Picture me playing: increasing pretend play dialogue of children with autism spectrum disorders

Classificação da participação de crianças em ocupações nos contextos escolares na perspectiva da terapia ocupacional

Resumo A Educação Infantil é caracterizada por ocupações relacionadas ao brincar, ao autocuidado e à aprendizagem. Para a terapia ocupacional, a participação nessas ocupações reflete no desenvolvimento físico, cognitivo, social, afetivo e ocupacional das crianças. Este estudo objetivou analisar formas de participação infantil em ocupações nos contextos escolares e propor critérios para classificação dessa participação, na perspectiva da terapia ocupacional. Foi realizada uma pesquisa qualitativa, de observação participante a partir da técnica das Descrições Narrativas. Participaram deste estudo quatro crianças com desenvolvimento típico (DT) e quatro crianças que faziam parte do Público-Alvo da Educação Especial (PAEE), sendo uma com deficiência física e três com Transtorno do Espectro Autista (TEA). Para a análise dos dados, a técnica de Análise do Conteúdo fez emergir quatro formas de participação, a partir de elementos como envolvimento na ocupação, assistência necessária ou autonomia na participação, tolerância, interações sociais, motivação e iniciativa. Essas formas de participação foram denominadas de participação plena, participação ativa assistida, participação rudimentar e participação restrita. A participação plena foi preponderante manifestada pelas crianças DT e a participação ativa assistida esteve relacionada à criança PAEE com deficiência física. Já a participação rudimentar e a participação restrita foram evidenciadas exclusivamente por crianças PAEE com TEA. Consideram-se os resultados relevantes para a identificação precoce de facilitadores e barreiras para a participação, bem como para o adequado provimento de condições e intervenções que potencializem a participação de todas as crianças nos ambientes escolares e para o fortalecimento e ampliação da atuação dos terapeutas ocupacionais nestes.

Looking back and moving forward: A scoping review of research on preschool autism interventions in the field of speech-language pathology

BACKGROUND & AIMS

Speech-language pathology services are frequently accessed by families of children who have suspected or diagnosed autism. This is expected given that social communication differences are a core feature of autism. This review looked broadly at the state of research in the field of speech-language pathology and preschool autism interventions in order to identify the types of studies that could be used to inform the practices of speech-language pathologists (SLPs), and to identify gaps in the field so they can be addressed in future research. Specifically, we examined the extent of research conducted on interventions delivered (at least in part) by SLPs to preschool children with suspected or diagnosed autism, identified the range of skill development areas targeted within the studies, and explored the characteristics of the interventions (i.e., theoretical models underlying the programs, service delivery models, treatment dosage).

METHODS

A scoping review of articles published between 1980 and 2019 was conducted using the five phases outlined by the Arksey and O'Malley framework: (a) articulating the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; and (e) collating, summarizing, and reporting the results.

MAIN CONTRIBUTION/RESULTS

A total of 114 studies met inclusion criteria with most published since 2010 and conducted within North America. Case study or single-subject study designs were the most frequently used. Interventions delivered solely by SLPs and by multiprofessional teams that included SLPs were relatively equally represented. Across the included studies, nine skill development areas were targeted, but interventions targeting social communication, language, and augmentative communication skills made up the vast majority of studies. There was relatively even distribution of interventions informed by child-centered, clinician-directed, and hybrid models. Explicit information detailing intervention characteristics (e.g., treatment dosage, professional training of clinicians delivering the intervention) was poorly reported in many studies. For those studies providing details, there was a great deal of variability in the nature of interventions (e.g., service delivery models, SLPs' role, dosage).

CONCLUSIONS

This review revealed that research in the area of autism interventions delivered, at least in part, by SLPs has markedly increased over the past 10 years. Still, there remains a need for more research, and greater transparency detailing the nature of the interventions being investigated. The research conducted to date captures the versatility of the SLP's role within preschool autism intervention. Improved reporting and studies with strong methodological rigor focused on capturing the complex and individualized nature of interventions are needed, as are intervention studies aligned with real-world community practice.

IMPLICATIONS

This review provides a comprehensive examination of the status of research on preschool interventions delivered to children with suspected or diagnosed autism within the field of speech-language pathology. Several directions for future research are provided, as are suggestions for improving the clinical applicability of results to further the development of effective, evidence-informed policy and practice in speech-language pathology.

Brief Report: A Randomized Controlled Trial of the Effects of RECALL (Reading to Engage Children with Autism in Language and Learning) for Preschoolers with Autism Spectrum Disorder

This study investigated the effects of a parent-implemented dialogic reading approach-Reading to Engage Children with Autism in Language and Learning (RECALL)-on the engagement in reading and inference-making ability for preschoolers with autism spectrum disorder (ASD). Thirty-one preschoolers (mean age = 5.90 years, SD = 0.69; 26 boys, 5 girls) were randomly assigned to a treatment or control group. Six weeks of RECALL significantly enhanced story comprehension, emotion knowledge, and reading engagement among preschoolers in the treatment group. This might be the first randomized controlled trial testing the effects of RECALL on children with ASD. Our findings suggest that additional instructional support such as the application of a prompting hierarchy during dialogic reading might help children with ASD reap greater benefits from shared book reading.

A Systematic Review of Interventions to Improve the Occupation of Play in Children With Autism

Play in children with autism spectrum disorder (ASD) is often atypical, yet consensus regarding effective occupational therapy strategies for improving play is not established. To examine the efficacy of strategies used in occupational therapy to improve play in ASD, authors completed a systematic review of papers from January 1980 through January 2019. Search terms included autism, Asperger's, ASD, autistic in combination with play, playfulness, pretend, imagination, praxis, creativity, and generativity. Twenty papers met inclusion criteria and were reviewed. Reviewed interventions included parent education, modified play materials or environments, imitation of the child, and modeling by an adult, a peer, or video. Moderate to strong support exists for the specific strategies of imitation of the child and modeling for the child, with lesser or mixed support for other strategies. Certain strategies commonly used in occupational therapy may be effective in improving the occupation of play in ASD.

Predictors and Moderators of Spontaneous Pretend Play in Children with and without Autism Spectrum Disorder

Although pretend play has long been linked to children's normative cognitive development, inconsistent findings call for greater rigor in examining this relation (Lillard et al., 2013). Spontaneous pretend play is often impacted in atypical development, notably in autism spectrum disorder (ASD). Since ASD traits exist along a continuum in the general population, investigating how pretend play varies across the range of ASD symptoms by indexing variations in ASD traits in both typically developing and ASD populations may provide insight into how ASD symptoms may influence the relation between pretend play and associated processes in cognitive development. This study used rigorous observational methods to assess spontaneous pretend play. Specifically, 5-min free-play sessions with two discrete toy sets were double-coded by blinded coders (coder assignment counterbalanced). Key facets of pretense development [attribution of pretend properties (APP), object substitution (OS), imaginary objects] were examined. These facets of pretend play production were then analyzed in relation to ASD symptoms, as well as plausible, long-theorized correlates [theory of mind (ToM), verbal ability, familiarity, and interest in specific toys]. Forty children (M_age = 6;5, SD_age = 1.45; 29 males), six of whom met the threshold for ASD diagnosis via parent-reported ASD symptoms, participated in play sessions and completed measures of verbal IQ and ToM. Besides the measure of child ASD symptoms, parents completed a survey of their child's interest in and familiarity with the play session toys. Overall, greater ToM predicted more APP, and more interest in the toys presented predicted more OS. In terms of overall pretend play production, two results were counterintuitive. First, among children with more ASD symptoms, verbal ability marginally negatively predicted pretend play production. Second, among children with fewer ASD symptoms, ToM negatively predicted pretend play production. Further probing revealed that the negative effect of ASD symptoms on pretend play was simultaneously moderated by both variables: low ToM and high verbal ability both related to less pretend play production among children with more ASD symptoms. Implications for assessment and subsequent treatment for pretend ability among children with varying degrees of ASD symptoms, as well as for future research, are discussed.

Children with Autism Spectrum Disorder and Patterns of Participation in Daily Physical and Play Activities

Autism spectrum disorder (ASD) indicates several neurodevelopmental impairments which may end in impairments in motor or physical activities. Daily physical activity involvement was investigated in a total of 83 children (52 boys and 31 girls) with ASD aged 6–15 years. Results indicated that only 10 (12%) of children with ASD were physically active. Children were predominantly engaged in solitary play rather than social play activities. Gender, family income, and household structure were found to be associated with activity scores. Financial burden and lack of opportunities were noted as the leading barriers to physical activities. In conclusion, findings indicated a low rate of physical activity participation in children with ASD that is closely associated with sociodemographic variables.

Learning how to be a student: an overview of instructional practices targeting school readiness skills for preschoolers with autism spectrum disorder

Due to difficulties associated with autism spectrum disorder (ASD), many children with ASD will require additional support to actively participate in classroom activities. Therefore, it is important that professionals who work with young children with ASD know what skills to teach and how to teach them. Using the recent evidence-based practice review conducted by the National Professional Development Center on ASD, we have identified studies that targeted school readiness behaviors which can have implications for academic skill development. In this article, we evaluate (a) the types of skills that have been taught to preschool children with ASD, (b) the strategies used to teach specific skills, and (c) other descriptive information, such as who delivered the intervention and the setting in which the intervention took place. We conclude by offering suggestions for future research and considerations for professional development.

Autism spectrum disorders: is mesenchymal stem cell personalized therapy the future?

Autism and autism spectrum disorders (ASDs) are heterogeneous neurodevelopmental disorders. They are enigmatic conditions that have their origins in the interaction of genes and environmental factors. ASDs are characterized by dysfunctions in social interaction and communication skills, in addition to repetitive and stereotypic verbal and nonverbal behaviours. Immune dysfunction has been confirmed with autistic children. There are no defined mechanisms of pathogenesis or curative therapy presently available. Indeed, ASDs are still untreatable. Available treatments for autism can be divided into behavioural, nutritional, and medical approaches, although no defined standard approach exists. Nowadays, stem cell therapy represents the great promise for the future of molecular medicine. Among the stem cell population, mesenchymal stem cells (MSCs) show probably best potential good results in medical research. Due to the particular immune and neural dysregulation observed in ASDs, mesenchymal stem cell transplantation could offer a unique tool to provide better resolution for this disease.