Theory of mind predominantly associated with the quality, not quantity, of pretend play in children with autism spectrum disorder

Implementation of Learn to Play Therapy for Children in Special Schools

IMPORTANCE

Play is the primary occupation in childhood and fundamental to occupational therapy practice.

OBJECTIVE

To evaluate a play intervention in special school settings.

DESIGN

Pre- and postinvolvement of a 7-mo play program.

SETTING

Four special schools in Victoria, Australia, for children with IQs < 70.

PARTICIPANTS

Thirty-eight children with diagnoses including intellectual disability, autism, and global developmental delay, 7 teachers, 2 speech pathologists, and 2 occupational therapists.

INTERVENTION

Learn to Play Therapy for 1 hr per week over a 7-mo period.

OUTCOMES AND MEASURES

Pre-post outcome measures included children's pretend play skills, language, social skills, emotional regulation, and academic competence.

RESULTS

Mean age of 38 children (15 girls and 23 boys) at baseline was 5 yr 7 mo (SD = 0.46 yr). Results showed significant changes in children's pretend play (p = .03), ability to recall sentences (p = .02), social skills (p = .022), and academic competence (p = .012). Learn to Play had a large effect on children's narrative skills (d = 2.72). At follow-up, object substitution at baseline influenced expressive language (p < .001), narrative mean language utterance (MLU; p = .015), social skills (p < .001), and academic competence (p < .001); elaborate play at baseline plus time influenced social skills (p < .001); and elaborate play at baseline influenced narrative MLU (p =. 016), sentence recall (p = .009), and academic competence (p = .001).

CONCLUSIONS AND RELEVANCE

Embedding pretend play within practice positively influenced children's language, narrative, social, and academic skills. Plain-Language Summary: This study adds to the limited research on play-based therapy programs in special school settings for children with an IQ of less than 70. Children participated in Learn to Play Therapy, during which an occupational therapist, who has observed and assessed the child's play and understands the child's play abilities, played beside the child. Learn to Play Therapy is a child-centered therapy that is used to increase a child's ability to self-initiate and enjoy pretend play. The positive impacts of supporting the children's pretend play ability were highlighted by increases in their pretend play, language, social skills, academic competence, and narrative language after participating in Learn to Play Therapy in their special schools.

Interpreting the results of explicit and applied theory of mind collectively in autistic children: A solution from Rasch analysis

LAY ABSTRACT

Theory of mind is an ability to infer others' mental states, which is a foundation for generating appropriate social responses. Theory of mind can be conceptually divided into two related but distinguishable constructs: explicit theory of mind (conceptual knowledge/information about others' mental states) and applied theory of mind (the ability to use theory of mind skills in real-life contexts). Although these two theory of mind scores can be described by the percentages of children in the early, basic, and advanced developmental stages, the resulting information may not be sufficient to determine the corresponding relationships between these two theory of mind constructs or identify children with mismatched theory of mind abilities (e.g. children who have difficulty in effectively applying their theory of mind knowledge in real-life contexts). To resolve these limitations, methods for simultaneously interpreting the relationships between the two theory of mind scores are proposed. Based on the findings, each applied theory of mind score can reflect multiple scores of explicit theory of mind. In particular, the results do not take measurement error into consideration, which would make them more ambiguous. Therefore, the scores of applied theory of mind should be interpreted carefully, given that children who have the same applied theory of mind score may actually have high or low explicit theory of mind. Regarding the method for joint interpretation, cutoff scores were selected to identify children who have mismatched theory of mind abilities (high explicit theory of mind with low applied theory of mind or low explicit theory of mind with high applied theory of mind) and determine the priority for interventions.

Maternal Variability of Amplitudes of Frequency Fluctuations Is Related to the Progressive Self-Other Transposition Group Intervention in Autistic Children

The self-to-other model of empathy (SOME) states that a key reason for the empathic deficiency in autistic individuals is the imbalance of the self-other switch. The existing interventions of theory of mind contain training of self-other transposition ability but combined with other cognitive trainings. The self-other distinction brain areas of autistic individuals have been revealed, but the brain areas of the self-other transposition ability and its intervention have not been investigated. There are normalized amplitudes of low-frequency fluctuations (mALFFs) within 0.01-0.1 Hz and many normalized amplitudes of frequency fluctuations (mAFFs) within 0-0.01, 0.01-0.05, 0.05-0.1, 0.1-0.15, 0.15-0.2, and 0.2-0.25 Hz. Therefore, the current study established a progressive self-other transposition group intervention to specifically and systematically improve autistic children's self-other transposition abilities. The transposition test with a three mountains test, an unexpected location test, and a deception test was used to directly measure autistic children's transposition abilities. The Interpersonal Responsiveness Index Empathy Questionnaire with perspective-taking and fantasy subscales (IRI-T) was used to indirectly measure autistic children's transposition abilities. The Autism Treatment Evaluation Checklist (ATEC) was used to measure autistic children's autism symptoms. The experiment was designed with two (intervention: experimental group vs. control group) independent variables and two (test time: pretest vs. posttest or tracking test) × three (test: transposition test vs. IRI-T test vs. ATEC test) dependent variables. Furthermore, it used eyes-closed resting-state functional magnetic resonance imaging to investigate and compare the relevant maternal mALFFs and average energy rank and energy rank variability of mAFFs of autistic children's transposition abilities, autism symptoms, and intervention effects. The results showed the following: (1) There were many improvements (pretest vs. posttest or tracking test) greater than chance 0 in the experimental group, such as the three mountains, lie, transposition, PT, IRI-T, PT tracking, cognition, behavior, ATEC, language tracking, cognition tracking, behavior tracking, and ATEC tracking improvements. However, there was no improvement greater than chance 0 in the control group. (2) The maternal mALFFs and maternal average energy rank and energy rank variability of mAFFs could predict the autistic children's transposition abilities, autism symptoms, and intervention effects with some overlap and some difference in maternal self-other distinction, sensorimotor, visual, facial expression recognition, language, memory and emotion, and self-consciousness networks. These results indicated that the progressive self-other transposition group intervention successfully improved autistic children's transposition abilities and reduced their autism symptoms; the intervention effects could be applied to daily life and last up to a month. The maternal mALFFs, average energy rank, and energy rank variability of mAFFs were three effective neural indictors of autistic children's transposition abilities, autism symptoms, and intervention effects, and the average energy rank and energy rank variability of mAFFs were two new neural indictors established in the current study. The maternal neural markers of the progressive self-other transposition group intervention effects for autistic children were found in part.

Applied behavioral analysis for the skill performance of children with autism spectrum disorder

Introduction

Autism spectrum disorder (ASD) has characteristics that have been observed to develop over time, such as the difficulty of affective, sensory, and emotional processing, which trigger some problems during childhood, limiting children's development. Applied behavior analysis (ABA) is among the therapeutic approaches for ASD, in which treatment can be tailored according to the patient's objectives.

Objective

Based on ABA, we aimed to analyze the therapeutic strategy for independence in different skill performance tasks of patients diagnosed with ASD.

Method

This is a retrospective observational case series study including 16 children diagnosed with ASD who received ABA-based treatment at a therapeutic clinic in Santo Andre city, São Paulo State, Brazil. Individual task performance of different skill domains was registered in the ABA+ affective intelligence® software throughout the 12 months (from January 2021 to January 2022) of routine treatment.

Results

The evolution of skills was observed between the T0 and T1 intervals, with improved skills over the observed period.

Conclusion

The strategy based on the ABA methodology improved children's skill performance over the observed period.

Interventions to Support Participation in Play for Autistic Children and Youth (Dates of Review: 2013-2021)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings to support participation in play for autistic1 children and adolescents (birth to 18 yr).

Autistic children who create imaginary companions: Evidence of social benefits

LAY ABSTRACT

Research on neurotypical children with imaginary friends has found that those with imaginary friends have better social skills and are more able to think about how other people's minds work compared to children without imaginary friends. Research shows that some autistic children also create imaginary friends. This article is the first to look at whether or not autistic children with imaginary friends have stronger social skills and an improved ability to think about others' minds than those without imaginary friends. We asked parents to report about their children aged 5 to 12. Finding almost half reported their child had an imaginary friend, a much larger number than previous research with younger children. Our findings also suggested that autistic children with imaginary friends were better able to understand others' minds and had stronger social skills than their peers without imaginary friends. The children's language ability did not influence this. The findings of this study add to the evidence that with respect to the creation imaginary friends and their potential benefits, the play profiles of autistic children are similar to the general population. It also provides more evidence that the understanding of others' minds is not all or nothing in autism and gives reason for researchers to investigate whether the causes of these differences are the same or different for autistic children.

Effectivity of Play-Based Interventions in Children with Autism Spectrum Disorder and Their Parents: A Systematic Review

Evidence of the effectivity of play-based interventions in children with autism spectrum disorder (ASD) was evaluated by PRISMA-based literature study and a Risk of Bias (RoB) assessment. Many of the 32 eligible randomized controlled trials (RCT) reported improved social interaction, communication, daily functioning and play behaviour. They also reported decreased problem behaviour, better parental attunement and parent-child interaction. We assessed 25/32 of the RCTs with high RoB, mainly related to homogeneity of the study population, lack of power, and performance bias. We concluded with due care that the effectivity of play-based interventions differed across RCTs, most reported improvements are found in ASD symptoms, everyday functioning, and parental attunement. In future research, findings should be replicated, taking account of the RoB.

The process of Learn to Play Therapy with parent-child dyads with children who have autism spectrum disorder

INTRODUCTION

Learn to Play Therapy aims to build children's ability to spontaneously initiate pretend play. The purpose of this study was to explore evidence for this therapy for children with autism spectrum disorder by investigating the changes in a child's pretend play and key techniques used in the process of therapy.

METHODS

Six children with a diagnosis of autism spectrum disorder (mean age = 3.8 years; SD = 1.2 years) were engaged in therapy sessions with a parent. Four therapy session videos for each child were selected across four time points from 15 videos of each child, representing 6 months of therapy. Retrospective video analysis was used to investigate the changes in the child's ability by coding six play skills and enjoyment of play. Key techniques in the process of Learn to Play Therapy were analysed by frequency of occurrence during sessions.

RESULTS

There was a significant increase in the child's pretend play ability for play scripts (p = .042), sequences of play actions (p = .043), object substitution (p = .043), doll/teddy play (p = .028), social interaction (p = .043) and enjoyment (p = .026). There was a mirroring of the therapist, parent and child for all key techniques, with parents showing increased frequency rates after Time 1. Repetition with variation decreased by Time 4. Challenging the child showed higher rates in Times 2 and 4. Focussed attention remained stable, and the child's talk during play had the highest total frequency.

CONCLUSION

Learn to Play Therapy is an effective therapy in building pretend play ability in children with autism, with parents increasing their involvement in using the key techniques after Time 1. The results inform therapists on how the key techniques were used within the therapy sessions to increase the child's pretend play ability.

Pretend play ability in preschool-aged children with an acquired brain injury

INTRODUCTION

This study compares the self-initiated pretend play abilities of preschool-aged children with an acquired brain injury, with the self-initiated pretend play ability of their neurotypical peers.

METHOD

A non-experimental group comparison was conducted between 22 preschool-aged neurotypical children (M = 52.8 months, SD = 7.1 months) and 21 children with an acquired brain injury (ABI, M = 50.5 months, SD = 11.9 months), who had been discharged from inpatient rehabilitation and who were able to engage in a play session. The children were assessed individually using the Child-Initiated Pretend Play Assessment (ChIPPA).

RESULTS

The children with an ABI had significantly lower scores in pretend play ability than their neurotypical peers as measured by the percentage of elaborate play actions in both the conventional (P < .000) and symbolic (P < .000) sections of the ChIPPA, as well as the number of object substitutions (P < .000). The children with an ABI completed significantly less of the play time required compared with their neurotypical peers (P = .001); 66% could not play for the required time. There was no significant difference in the ChIPPA scores of the children with an ABI injured before and after the age of 18 months, nor between children with a severe or moderate injury.

CONCLUSION

The quality and the quantity of pretend play of preschool-aged children with an ABI are significantly below that of their neurotypical peers. Assessment of pretend play ability and direct intervention in ABI rehabilitation by occupational therapists is essential to enable children with an ABI to participate in pretend play and garner the developmental benefit this affords.

Construct validity of the Child-Initiated Pretend Play Assessment-For 3-year-old Brazilian children

INTRODUCTION

Play is an indication of children's development and how they function. In occupational therapy it is regarded as an important occupation of childhood. Assessment of a child's play should be included in the test batteries of occupational therapists, who understand the construct validity of the assessment they have chosen. Our aim was to provide evidence of reliability, internal consistency and hypotheses testing of the construct validity of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment.

METHODS

Two hundred typically developing Brazilian children aged 3 years were evaluated individually using the Child-Initiated Pretend Play Assessment.

RESULTS

The internal consistency showed a Cronbach's alpha coefficient to Percentage of Pretend Play Actions (PEPA) of 0.86 and NOS of 0.81. There were significant differences between the younger children (aged 36-41 months) and the older children (aged 42-47 months) for elaborate play across both conventional-imaginative play (p = .002), symbolic play (p = .012), and the combined score (p = .005). There were significant differences between younger and older girls for elaborate play with symbolic play materials (p = .009) and elaborate play overall (p = .039). There were significant differences between young and older boys for elaborate play with conventional toys (p = .006) and elaborate play overall (p = .025). There were no significant differences for object substitution or imitated actions.

CONCLUSION

The measurement properties of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment for 3-year-old Brazilian children identified evidence for response processes, internal structure, with discussion of consequences of testing for 3-year-old Brazilian children.

Diseño de un software para estimulación del componente socio-emocional en niños con trastorno del espectro autista

Los trastornos del espectro autista se caracterizan por la presencia de limitaciones en la reciprocidad emocional e interacción social. En esta investigación se diseñó y validó por contenido un software para la estimulación de habilidades de comprensión emocional y social en niños con trastorno del espectro autista de alto nivel de funcionamiento. El software está conformado por tres dimensiones: reconocimiento emocional, comprensión emocional y comprensión de creencias; cada dimensión cuenta con niveles de complejidad baja, media y alta. La investigación se desarrolló bajo un diseño instrumental de corte psicométrico donde las unidades de análisis fueron las actividades validadas por 9 jueces, 8 de ellos expertos en neuropsicología e intervención en autismo y un juez experto en ingeniería y desarrollo de software. Los datos fueron analizados mediante la fórmula de coeficiente de razón de validez de contenido y los resultados muestran que se valida sin modificaciones el 99.06% de los ítems; el 0.4% de los ítems se conservan con modificaciones. Se concluye  que el software cuenta con un contenido válido para la estimulación del componente social y emocional en niños con trastorno del espectro autista de alto funcionamiento.

Prediction Of Playfulness By Pretend Play, Severity Of Autism Behaviors, And Verbal Comprehension In Children With Autism Spectrum Disorder

BACKGROUND

Children with autism spectrum disorder (ASD) often exhibit deficits in pretend play and have less playfulness. The purpose of this study was to evaluate the relationship between pretend play and playfulness in children with autism spectrum disorder, while controlling for severity of autism behaviors, verbal comprehension, and age.

METHODS

A sample of 72 children with ASD aged between 3 and 12 years were assessed with the Child-Initiated Pretend Play Assessment, Test of Playfulness, and Childhood Autism Rating Scale, respectively, for their pretend play, playfulness, and severity of autism behaviors. Correlation and multiple regression analyses were conducted.

RESULTS

The results of Pearson correlation coefficients revealed that the pretend play variables had mild to moderate associations with the playfulness variables (r = -0.25 to 0.68). The multiple regression analyses showed that, overall, the internal locus of control was the significant predictor of the pretend play variables (accounting for 5-47% of the variance, p < 0.001). The six pretend play variables were all important predictors of all playfulness variables (explaining 41-76% of the variance, p < 0.001-0.047). Particularly, the elaborate pretend play action was a significant predictor of all four playfulness variables. Our findings indicated that the more children with ASD engaged in pretend play, the more they experienced playfulness.

CONCLUSION

Clinicians could help children with ASD improve their feeling of being in charge of their play in order to develop better performance in pretend play. Assisting children with ASD to engage in pretend play is important to promote their internal experience of playfulness.