Generativity in the play of young people with autism

Embracing neurodiversity in doll play: Investigating neural and language correlates of doll play in a neurodiverse sample

Doll play may provide opportunities for children to rehearse social interactions, even when playing alone. Previous research has found that the posterior superior temporal sulcus (pSTS) was more engaged when children played with dolls alone, compared to playing with tablet games alone. Children's use of internal state language (ISL) about others was also associated with pSTS activity. As differences in social cognition are frequently observed in autistic people, we were interested in the brain and language correlates of doll play in children with varying levels of autistic traits. We investigated children's (N = 57, mean age = 6.72, SD = 1.53) use of ISL and their pSTS brain activity using functional near-infrared spectroscopy (fNIRS) as they played with dolls and tablet games, both alone and with a social partner. We also investigated whether there were any effects of autistic traits using the parent-report Autism Spectrum Quotient-Children's Version (AQ-Child). We found that the left pSTS was engaged more as children played with dolls or a tablet with a partner, and when playing with dolls alone, compared to when playing with a tablet alone. Relations between language and neural correlates of social processing were distinct based on the degree of autistic traits. For children with fewer autistic traits, greater pSTS activity was associated with using ISL about others. For children with more autistic traits, greater pSTS activity was associated with experimenter talk during solo play. These divergent pathways highlight the importance of embracing neurodiversity in children's play patterns to best support their development through play.

Playing to Pretend or "Pretending" to Play: Play in Children with Autism Spectrum Disorder

Children diagnosed with autism spectrum disorder (ASD) exhibit early delays and deficits in play. In infancy, they engage in unusual exploratory behaviors with toys. As toddlers, they are slow to develop functional play, and in preschool some children with ASD fail to develop symbolic play despite having the necessary cognitive and language skills. Furthermore, when children with ASD are engaged in play, they demonstrate less playfulness. This article reviews the literature on the characteristics of exploratory, functional, and symbolic/pretend play in children with ASD and possible reasons for their unusual patterns of play development. Increased quantity and quality of play are frequent therapeutic goals for children with ASD. If play interventions are to be successful, it is critical that speech-language pathologists have an adequate assessment of children's play skills. Several frameworks and tools appropriate for assessing play in typical children and children with ASD are described.

Mother-Child Play: A Comparison of Autism Spectrum Disorder, Down Syndrome, and Typical Development

The purpose of the present study was to analyze mother-child collaborative play in children with Autism Spectrum Disorders (ASD) compared to children with Down Syndrome (DS) and typical developing children (TD). Children with ASD are often described as having deficient play skills, particularly in the symbolic domain. Caregivers’ involvement in child play activities increases the structural complexity of playing in both typically developing children and children with disabilities. Participants included 75 mothers and their children with ASD (n = 25), with down syndrome (n = 25) and with typical development (n = 25). Mother–child play sessions were analyzed using a coding system for exploratory and symbolic play. Results indicated that children with ASD showed more exploratory play compared to children in the other groups. No significant differences emerged between the three groups for child symbolic play or for mother play. These findings are discussed in relation to the debate about functional and symbolic play in children with ASD and in relation to the importance of setting and age for play assessment.

An Introduction to Play and the Preschool Child with Autistic Spectrum Disorder

As the main occupation of childhood, play is considered by occupational therapists as an important vehicle for the assessment and treatment of preschool children. For the child with autistic spectrum disorder (ASD), play not only offers a mechanism whereby the severity of the disorder can be ascertained but also enables interventions to be implemented and monitored.

This paper aims to summarise the current literature as it relates to the play of children with ASD. By doing so, it alerts the reader to the complexity of the issue of play as a means of assessment and intervention and highlights areas of continuing clinical and research concern.

Counterfactual Reasoning and False Belief Understanding in Children with Autism

The Sally-Anne task used to assess children’s understanding of false belief has traditionally been conceptualized as a test of mental state understanding in that it asks the child where a protagonist thinks an object is located when the protagonist has a false belief about the object’s location. However, a recent logical analysis by Peterson and Riggs identifies a strategy for such tasks involving a specific reasoning process they term subtractive reasoning. This can be assessed by asking the child a question such as, ‘If the marble had not been moved, where would it be now?’ Studies of typically developing children have shown strong associations between false belief and subtractive reasoning tasks even when verbal mental age is controlled. In the present study we replicated these experiments using children with autism and children with severe learning difficulties. Although significant correlations between the two tasks were found for all three groups, analyses of contingencies between the two tasks and comparison of their respective difficulty for each group suggested that ability in subtractive reasoning was a necessary but not sufficient component of successful performance in the false belief tasks. Our results indicate the presence of a further factor which is required in these tasks, and which is deficient in autism, and we argue that this may consist in a specific type of generativity.

Memory and generativity in very high functioning autism

JS is a highly able person with Asperger syndrome whose language and intellectual abilities are, and always have been, superior. The first part of this short article consists of JS's analytical account of his atypical memory abilities, and the strategies he uses for memorizing and learning. JS has also described specific difficulties with creative writing, which are outlined here. The second part of the article consists of an interpretation of the problems JS describes in terms of their implications for understanding the problems of generativity that contribute to the diagnostic impairments of imagination and creativity in autism.

Dysregulation of pretend play and communication development in children with autism

We hypothesized that the difficulties of the child with autism originate from disorders of organization and regulation of actions according to environmental changes. Autism impoverishes general mental representation skills, which are the basis of symbolic play and the development of communication. Twenty-one children with autism were compared with 14 children with global intellectual impairment and 15 matched typically developing children, on both regulation of play activities and communication development. Regulation of play was very disordered in children with autism, with breaking off, dissociation and instability of actions. However, in directed play their actions were more structured and corresponded to a better developmental level. In addition, dysregulation was associated with delayed, heterogeneous development of communication skills. The results of this study are in line with our hypotheses and emphasize the role of symbolic play in differential diagnosis and the value of therapies based on regulation processes and symbolic play.

Moral understanding in children with autism

Children with autism were compared with control groups on their ability to make moral judgements. Participants were presented with pairs of vignettes in which actions were either deliberate or accidental and caused injury to a person or damage to property. Participants were asked to judge which protagonist was the naughtier and to verbally justify this judgement. Results showed that the children with autism were as likely as controls to judge culpability on the basis of motive, and to judge injury to persons as more culpable than damage to property. Children with autism also offered some appropriate verbal justifications for their judgments although most justifications were of poor quality and reiterated the story. Results are discussed in terms of theory of mind and the possible role of deficits in complex reasoning and executive functions.

A Review of Research into Pretend Play in Autism

Autism is currently diagnosed, in part at least, on the basis of problems in imagination. The article reviews the empirical evidence of difficulties in pretend play in autism, and focuses in particular on individuals’ ability to engage in pretence in free play conditions, to produce pretence in more structured situations, and to make sense of pretend actions carried out by another person. These data suggest that individuals with autism have a marked difficulty in producing pretend play, but one that is reduced by providing substantial structure to the play situation or by testing comprehension of pretence. The implications of these findings for theories of pretend play in autism, in terms of an inability to conceive of non-literal situations, a difficulty in imposing a pretend usage on an object, or a failure to gain a benefit from engaging in pretend play, are discussed.

A comparison of the effects of rhythm and robotic interventions on repetitive behaviors and affective states of children with Autism Spectrum Disorder (ASD)

Repetitive behaviors and poor affect regulation are commonly seen in children with Autism Spectrum Disorder (ASD). We compared the effects of two novel interventions - rhythm and robotic therapies, with those of a standard-of-care intervention, on the repetitive behaviors and affective states of 36 children with ASD between 5 and 12 years using a randomized controlled trial design. We coded for frequencies of sensory, negative, and stereotyped behaviors and the duration of positive, negative, and interested affective states in children during early, mid, and late training sessions. In terms of repetitive behaviors, in the early session, the rhythm and robot groups engaged in greater negative behaviors, whereas the comparison group engaged in greater sensory behaviors. With training, the rhythm group reduced negative behaviors whereas there were no training-related changes in the other groups. In terms of affective states, the rhythm and robot groups showed greater negative affect, whereas the comparison group demonstrated greater interested affect across all sessions. With training, the rhythm group showed a reduction in negative affect and an increase in interested affect whereas the robot group showed a reduction in positive affect. Overall, it appears that rhythm-based interventions are socially engaging treatment tools to target core impairments in autism.

A preliminary investigation of the relationship between sensory processing and social play in autism spectrum disorder

There are well-documented play deficits in autism beginning with infant object and social play. To create effective interventions, the predictors of play deficits in autism must be established. Individuals with autism spectrum disorder (ASD) frequently report sensory processing difficulties including poor praxis; however, these are potential predictors of play that have not been well studied. Using a data set of 162 individuals with ASD, this study examined the direct and indirect relationships between sensory processing and social play performance via structural equation modeling. The best fitting model suggested that sensory system functions predict praxis and play in combination, providing preliminary evidence that sensory functions are related to social play in combination with praxis in children with ASD. The findings suggest future avenues for research. [OTJR: Occupation, Participation and Health 2013;33(3):159-167.].

Object identification and imagination: an alternative to the meta-representational explanation of autism

Past research has focused on pretend play in infants with autism because it is considered an early manifestation of symbolic or imaginative thinking. Contradictory research findings have challenged the meta-representational model. The intent of this paper is to propose that pretend play is the behavioral manifestation of developing imaginative ability, the complexity of which is determined by the degree of progression from part-object/inanimate object to whole-object/human object identification. We propose that autism is the result of non-completion of this process to varying degrees. This not only affects early pretend play behaviors, but also later social, language, and cognitive skills derived from the level of imagination-based sophistication achieved during foundational periods available for early identification.

The role of high level play as a predictor social functioning in autism

Play and social abilities of a group of children diagnosed with high functioning autism were compared to a second group diagnosed with a variety of developmental language disorders (DLD). The children with autism engaged in fewer acts of high level play. The children with autism also had significantly lower social functioning than the DLD group early in the play session; however, these differences were no longer apparent by the end of the play session. In addition, a significant association existed between play and social functioning regardless of diagnosis. This suggests that play may act as a current indicator of social ability while providing an arena for social skills practice.

Brief report: designing a playground for children with autistic spectrum disorders--effects on playful peer interactions

This study investigated possible changes in social play and initiations in eight boys (5 to 7-years-old) with autistic spectrum disorders (ASD) who were moving from an old to a new school playground that was designed specifically to enhance playful peer interaction. Each boy was observed for half an hour over three occasions in the old, then the new setting. The playgrounds differed in design, spatial density and identity of potential play partners. As hypothesised, frequency of group play and overall social initiations increased significantly in the new setting. We discuss how playgrounds with appropriate levels of physical challenge and support for both structured, imaginative play and solitary observation may support peer interactions in children with ASD.

Recess is Time-in: Using Peers to Improve Social Skills of Children with Autism

Children with autism face enormous struggles when attempting to interact with their typically developing peers. More children are educated in integrated settings; however, play skills usually need to be explicitly taught, and play environments must be carefully prepared to support effective social interactions. This study incorporated the motivational techniques of Pivotal Response Training through peer-mediated practice to improve social interactions for children with autism during recess activities. A multiple baseline design across subjects was used to assess social skills gains in two elementary school children. The results demonstrated an increase in important social skills, namely social initiations and turn taking, during recess.

Spontaneity of communication in individuals with autism

This article provides an examination of issues related to spontaneity of communication in children with autism. Deficits relating to spontaneity or initiation are frequently reported in individuals with autism, particularly in relation to communication and social behavior. Nevertheless, spontaneity is not necessarily clearly conceptualized or measured. Several approaches to conceptualization of communicative spontaneity are examined with a particular focus on the continuum model and how it might be practically applied. A range of possible explanations for deficits in spontaneity of communication in children with autism is subsequently explored, including external factors (highly structured teaching programs, failure to systematically instruct for spontaneity) and intrinsic characteristics (intellectual disability, stimulus overselectivity, weak central coherence). Possible implications for future research are presented.

Factors affecting conscious awareness in the recollective experience of adults with Asperger’s syndrome

have shown a small but significant impairment of autonoetic awareness or remembering involved in the episodic memory experiences of adults with Asperger's syndrome. This was compensated by an increase in experiences of noetic awareness or knowing. The question remains as to whether the residual autonoetic awareness in Asperger individuals is qualitatively the same as that of typical comparison participants. Three experiments are presented in which manipulations that have shown differential effects on different kinds of conscious awareness in memory in typical populations are employed with a sample of adults with Asperger's syndrome. The results suggest that the experiences of remembering reported by such individuals, although reduced in quantity, are qualitatively similar to those seen in the typical population. The results are discussed in the context of current theories of awareness in episodic memory.

Effects of an individual work system on the independent functioning of students with autism

This study examined the effects of a work system on the independent work and play skills of students with autism. Work systems, an element of structured teaching developed by Division TEACCH, are organized sets of visual information that inform a student about participation in work or play areas. A single subject withdrawal of treatment design, with replications across three participants, was used to assess the on-task behavior and work completion skills of the students in classroom and employment settings as a result of the intervention. Observational data indicated that all students showed increases in on-task behavior, increases in the number of tasks completed or play materials utilized, and reduction of teacher prompts. The results were maintained through the 1-month follow-up.

Examining the relationship between executive functions and restricted, repetitive symptoms of Autistic Disorder

The executive function theory was utilized to examine the relationship between cognitive process and the restricted, repetitive symptoms of Autistic Disorder (AD). Seventeen adults with AD were compared to 17 nonautistic controls on a new executive function battery (Delis-Kaplin Executive Function Scales). Restricted, repetitive symptoms were measured by a variety of instruments (i.e., the Autism Diagnostic Observation Schedule, Autism Diagnostic Interview-Revised, Gilliam Autism Rating Scale, and the Aberrant Behavior Checklist). The study replicated the executive function profile that has been reported in adults with AD. In addition to the replication findings, the study found several executive processes (i.e., cognitive flexibility, working memory, and response inhibition) were highly related to the restrictive, repetitive symptoms of AD; whereas, other executive process (i.e., planning and fluency) were not found to be significantly correlated with restricted, repetitive symptoms. Similarly, we found an executive function model consisting of relative strengths and deficits was the best predictor of restricted, repetitive symptoms of autism. The implications for the executive function theory and how the theory predicts core symptoms of autism are discussed.

Pervasive developmental disorders: a 10-year review

OBJECTIVE

To summarize recent advances about the nature, diagnosis, and treatment of pervasive developmental disorders.

METHOD

Review of Medline databases, books, and book chapters published between July 1989 and November 1999.

RESULTS

Clinical and genetic studies support expansion of the concept of autism to include a broader spectrum of social communication handicaps. The prevalence of autism is approximately 1 per 2,000; the prevalence of autism and Asperger's disorder together is 1 per 1,000. The Checklist for Autism in Toddlers is a useful screening instrument for 18-month-old children; the Autism Diagnostic Interview-Revised and the Autism Diagnostic Observation Schedule are instruments of choice for research. Although twin and family studies clearly support genetic factors as important in autism, linkage analysis studies indicate that many genes may be involved. There is no one treatment of choice. Social-pragmatic approaches, augmented by individualized strategies and social coaching, may be best for teaching social communication skills. Pharmacological interventions have a limited role in improving social communication, but selective serotonin reuptake inhibitors and atypical neuroleptic medications may help ameliorate aggression, hyperactivity, and other secondary problems.

CONCLUSIONS

Private and government agencies must continue to support basic and applied research.

Longitudinal assessment of play and adaptive behavior in young children with developmental disabilities

Deficits in appropriate play have been widely documented among children with developmental disabilities. However, there has been little research on the development of play or the relation between play and adaptive behavior in such children. The present study involved a longitudinal assessment of play and adaptive behavior among 13 preschool children with developmental disabilities. Children were assessed every 6 months over a 3-year period. Assessments included standardized ratings of adaptive behavior and videotape observations during unstructured free-play times in the preschool classroom. Adaptive behavior increased by almost one standard deviation from the first to the last round of data collection. Appropriate play was observed during approximately 20% of each 30-min observation and showed little overall change over 3 years of study. Observed play was primarily functional (57%) and exploratory (28%) with less constructive (5%) and pretend (10%) play. Adaptive behavior scores were not consistently correlated with the amount or type of play. The results suggest little overall relation between appropriate play and other major domains of adaptive behavior. Implications for play-based assessment and intervention in early childhood special education are discussed.

Spontaneous play in children with autism: a reappraisal

Much controversy remains regarding the ability of children with autism to engage in spontaneous play. In this study children with autism, Down syndrome and typical development with verbal mental ages of approximately 2 years were assessed for play abilities at three data points. Even in this group of children with autism, who had relatively low verbal mental ages, symbolic play skills were not totally absent. However, it was possible to distinguish their pattern of play behaviors from the other two groups. Consequentially, it is argued that there are unusual features in early spontaneous play in children with autism and these atypical patterns are not restricted to their difficulties in the production of symbolic play. Such differences in early spontaneous play raise interesting questions about the etiology of autism, the direction of future research, and the theoretical models that can account for the condition.

Asperger syndrome and high-functioning autism

This paper reviews the history of Asperger syndrome (AS) and high-functioning autism (HFA), current diagnostic concepts and criteria, some controversial diagnostic issues, epidemiology, background factors, outcome, and intervention guidelines.