery. The norm
sample in Finland is representative of the Finnish population of children aged three to
sixteen for sex, race/ethnicity, parental education level and geographic region. The internal
reliability coefficient is adequate for a very broad range from .67 to .93 (Brooks, Sherman,
and Strauss 2009).
The WPPSI-III is a norm-based, standardised instrument designed to measure cogni-
tive skills in children aged two years through seven years. The norm sample in Finland is
representative of the Finnish population of children (aged 2 years 6 months to 7 years 3
months) for sex, race/ethnicity, parental educational level and geographic region. It con-
sists of subtests of Receptive Vocabulary, Information, Block Design, Object Assembly,
Word Reasoning, Matrix Reasoning, Picture Concepts and Symbol Coding. The reliability
coefficient of the WPPSI-III subtests ranges from .83 to .95.
The tasks in the present study measured the children’s perceptual flexibility, planning,
inhibitory control and attention regulation. A clinical neuropsychologist oversaw the
rating and standardised the assessments.
Symbol search and coding (from WPPSI-III). In a symbol search a child determines
whether a target symbol appears in a row with symbols that are the same or different.
This is performed with an attentive visual search in which there is a 120-second time
limit. In symbol coding a child copies symbols, and symbol pairs are matched with the
simple geometrical symbols on the form. This task also has a time limit of 120 s. Both
tasks call for attention regulation, flexibility and inhibitory control.
Attention regulation, design fluency and design copying (from NEPSY-II). The attention
regulation task measures a child’s ability to maintain selective visual vigilance. Accord-
ingly, the child follows a stimulus row with slightly different patterns and marks the
required stimulus as quickly as possible. The time limit is 180 s. Design fluency assesses
the behavioural productivity of the child’s ability to generate figures by connecting five
dots. There are two types of design tasks: structured and random, neither of which has
a time limit. The design copying task is intended to measure motor and visual-perceptual
skills associated with the ability to copy two-dimensional geometrical figures. In this task,
the child copies figures from an exercise book without any time limit.
From these five tasks, we formulated the sum of the variable ‘cognitive skills’. The Cron-
bach alpha for the variable was 0.734.
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 7

Vocabulary
Vocabulary is known to be a good indicator of language abilities (e.g. Duff et al. 2015;
Klem et al. 2014). In the present study, the children’s language skills were measured
with the vocabulary task in the WPPSI-III, which consisted of 29 words. In this task, a
word is said aloud and the children must explain what it means in their own words. A
clinical neuropsychologist rated the answers according to precise instructions in the
assessment method. The scores were subsequently converted to standard points.
The raw scores in composites of the cognitive tasks (WPPSI-III and NEPSY-II) and voca-
bulary tasks (WPPSI-III) were converted to standardised scores following the instructions
in the assessment manuals. Standardised scores were given according to the age of the
child in months in order to compare scores among children of different ages.

Analysis process
Statistical analyses were conducted using SPSS IBM 20 software. Descriptive statistics were
obtained to illustrate the children’s scores in play behaviour and in cognitive and language
skills. We examined separate measurements divided into status groups with covariance
analyses (ANCOVA). The impact of the children’s gender was a covariate because there
were more boys among the children with SEN.
Changes in play behaviour, cognitive skills and language skills were measured with a
general linear model, using a repeated measure with a Bonferroni correction. Employing
linear regression analysis, we measured how special educational needs and play behaviour
explained children’s cognitive and language skills. The intensity of the regressions expla-
nation was verified with an F-test, while model intensity was measured with a multiple
correlation square (R2), and individual variables were calculated with a standardised
beta coefficient.

Results
There were no significant differences in family composition, occurrence of learning
difficulties in family members or socio-economic status between families with or
without children with SEN. In addition, demographic factors were not related to the chil-
dren’s play behaviour, cognitive skills or language skills. In this study, we did not focus on
gender differences because of the gender skewness. There were significantly more boys
with SEN than girls (95 boys, 26 girls), and more girls without SEN than boys (96 girls,
72 boys). Unfortunately, there were many drop-outs (repeat measurement, 42%; post-
measurement, 61%) due to the fact that some of the children entered elementary school
during the study.

Descriptive statistics
The descriptive statistics across the measurement points are presented in Table 3. A total
of 115 children were involved in all three measurements. As can be seen, the children who
had difficulties with language and self-regulation caught up with the children without
SEN. On the other hand, children with severe disabilities lagged behind the other children
in every respect.
8 J. KESÄLÄINEN ET AL.

Table 3. Descriptive statistics (The p values in relation to children without SEN are shown).
Pre-measure Repeat measure Post-measure
PPBS: Reticent behaviour Children without SEN Children without SEN Children without SEN
N 167 N 117 N 22
Mean 2.3069 Mean 2.0078 Mean 1.8068
Std. Deviation .79469 Std. Deviation .74688 Std. Deviation .73570
Language Disorders Language Disorders Language Disorders
N 37 N 26 N7
Mean 2.7162 Mean 2.4808 Mean 2.4643
Std. Deviation 1.01919 Std. Deviation .88579 Std. Deviation .90633
p = .052 p = .062 p = .276
Self-regulatory Difficulties Self-regulatory Difficulties Self-regulatory Difficulties
N 54 N 40 N7
Mean 2.8657 Mean 2.5271 Mean 1.7500
Std. Deviation .85052 Std. Deviation .95489 Std. Deviation .40825
p < .001 p = .006 p = 1.000
Severe Disabilities Severe Disabilities Severe Disabilities
N 22 N 12 N4
Mean 3.2917 Mean 3.5417 Mean 2.9375
Std. Deviation .97920 Std. Deviation 1.18625 Std. Deviation .82601
p < .001 p < .001 p = .044
PPBS: Solitary play Children without SEN Children without SEN Children without SEN
N 167 N 117 N 22
Mean 2.6467 Mean 2.3974 Mean 2.3030
Std. Deviation .65471 Std. Deviation .65912 Std. Deviation .57422
Language Disorders Language Disorders Language Disorders
N 37 N 26 N7
Mean 3.0676 Mean 2.6827 Mean 2.4643
Std. Deviation .82632 Std. Deviation .74685 Std. Deviation .68357
p = .009 p = .474 p = 1.000
Self-regulatory Difficulties Self-regulatory Difficulties Self-regulatory Difficulties
N 53 N 40 N7
Mean 2.8915 Mean 2.7375 Mean 2.2857
Std. Deviation .74761 Std. Deviation .85100 Std. Deviation .46611
p = .191 p = .081 p = 1.000
Severe Disabilities Severe Disabilities Severe Disabilities
N 22 N 12 N4
Mean 2.9205 Mean 3.6458 Mean 2.6875
Std. Deviation .91413 Std. Deviation 1.10504 Std. Deviation .51539
p = .567 p < .001 p = 1.000
PPBS: Outward directed solitary play Children without SEN Children without SEN Children without SEN
N 167 N 117 N 21
Mean 2.6347 Mean 2.4188 Mean 2.5714
Std. Deviation .88909 Std. Deviation .9009 Std. Deviation 1.06402
Language Disorders Language Disorders Language Disorders
N 37 N 26 N7
Mean 2.5405 Mean 2.5192 Mean 2.5000
Std. Deviation 1.18074 Std. Deviation .97448 Std. Deviation 1.11803
p = 1.000 p = 1.000 p = 1.000
Self-regulatory Difficulties Self-regulatory Difficulties Self-regulatory Difficulties
N 52 N 40 N7
Mean 2.5673 Mean 2.5750 Mean 2.6429
Std. Deviation 1.08025 Std. Deviation 1.17424 Std. Deviation 1.21499
p = 1.000 p = 1.000 p = 1.000
Severe Disabilities Severe Disabilities Severe Disabilities
N 22 N 11 N4
Mean 1.8864 Mean 2.3182 Mean 2.3750
Std. Deviation .97507 Std. Deviation 1.30906 Std. Deviation 1.79699
p = 1.000 p = 1.000 p = 1.000
PPBS: Social play Children without SEN Children without SEN Children without SEN
N 167 N 117 N 22
Mean 4.1625 Mean 4.5370 Mean 4.4924
Std. Deviation .92835 Std. Deviation .71052 Std. Deviation .73908

(Continued )
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 9

Table 3. Continued.
Pre-measure Repeat measure Post-measure
Language Disorders Language Disorders Language Disorders
N 37 N 26 N7
Mean 3.1396 Mean 3.6423 Mean 4.3095
Std. Deviation 1.18603 Std. Deviation .99882 Std. Deviation .76636
p < .001 p < .001 p = 1.000
Self-regulatory Difficulties Self-regulatory Difficulties Self-regulatory Difficulties
N 53 N 40 N7
Mean 3.3302 Mean 3.6625 Mean 4.2857
Std. Deviation .99544 Std. Deviation 1.10433 Std. Deviation 1.10853
p < .001 P < .001 p = 1.000
Severe Disabilities Severe Disabilities Severe Disabilities
N 22 N 12 N4
Mean 2.4394 Mean 2.3264 Mean
Std. Deviation 1.31590 Std. Deviation 1.28534 Std. Deviation
p < .001 p < .001 p < .001
PPBS: Rough-and- tumble play Children without SEN Children without SEN Children without SEN
N 167 N 116 N 22
Mean 2.7665 Mean 2.9569 Mean 2.3864
Std. Deviation .99363 Std. Deviation .83293 Std. Deviation.85818
Language Disorders Language Disorders Language Disorders
N 37 N 26 N7
Mean 2.5135 Mean 2.4808 Mean 2.6429
Std. Deviation 1.13337 Std. Deviation 1.01470 Std. Deviation 1.31385
p = 1.000 p = .120 P = 1.000
Self-regulatory Difficulties Self-regulatory Difficulties Self-regulatory Difficulties
N 52 N 40 N7
Mean 3.1923 Mean 3.4375 Mean 3.5000
Std. Deviation 1.17638 Std. Deviation 1.09303 Std. Deviation 1.15470
p = .064 p = .033 p = .142
Severe Disabilities Severe Disabilities Severe Disabilities
N 22 N 11 N4
Mean 2.4091 Mean 2.3636 Mean 2.6250
Std. Deviation .92113 Std. Deviation 1.14217 Std. Deviation 1.70171
p = .794 p = .274 p = 1.000
Cognitive skills Children without SEN Children without SEN Children without SEN
N 143 N 103 N 66
Mean 9.3667 Mean 9.5173 Mean 10,8039
Std. Deviation 2.18418 Std. Deviation 3.92599 Std. ||Deviation 1,87757
Language Disorders Language Disorders Language Disorders
N 36 N 19 N 18
Mean 7.0157 Mean 6.3958 Mean 7.3833
Std. Deviation 2,35830 Std. Deviation 2.38907 Std. Deviation 4.23718
p < .001 p < .001 p = .174
Self-regulatory Difficulties Self-regulatory Difficulties Self-regulatory Difficulties
N 52 N 34 N 18
Mean 6.6138 Mean 6.2853 Mean 6.0200
Std. Deviation 2.89139 Std. Deviation 2.35615 Std. Deviation 4.32301
p < .001 p < .001 p = .003
Severe Disabilities Severe Disabilities Severe Disabilities
N 19 N 10 N9
Mean 5.2786 Mean 3.8051 Mean 3.4600
Std. Deviation 3.92599 Std. Deviation 2.14662 Std. Deviation 2.49960
p < .001 p < .001 p < .001
Vocabulary Children without SEN Children without SEN Children without SEN
N 121 N 146 N 61
Mean 10.03 Mean 9.32 Mean 10.1833
Std. Deviation 3.279 Std. Deviation 2.666 Std. Deviation 2.89647
Language Disorders Language Disorders Language Disorders
N 26 N 32 N 18
Mean 5.26 Mean 5.59 Mean 6.8235
Std. Deviation 2.306 Std. Deviation 3.172 Std. Deviation 2.74398

(Continued )
10 J. KESÄLÄINEN ET AL.

Table 3. Continued.
Pre-measure Repeat measure Post-measure
p < .001 p < .001 p < . 001
Self-regulatory Difficulties Self-regulatory Difficulties Self-regulatory Difficulties
N 45 N 47 N 16
Mean 7.56 Mean 6.43 Mean 7.2500
Std. Deviation 3.271 Std. Deviation 3.363 Std. Deviation 3.5188
p < 001 p < .001 p = .003
Severe Disabilities Severe Disabilities Severe Disabilities
N 19 N 17 N7
Mean 3.60 Mean 4.31 Mean 4.0000
Std. Deviation 1.430 Std. Deviation 1,797 Std. Deviation .89443
p < .001 p < .001 p < .001

Play behaviour
Children with self-regulatory difficulties and severe disabilities displayed more reticent
behaviour than children without SEN in both the pre- and the repeat measurements.
The disparity between children with severe disabilities and children without SEN was
still evident in the post-measurement.
In the repeat measurement, children with severe disabilities engaged in more solitary
play than other children. Children with language difficulties engaged in more solitary
play in the pre-measurement than children without SEN; however, the difference was
no longer apparent in the repeat measure.
The status groups differed from each other with regard to social play. Considering the chil-
dren’s social play behaviour, there were differences among the status groups. Both pre- and
repeat measurements illustrated that there were significant differences between children
with and without SEN in their social play (p < .05 in all SEN groups). In the post-measure-
ments, there were significant differences only in the severe disabilities group (p < . 01 and
p < . 05). This indicates that children with language disabilities and children with self-regu-
lation difficulties learn social play skills in integrated ECSE groups (see Table 4).
The children with self-regulatory difficulties engaged in more rough-and-tumble play
than other children in the repeat measurement, but not in the post-measurement.

Cognitive skills
The children with self-regulatory difficulties showed the least progress in cognitive skills
(F2,6 = 9.77, p = <.01), while the children with language disorders caught up with the chil-
dren without SEN in cognitive skills. The children with severe disabilities lagged behind
the others in all tasks across every point of measurement (p < .01).

Vocabulary
There was a significant difference in vocabulary tasks between children with and without
SEN. In every measurement point, all SEN groups differed from the children without SEN
(p < .01, in all SEN groups).

Explaining the changes

Our results revealed that language skills did not explain the changes in cognitive skills.
Instead, the changes were significantly explained by the status groups and social play.
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 11

Table 4. Development in children’s social play behaviour.

Pre-measure
Without SEN ↔ Language disorders
(p < .01)
Without SEN ↔ Self-regulatory
difficulties (p < .01)
Without SEN ↔ Severe disabilities
(p < .01)
Repeat measure
Without SEN ↔ Language disorders
(p < .01)
Without SEN ↔ Self-regulatory
difficulties (p < .01)
Without SEN ↔ Severe disabilities
(p < .01)
Post-measure
Without SEN ↔ Severe disabilities
(p < .01)
Language disorders ↔ Severe disabilities
(p = .03)
Self-regulatory difficulties ↔ Severe
disabilities (p = .03)

The most interpretative model was synthesis with the post-measurement variables of
social play and the children’s status group (F2,26 = 33,9, p = <.01). Consequently, the chil-
dren’s status group and social play behaviour explained 72% of the variance in the cogni-
tive skills (R square = .723) results.

Discussion
The results regarding the connection between play behaviour development and cognitive
skills show that children with language disabilities and children with self-regulation difficul-
ties learn social play skills in integrated ECSE groups. Children with language disorders
developed in the area of cognitive skills, reaching the same level as children without SEN
during the period of study. We assume that they learned cognitive skills from their teachers
but also, as in Vygotsky’s ZPD, from more capable peers with whom they played. Children
with self-regulation difficulties also learned social play skills, but their cognitive skills did not
reach the same level as children without SEN and as children with language disorders.
The expected result was the non-optimal developmental path for children with severe
disabilities in all skills measured. These children have physical limitations that make it
harder for them to learn. Nevertheless, their participation in integrated learning situations
must be maintained because they also benefit from interaction with others (Causton-
Theoharis and Malmgren 2005). Play involves positive interaction between children
with and without SEN and is therefore a fundamental precondition of inclusion. Being
accepted by one’s peers builds a positive self-concept and promotes social fellowship (Syr-
jämäki, Pihlaja, and Sajaniemi 2018).
A question remains as to whether the children with self-regulatory difficulties would
have attained the level of other status groups if the follow-up period had been longer.
An extended follow-up could not be conducted in the framework of this study because
after the pre-school year, the children who were engaged in the study started elementary
school and their environment changed. Early childhood pedagogy in Finland is focused on
play, and hence children engage in play for most of the day in kindergarten. At elementary
school, the pedagogical emphasis is more on learning skills, and play diminishes.
With regard to family background, our findings differed from those in previous studies
(e.g. Ahnert 2003; Eccles and Davis-Kean 2005; Noble, Norman, and Farah 2005;
Hackman et al. 2014). According to our results, parents’ socio-economic or educational
backgrounds did not correlate with the children’s special educational needs or their cog-
nitive skills. One reason for this finding could be that parents who consented to their chil-
dren’s participation were more interested than average in their children’s development.
The participating families were middle-class families, who are generally interested in
12 J. KESÄLÄINEN ET AL.

their children’s success, (Exley 2013, 77–94). The Finnish education system, however,
evens out these class distinctions (Kupiainen, Hautamäki, and Karjalainen 2009).
An earlier study (Alijoki et al. 2013) showed that interventions in these integrated
groups were strongly emphasised as a means of supporting children’s language develop-
ment. There was less support for children’s emotional development, even though most
of the children with SEN had self-regulation difficulties.
The results indicated that the children with language disorders caught up with the chil-
dren without SEN in cognitive skills. Children with self-regulatory difficulties and children
with severe disabilities did not. In light of the present study, it is important to support chil-
dren’s language development. The results of the vocabulary task show that there is a sig-
nificant difference between children with and without SEN when it comes to how they
understand the meaning of given words. In addition to vocabulary skills, it is also essential
to support children’s self-regulation because a child who lacks self-regulation is unable to
focus on social interaction, cognitive skills or language activities. In these situations, chil-
dren need co-regulation by adults (Sajaniemi et al. 2015). Understanding the neural basis
of stress may help teachers to understand both the development of stress regulation and its
disorders (Aro 2011a). As a consequence, teachers can support children in learning to
control their emotions, which is an ability increasingly needed today. Sajaniemi et al.
(2015) point out that in today’s world the factors that influence children’s development
must be re-evaluated. It is essential to learn to control information overload, tolerate
uncertainty, and regulate the mind.
From the perspective of this research, the most fundamental and most important ped-
agogical aim is to boost social play. Children learn through play and its enhancement
opens windows on enjoyment, interaction and participation which, in turn, increase the
opportunities to learn. Lack of self-regulation abilities usually causes problems in play
behaviour, and therefore early childhood pedagogy needs to support the play of children
with self-regulation challenges in particular.

Limitations and implications for the future

This study has some limitations that should be taken into consideration when interpret-
ing the results. The sample for the post-measurement was smaller than the pre- and the
repeat measurements because some children had already left the groups. In future
research it would be interesting to follow the children’s learning for a longer period of
time and investigate how their play behaviour and cognitive and language skills
develop during the first years at school. One question that has emerged is whether the
learning paths for children with SEN in elementary school are similar to their learning
paths in integrated ECSE.
The methods for evaluating cognitive skills were carefully selected on the basis of their
feasibility in group situations, and were therefore well suited to the framework and
purpose of this study. Vocabulary was used because it is known to be a good indicator
of language abilities. It was also easy to test and schedule during daily kindergarten
activities. However, the methods used were somewhat limited; in order to obtain a
more comprehensive understanding of the complexity of cognitive and language
skills, more specific measurements are needed. In addition, in future research, comp-
lementary qualitative data such as video material can provide valuable information
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 13

about learning situations and the ways in which teachers can improve children’s learning
and self-regulation skills.

Disclosure statement
No potential conflict of interest was reported by the authors.

Funding
This study was supported by a grant from the Jenny and Antti Wihuri Foundation; Jenny ja Antti
Wihurin Rahasto.

Notes on contributors
Jonna Kesäläinen is a PhD student at the University of Helsinki. Her research is in the field of early
childhood special education focusing on children’s learning, temperament and stress regulation.
Eira Suhonen is an adjunct professor at the University of Helsinki. Her main research interest is in
early childhood special education. She has focused in her research on play and early intervention.
She is also specialized in analyses of biomarkers of stress response regulation in children.
Alisa Alijoki is University Lecturer at the University of Helsinki. Her main research interest is in
early childhood special education. She has focused in her research on early intervention.
Nina Sajaniemi is a professor of early education and a clinical neuropsychologist. Her areas of
expertise are in developmental sciences and in educational psychology. Her research interests are
in stress regulation, interaction, social behaviour and pedagogical sensitivity.

ORCID
Jonna Kesäläinen http://orcid.org/0000-0002-6247-6763

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