Executive function deficits and the pretend play of children with autism: a research note

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.

Executive function predicts the development of play skills for verbal preschoolers with autism spectrum disorders

Executive function and play skills develop in early childhood and are linked to cognitive and language ability. The present study examined these abilities longitudinally in two groups with autism spectrum disorder-a group with higher initial language (n = 30) and a group with lower initial language ability (n = 36). Among the lower language group, concurrent nonverbal cognitive ability contributed most to individual differences in executive function and play skills. For the higher language group, executive function during preschool significantly predicted play ability at age 6 over and above intelligence, but early play did not predict later executive function. These results suggested that factors related to the development of play and executive function differ for subgroups of children with different language abilities and that early executive function skills may be critical in order for verbal children with autism to develop play. Autism Res 2016, 9: 1274-1284. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

A longitudinal study of pretend play in autism

This study describes a longitudinal design (following subjects described in Rutherford & Rogers [2003, Journal of Autism and Developmental Disorder, 33, 289-302]) to test for predictors of pretend play competence in a group of children with autism. We tested the hypothesis that developmental change in pretend play performance can be predicted by earlier measures of either executive function, intersubjectivity, imitation, or general development. Participants at the time of follow-up testing were 28 children with autistic disorder (mean chronological age (CA) 57.6 months), 18 children with other developmental disorders (mean CA 59.0 months), and 27 typically developing children (mean CA 30.1 months). Children with autism were profoundly delayed given both competence (prompted) measures as well as performance (spontaneous) measures. Joint attention at time 1 strongly and uniquely predicted pretend play development.

Executive Functioning in Children with an Autism Spectrum Disorder: Can We Differentiate Within the Spectrum?

The aim of this study was to investigate whether children with high-functioning autism (HFA), Asperger's syndrome (AS), and pervasive developmental disorder not otherwise specified (PDDNOS) can be differentiated from each other and from normal controls on their neurocognitive executive functioning (EF) profile. Children with HFA and AS showed the most EF deficits. The EF profile of the PDDNOS group was more disturbed that the normal control group, but was less disturbed than the profile of the HFA and AS groups. Little difference was found between the three PDD subtypes with respect to EF. This study supports the view that executive dysfunctioning plays an important role in autism. The usefulness of a distinction between different PDD subtypes was not demonstrated.

Counterfactual and mental state reasoning in children with autism

The contributions of counterfactual conditional reasoning (CCR), belief understanding, and inferential reasoning to the performance of children with autism (CWA) on standard false belief tasks were investigated. To assess the roles of these three factors, we compared the performance of CWA on physical-state CCR tasks (which do not require either an understanding of belief or inferential reasoning); on Wellman and Bartsch's (1988) nonstandard tests of false belief (which require an understanding of belief, but not CCR or inferential reasoning), and on standard tests of false belief tasks. The CWA were impaired relative to controls on the physical-state CCR and standard false-belief tasks, but not on the nonstandard false-belief tasks, and the CWA's performance on the physical-state CCR and standard false-belief tasks correlated highly, even when the effects of verbal ability were partialled out. Finally, the CWA's performance on standard false-belief tasks was more impaired than their performance on the physical-state CCR tasks. We concluded that impaired performance on standard false-belief tasks in autism is associated with defective competence in CCR (or some of its component skills), plus defective competence in inferential reasoning and possibly generativity, but that impaired performance is not caused by an inadequate understanding of belief. The results are discussed in relation to other hypotheses concerning the cause or causes of impaired performance on standard false-belief tasks in children with autism.

Cognitive underpinnings of pretend play in autism

This article examines the cognitive underpinnings of spontaneous and prompted pretend play in 28 young children with autism, 24 children with other developmental disorders, and 26 typical children. The article compares theories that consider either theory of mind (ToM) or executive function (EF) to be causally important deficits in the development of pretend play in autism and important factors in pretend play. Each of these two theories posits a cognitive precursor to pretense, which would need to be present in typical development, and the absence of which could explain pretend play deficits in children with developmental disabilities such as autism. We tested which of these theories better predicts a child's production of pretend play. Children with autism were significantly delayed on pretend play scores. They also had significant deficits in our ToM measure, but not our EF measures. Regression analyses suggested a role for our measure of generativity, one of the EF measures.

Regulation of cognitive activity and early communication development in young autistic, mentally retarded, and young normal children

Based on the Piagetian framework, this study examined regulation of cognitive activity and developmental communication profiles and their interrelationship in groups of autistic, mentally retarded, and normal children of comparable overall, verbal, and oculo-manual developmental ages (from 6 to 24 months). Regulation of activity was assessed with both an object permanence test and an original behavior grid, and development of communication skills with the Guidetti-Tourrette scales (French adaptation of the Seibert-Hogan scales). The results showed evidence of certain types of dysregulation of cognitive activity and a general delay in communication ability in autistic children compared to the other two groups. Moreover, although the intensity of some of these disorders decreased in relation to the developmental levels of social interaction and joint attention in normal children, they were related to both high and low levels of development of social interaction only in autistic children. These findings raise the hypothesis of a relationship between a disorder of disengaging from an activity and developmental levels of social interaction noted at two transitory periods of early development (12 and 24 months) only in children with autism. Developmental and neuropsychological interpretations of this particular pattern are proposed.

Taking a closer look at functional play in children with autism

Research evidence indicates that children with autism may experience problems with functional play, in addition to their well-documented deficits in symbolic play. However, as a result of the tendency of previous studies to group all functional play into a single category, the precise nature and extent of this deficit remains unclear. The present study undertook a more refined analysis of such play, subtyping the functional acts into various categories, in terms of the developmental progression suggested by research with typical infants. The functional play of children with autism was compared to that of developmentally matched children with Down syndrome and typical infants. Although there were no group differences in overall measures of the proportion of total play time spent in functional play and in the number of functional acts performed, a closer analysis of the composition of this play did reveal striking, qualitative differences. The functional play of the autism group was less elaborated, less varied, and less integrated than that of the controls. The implications of these findings are explored in relation to current theoretical models of autism and in relation to the role of other people in mediating the appropriate use of objects.

Counterfactual syllogistic reasoning in normal 4-year-olds, children with learning disabilities, and children with autism

Instruction encouraging imagery improves logical reasoning with counterfactual premises by normal preschool children. In contrast, children with autism have been reported to reason accurately with counterfactual premises in the absence of such instruction (F. J. Scott, S. Baron-Cohen, & A. M. Leslie, 1999). To investigate this pattern of findings, we compared the performance of children with autism, children with learning disabilities, and normally developing 4-year-olds, who were given reasoning problems both with and without instruction in two separate testing sessions 2 to 3 weeks apart. Overall, instruction to use imagery led to persistent logical performance. However, children with autism displayed a distinctive pattern of responding, performing around chance levels, showing a simple response bias, and rarely justifying their responses by elaborating on the premises. We propose that instruction boosts logical performance by clarifying the experimenter's intention that a false proposition be accepted as a basis for reasoning and that children with autism have difficulty grasping this intention.

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.

Autism: towards an integration of clinical, genetic, neuropsychological, and neurobiological perspectives

Autism constitutes one of the best validated child psychiatric disorders. Empirical research has succeeded in delineating the key clinical phenomena, in demonstrating strong genetic influences on the underlying liability, and in identifying basic cognitive deficits. A range of neurobiological abnormalities has also been found, although the replicability of specific findings has not been high. An understanding of the causal processes leading to autism, and accounting for the marked variability in its manifestations, requires an integration across these different levels of enquiry. Although this is not yet possible, a partial integration provides a useful strategy for identifying key research questions, the limitations of existing hypotheses, and future research directions that are likely to prove fruitful. The research findings for each research level are critically reviewed in order to consider how to move towards an integration across levels.