Systematic observation of play behavior in autistic children

Play Behaviors of Young Children with Autism

Autism has been shown to be associated with deficits in play behavior. The play behaviors of children with autism indicate that they tend to have severe deficits in play, both with toys and with regard to social behaviors. A consistent finding in the literature has been that both symbolic play and symbolic language are areas in which children with autism show specific impairments. Interventions to promote the play behaviors of these children have involved the use of either nonhandicapped or disabled peers, the use of specific instructions or verbal and physical prompts, highly structured one-to-one interactions involving adults and peers, or manipulation of the setting. Although different intervention techniques have been successful in promoting play behaviors, there is some concern about lasting effects after the intervention.

Research on the Neuropathophysiology of Autism and its Implications for Occupational Therapy

Basic research has linked autism to an underlying neuropatho-physiologic substrate, but, for the most part, educational planning for autistic children has yet to undergo significant change as a consequence of these findings. With occupational therapy's emphasis on the neurobiologic substrates of functional performance, it may be that researchers in this profession can, based on the current etiologic breakthroughs, develop new theories of practice, or refine existing ones, pertinent to autism. This article reviews recent research on the etiology of autism and discusses educational assessment and programming in light of these findings. Implications for occupational therapy are addressed, and it is recommended that occupational therapist involvement in autism be expanded through instrument development and refinement of theories used in clinical practice. Through this enterprise, occupational therapy may further establish its role in the educational management of autistic children, clarifying its relationship to special education.

Neurobiology of social behavior abnormalities in autism and Williams syndrome

Social behavior is a basic behavior mediated by multiple brain regions and neural circuits, and is crucial for the survival and development of animals and humans. Two neuropsychiatric disorders that have prominent social behavior abnormalities are autism spectrum disorders (ASD), which is characterized mainly by hyposociability, and Williams syndrome (WS), whose subjects exhibit hypersociability. Here we review the unique properties of social behavior in ASD and WS, and discuss the major theories in social behavior in the context of these disorders. We conclude with a discussion of the research questions needing further exploration to enhance our understanding of social behavior abnormalities.

Pioneers in pediatric psychology: integrating nutrition and child development interventions

As part of the Pioneers in Pediatric Psychology series, this article provides a brief personal account of Maureen Black's career as a pediatric psychologist. It traces the transition of the Society of Pediatric Psychology (SPP) from a section of the Division of Clinical Psychology of the American Psychological Association (APA) to an independent division of APA, which occurred during my presidency of SPP. The article addresses three aspects of pediatric psychology that have been central to my career: pediatric nutritional problems, global child development, and the advancement of children's health and development through policy-related strategies. The article concludes with Lessons Learned and Recommendations for the future of pediatric psychology.

Annual research review: re-thinking the classification of autism spectrum disorders

BACKGROUND

The nosology of autism spectrum disorders (ASD) is at a critical point in history as the field seeks to better define dimensions of social-communication deficits and restricted/repetitive behaviors on an individual level for both clinical and neurobiological purposes. These different dimensions also suggest an increasing need for quantitative measures that accurately map their differences, independent of developmental factors such as age, language level and IQ.

METHOD

Psychometric measures, clinical observation as well as genetic, neurobiological and physiological research from toddlers, children and adults with ASD are reviewed.

RESULTS

The question of how to conceptualize ASDs along dimensions versus categories is discussed within the nosology of autism and the proposed changes to the DSM-5 and ICD-11. Differences across development are incorporated into the new classification frameworks.

CONCLUSIONS

It is crucial to balance the needs of clinical practice in ASD diagnostic systems, with neurobiologically based theories that address the associations between social-communication and restricted/repetitive dimensions in individuals. Clarifying terminology, improving description of the core features of ASD and other dimensions that interact with them and providing more valid and reliable ways to quantify them, both for research and clinical purposes, will move forward both practice and science.

Elevated cortisol during play is associated with age and social engagement in children with autism

BACKGROUND

The hallmark characteristic of autism is impaired reciprocal social interaction. While children find social interaction stress-reducing, many children with autism may find social interaction stress-inducing. The current study was designed to examine stress responsivity as measured by cortisol by comparing children with autism to neurotypical peers during an ecologically valid 20-minute playground paradigm.

METHODS

The experiment involved sets of three children: a child with autism, a neurotypical child, and a confederate. Participants included 45 prepubescent males between 8 and 12 years of age (21 with autism and 24 neurotypical children).

RESULTS

Children with autism showed fewer initiations (χ²(1) = 4.03, P = 0.044), rejected initiations from others more (χ²(1) = 7.10, P = 0.008) and spent less time interacting during motor (F(1,43) = 16.7, P = 0.0002) and cooperative (F(1,43) = 14.78, P = 0.0004) play. Repeated measures analysis of the cortisol values revealed a significant model (χ²(4) = 22.76, P < 0.0005) that included time of measurement, diagnosis and age as main effects and an interaction between diagnosis and age. Thus, as age increased among children with autism, they experienced enhanced cortisol levels while age did not modify expected cortisol levels for typical children. Stress responsivity was associated with more peripheral equipment play for motor (χ²(3) = 12.3, P = 0.006) and cooperative (χ²(3) = 8.24, P = 0.04) play as well as reduced nonverbal social skills during motor (χ²(1) = 5.52, P = 0.018) and cooperative play (χ²(1) = 4.53, P = 0.033).

CONCLUSIONS

Overall, children with autism engaged in fewer social overtures and spent less time interacting than typically developing peers during play. The peer interaction paradigm resulted in significantly higher levels of cortisol in many children with autism. Distinct patterns emerged within the autism group based on developmental (older), biological (cortisol responder) and behavioral patterns (peripheral group interaction). The enhanced cortisol response was observed in children who voluntarily engaged in interaction; thus, it does not support the notion of a response to social threat. Rather, it appears to reflect attendant metabolic preparedness and enhanced arousal from engaging socially. The data suggest that many children with autism activate hypothalamic-pituitary-adrenal responses in relatively benign social situations, which appears to be a function of age and level of social engagement. The findings support the need to teach coping strategies in addition to fundamental social skills to youth with autism.

The neurobiology of social play behavior in rats

Social play behavior is one of the earliest forms of non-mother-directed social behavior appearing in ontogeny in mammalian species. During the last century, there has been a lot of debate on the significance of social play behavior, but behavioral studies have indicated that social play behavior is a separate and relevant category of behavior. The present review provides a comprehensive survey of studies on the neurobiology of social play behavior. Evidence is presented that opioid and dopamine systems play a role in the reward aspect of social play behavior. The role of cholinergic, noradrenergic and opioid systems in attentional processes underlying the generation of social play behavior and the involvement of androgens in the sexual differentiation of social play behavior in rats is summarized. It is concluded that there is not only behavioral, but also neurobiological evidence to suggest that social play behavior represents a separate category of behavior, instead of a precursor for adult social, sexual or aggressive behavior.

The social behavior of autistic children with younger and same-age nonhandicapped peers

Results of a study observing autistic children's interactions with nonhandicapped and autistic peers are reported. Six 8- to 12-year-old autistic children played in dyads with younger, normally developing kindergarten children and with nonhandicapped peers matched on chronological age for 10 15-minute sessions spaced over 3 weeks and then with a playmate of the alternate age for another 10 sessions. After intervention, all subjects showed gains in proximity, orientation, and responsiveness when playing with nonhandicapped peers and with autistic classmates. Same-age nonhandicapped playmates initiated more frequently than did younger nonhandicapped playmates and were better able to modify their initiations in ways that increased the likelihood of response from the autistic children.

The psychobiology of play: theoretical and methodological perspectives

The social play of pairs of juvenile rats can be brought under tight experimental control using social deprivation, and it can be objectively quantified by measurement of pinning behavior. Research and conceptual issues concerning this paired-encounter procedure are summarized, including issues related to measurement, gender differences (and the absence thereof), relations between play and aggression, the regulatory processes interacting with and underlying play, the neurochemical and neuroanatomical substrates of play, the functions of play in dominance and other adult behaviors. Existing results suggest the operation of a harmoniously operating brain process which generates a unique emotive brain process that is appropriately referred to as social play. Although the concept of play remains to be adequately defined, the position is advocated that rigorous psychobiological analysis will ultimately provide an empirical definition based upon neural circuit characteristics. Analysis of the underlying circuits may help reveal the manner in which more complex levels of behavioral competence arise ontogenically, and work in the area may yield clues to the genesis of several psychopathologies.

Influencing leisure choices of autisticlike children

A leisure education program was implemented with three autisticlike children. Based on an assessment phase, potential recreational activities were designated as high interest or low interest for each subject. During the leisure educational training phase, choices were provided between high- and low-interest activities under three alternating conditions. During the Prompt and Praise condition the instructor prompted the subject to engage in a low-interest activity for 2 minutes and then allowed a free choice for 2 minutes. During the Praise Anything condition the instructor allowed free choices every 2 minutes. During the Token condition the subject was provided a free choice every 2 minutes, but a token economy was established contingent on engaging in low-interest activities. The Prompt and Praise condition was superior to the other two conditions in encouraging participation in low-interest recreational activities.

Symbolic play in autistic, Down's, and normal children of equivalent mental age

The study assessed free play and response to modeled symbolic play with animate toys and realistic and substitute accessories in 10 autistic children and 10 Down's syndrome and 10 normal preschooler controls. Groups were matched on Peabody Picture Vocabulary Test mental age (PPVT MA) range and Mdn (2.5 years). Autistic children played less than controls, imitated less well, and, on structured baseline trials, showed lower level play. Symbolic fluency differentiated all groups in structured play. Symbolic fluency for free and structured play was positively correlated with PPVT MA in autistic children; level of play was most highly correlated with PPVT MA in normal children. Findings suggested impaired imitative capacity and symbolic functioning in autism.