Behavioral Approaches to Promoting Play

Early postnatal hypothyroidism reduces juvenile play behavior, but prenatal hypothyroidism compensates for these effects

Perinatal hypothyroidism causes long-lasting effects on behavior, including hyperactivity, cognitive delays/deficits, and a reduction in anxiety. Although there is some evidence that hypothyroidism during fetal development in humans has been associated with later autism spectrum disorder diagnosis or autism-like traits, the relationships between early thyroid hormones and social behaviors are largely unknown. Previously, we found that a moderate dose of the hypothyroid-inducing drug methimazole during embryonic and postnatal development dramatically increased juvenile play in male and female rats. The goal of the current study was to determine the extent to which thyroid hormones act in prenatal or postnatal development to organize later social behaviors. Subjects were exposed to methimazole in the drinking water during prenatal (embryonic day 12 to birth), postnatal (birth to postnatal day 23), or pre- and postnatal development; control animals received regular drinking water throughout the experiment. They were tested for play behavior as juveniles (P30-32). We found an interaction between pre- and postnatal methimazole administration such that postnatal hypothyroidism decreased some play behaviors, whereas sustained pre- and postnatal hypothyroidism restored play to control levels. The effects were similar in males and females. To our knowledge, this is the first report of an interaction between pre- and postnatal hypothyroidism on later behavior. The complexity of the timing of these effects may help explain why epidemiological studies have not consistently found a relationship between gestational hypothyroidism and later behavior.

Model Teachers or Model Students? A Comparison of Video Modelling Interventions for Improving Reading Fluency and Comprehension in Children with Autism

Video modelling (VM) interventions have been used to improve the fluency of individuals with learning disabilities and reading difficulties; this study aimed to replicate these findings with autism spectrum disorder (ASD) students. Four children with ASD (aged between 8 and 15) experienced two VM interventions, across 10 sessions, during an alternating treatments design: VM using a teacher model, and feedforward video self-modelling (FFVSM) where the student acted as the model. For two participants, FFVSM was found to be an effective intervention but overall, results for both interventions were inconsistent with previous research. Talking Mats Interviews were used to include these individuals within the social validation process of behavioural research.

Hyperactivation of the amygdala correlates with impaired social play behavior of prepubertal male rats in a maternal immune activation model

Maternal infection during pregnancy is an environmental risk factor for neurodevelopmental dysfunction, such as autism spectrum disorder (ASD). This study investigated the effect of maternal immune activation (MIA) on the behavior profile of prepubertal offspring and whether MIA alters the neuronal activation pattern of brain areas related to social play behavior. Pregnant Wistar rats received 500 μg/kg of lipopolysaccharide or saline solution on gestational day 16. Their offspring were tested using behavioral tasks to capture some of the core and associated ASD-like symptoms. Neuronal activation, indexed via c-fos expression after social play behavior, was evaluated in several brain areas. MIA had a number of adverse effects on dams and reduced the number of successful births and litter size. MIA induced sex-specific autistic-like features by a reduction in ultrasonic vocalizations in response to separation from the mother and nest, reduction in discrimination between neutral odors and their nest odor, moderate effect in stereotypies in the hole-board test, impaired risk assessment phenotype, and reduction in social play behavior without changes in locomotor activity only in prepubertal male offspring. A decrease in social play behavior may be associated with a decrease in the number of c-fos-positive cells in the prefrontal cortex and striatum, but hyperactivation of the basolateral and basomedial amygdala. Prenatal immune challenge results in ASD-like symptoms such as impaired risk assessment behavior, communication, and social interactions in male prepubertal offspring. Impaired social play behavior is correlated with neuronal hyperactivation in the amygdala.

Joseph S. Coaching via Telehealth: Caregiver-Mediated Interventions for Young Children on the Waitlist for an Autism Diagnosis Using Single-Case Design

Years can elapse between parental suspicion of a developmental delay and a diagnostic assessment, ultimately delaying access to medically necessary, autism-specific intervention. Using a single-case, concurrent multiple baseline design, autism spectrum disorder symptomology (i.e., higher-order restrictive and repetitive behaviors and interests; higher-order RRBIs) was targeted in toddlers (21-35 months) waiting for a diagnostic appointment. Caregivers were coached via telehealth to mediate early intervention to decrease interfering, inflexible higher-order RRBIs during play using four evidence-based applied behavior analytic strategies: modeling, prompting, differential reinforcement of appropriate behaviors, and response interruption and redirection. Six mother-child dyads were recruited from pediatrician offices and early intervention service districts in the United States. All families were considered under-served, under-resourced, or living in rural locations. A visual analysis of the data combined with Tau-U revealed a strong basic effect between the intervention package and parent strategy use and child flexible and inflexible behavior. Findings were consistent across participants with one exception demonstrating a moderate effect for flexible behaviors yet a strong effect for inflexible behaviors. Standardized mean difference was beyond zero for all participants. Implications for science and practice include support for early intervention of higher-order RRBIs for young children with and at risk for ASD.

Caregivers can implement play-based instruction without disrupting child preference

Young children diagnosed with autism spectrum disorder often require systematic teaching to learn new skills, and caregivers can teach their children by embedding learning opportunities in a play-based context. However, researchers have not evaluated procedures to train caregivers how to implement a combination of strategies designed to establish rapport and early language skills while maintaining play as a preferred context. Caregiver-child dyads composed of 2 mothers and their sons were recruited to participate. A multiple-probe design across strategies was used to demonstrate the efficacy of behavioral skills training on the mothers' integration of parallel play, child-directed interaction, teaching requests (mands), and teaching labels (tacts). Both children acquired the target requests and labels as a function of their mothers' teaching. By assessing the children's preferences, we confirmed the teaching strategies did not decrease toy engagement or the value of playing with their mother. We obtained stimulus generalization of the mothers' implementation of the strategies from a clinic to their home and maintenance of mother and child performance across a month.

Varied treatment response in young children with autism: A relative comparison of structured and naturalistic behavioral approaches

Heterogeneity of treatment response is common in children with autism spectrum disorder. Thus, many providers vary the intervention used based on child characteristics and learning domain. An improved understanding of how to match treatments to different children and domain areas may enhance efforts to individualize treatment and improve treatment response. This study evaluated the relative efficacy of discrete trial training and pivotal response training for teaching young children at risk for autism spectrum disorder receptive and expressive language, play, and imitation skills. Using a single-subject adapted alternating treatments design, children received both the treatments for 12 weeks. Data were collected during treatment and at 3-month follow-up. All participants acquired target skills in both treatments and demonstrated some generalization, maintenance, and spontaneous skill use. Pivotal response training and discrete trial training were each more effective for some children and domains. The results suggest that early rates of learning may be predictive of longer-term treatment response and useful in informing treatment decisions.

Teaching Object Play to Young Children With Disabilities: A Systematic Review of Methods and Rigor

In this systematic review, we examined the rigor and outcomes across 27 object play intervention studies using single-case research methodology. We focused on studies including children age 5 years or younger and examined several descriptive characteristics including materials, instructional packages, and settings. We also analyzed the facilitation and measurement of generalized play and several methodological features including quality, rigor, and visual analysis procedures. Overall, the identified studies demonstrated positive outcomes, although quality and rigor limited interpretations of the outcomes. Previous reviews also have noted strong outcomes and weak to moderate quality for single-case studies. Our results should be interpreted with caution given previous reviews of play intervention studies identified strong outcomes and quality from group-design studies. Additional replications testing robust interventions using single-case research with strong methodological rigor are warranted.

Increasing "Object-Substitution" Symbolic Play in Young Children With Autism Spectrum Disorders

Children with autism spectrum disorders (ASD) may not develop symbolic play skills, so such skills need to be taught specifically. We report an experiment regarding a procedure targeting "object-substitution" symbolic play skills. The "object-substitution" symbolic play behavior occurred when the child labeled a common object with the name of a substitute and used the object to perform a play action (e.g., As she put a bowl on her head, she called it a hat). A multiple probe across behaviors design was employed with five children (four boys and one girl, aged 3 to 6 years) with ASD. All children had verbal communication and demonstrated functional play and generalized imitation, but no symbolic play skills prior to the study. The instruction consisted of intraverbal training, picture prompts, and modeling of play actions. All children demonstrated object-substitution symbolic play skills after the instruction. The occurrences of response generalization were also discussed.

Increasing Functional Leisure Engagement for Children With Autism Using Backward Chaining

Research with individuals with disabilities has demonstrated the utility of intervention approaches to address toy play, also referred to as functional leisure engagement (FLE). Examples include prompting FLE, blocking stereotypy, and differentially reinforcing appropriate FLE with social or automatic (i.e., access to stereotypy) reinforcers. Backward chaining has yet to be evaluated, but may be useful for establishing more complex FLE. The current study employed a treatment package consisting of these components with three school-aged children with autism in a therapeutic classroom. Effects were evaluated during pretest and posttest sessions, which consisted of free access to toys in a novel setting. The percentage of session with FLE was evaluated using a multiple probe design across participants. Results showed all participants demonstrated an increase in FLE and two participants showed decreased stereotypy. Feasibility for classroom implementation is discussed.

Do behavioural approaches teach children with autism to play or are they pretending?

Play is, by definition, internally motivated, flexible, spontaneous and voluntary. Yet some researchers claim to have taught children with autism to play using behavioural interventions that are heavily structured, repetitive and make use of external reinforcements. In the current systematic review, we examine the extent to which these claims are supported by the evidence presented by the researchers themselves. We conclude that the most effective behavioural interventions have been those which have built on children's existing abilities or have relied on the motivating nature of activities themselves rather than on external rewards. We discuss the problems inherent in distinguishing between behavioural and cognitive change in children's play and highlight generalization as a poorly understood but focal process. Finally, we discuss the value of teaching children with autism play behaviours when these are not characterized by the defining qualities of play as a disposition.

Teacher ratings of evidence-based practices from the field of autism

Students who have a hearing loss and a comorbid diagnosis of an autism spectrum disorder (ASD) have multiple obstacles to overcome. Using Gallaudet Research Institute data, Szymanski, Brice, Lam, and Hotto calculated 1 deaf student in 59 received services for both a hearing loss and an ASD (Szymanski, Brice, Lam, & Hotto, 2012). Teachers of the deaf (TOD) in a Midwestern state completed a survey (N = 68) to indicate familiarity with evidence-based practices (EBP) from the field of ASD in order to confirm or reject the hypothesis that they would not report familiarity with these practices. Further analyses explored use and perceived effectiveness of EBP for those TOD who had familiarity with the instructional practices. Results of the study indicated that there was wide variance in TOD familiarity, use, and perceived effectiveness of the EBP.

Teaching play skills to young children with autism

BACKGROUND

Play is critical for the development of young children and is an important part of their daily routine. However, children with autism often exhibit deficits in play skills and engage in stereotypic behaviour. We reviewed studies to identify effective instructional strategies for teaching play skills to young children with autism.

METHOD

Empirical studies on teaching play skills to young children with autism published from 1990 to 2011 were located. These studies included single subject and group designs.

RESULTS

Twenty-six studies were reviewed. The majority of studies on teaching play skills used combined interventions. Children with autism improved their play skills, with direct intervention embedding their interests during play. Improvements in play skills increased positive social interactions and decreased inappropriate behaviour as collateral effects.

CONCLUSIONS

Further research is needed to develop more effective play skill interventions that assess the functional use of play and are implemented in the natural environment.

Using an iPad-based video modelling package to teach numeracy skills to a child with an autism spectrum disorder

PURPOSE

To evaluate the effectiveness of a video modelling package to teach a 5 year-old boy diagnosed with an autism spectrum disorder (ASD) basic numeracy skills. The treatment package consisted of iPad-based video modelling, gradual fading of video prompts, reinforcement, in vivo prompting and forward chaining.

METHODS

A single subject multiple baseline across numerals design with generalization and maintenance observational measures.

RESULTS

Clear gains were evident in the participant's ability to identify and write the Arabic numerals 1-7 and comprehend the quantity each numeral represents in association with the lagged intervention. Generalization and maintenance data demonstrated the robustness of the treatment effects.

CONCLUSIONS

IPad-based video modelling, when used in a package, can be an effective technique for teaching numeracy skills to children with an ASD. Systematic replication of this study with different participants is warranted.

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

This study examined the effectiveness of the Picture Me Playing intervention for increasing the play dialogue of preschool children with ASD during pretend play opportunities with typical peers. Picture Me Playing is a pictorially enhanced, script based intervention targeting character role play through a narrative vignette. A single-treatment counterbalanced design was utilized to contrast the performance of intervention and comparison groups, followed by within-subject analysis. Results indicated significant increases in play dialogue represented by both scripted and novel utterances. Results generalized to an unscripted play opportunity with novel toys.

How much change is true change? The smallest detectable difference of the Preschool Imitation and Praxis Scale (PIPS) in preschoolers with intellectual disabilities of heterogeneous aetiology

The teaching of imitation skills is often the first step in interventions for young learners with intellectual disabilities. The main goal of this study was to determine the smallest detectable difference (SDD) at 95% confidence of the Preschool Imitation and Praxis Scale (PIPS) in preschoolers with intellectual disabilities. Two raters independently scored videotapes of the imitation performance of 44 preschoolers (27 with Down syndrome, 10 with Non-Specific Mental Retardation and 7 with Low-functioning Autism) between 13 and 58 months of age (mean age 39.6 months, SD 11.9 months). Results revealed that the PIPS demonstrated acceptable interrater reliability on item level (weighted kappa values ranged from 0.52 to 0.96) and scale level (ICC = 0.986; 95% CI: 0.975-0.993). The SDD of the PIPS was 7.2%, indicating that the change score rated by different raters for an individual child with an intellectual disability is valid and that the PIPS can be used by early interventionists and researchers as an outcome measure to determine children's maturation or improvement.

Is video-based instruction effective in the rehabilitation of children with autism spectrum disorders?

OBJECTIVE

To review intervention studies on the use of video-based instruction for teaching adaptive behaviours to children with autism spectrum disorders (ASD).

REVIEW PROCESS

Electronic and hand searches were conducted to identify intervention studies that focus on using video-based instruction to teach adaptive behaviours to children with ASD. Studies that met the inclusion criteria were summarized in terms of: (a) participants, (b) setting, (c) model type, (d) target skills, (e) intervention type, (f) design and (g) outcomes.

OUTCOMES

Forty-four studies encompassing 49 experiments met the inclusion criteria. The studies targeted a range of adaptive behaviours and academic skills. Most studies reported positive results, but the certainty of evidence was not strong for all of the studies due to reliance on pre-experimental designs.

CONCLUSION

The results from this review support the use of video-based instruction in the rehabilitation of children with ASD.

The Effects of an Abolishing Operation Intervention Component on Play Skills, Challenging Behavior, and Stereotypy

The purpose of this study was to reduce stereotypy and challenging behavior during play skills instruction by adding an abolishing operation component (AOC) to the intervention strategy. An alternating treatments design compared one condition in which participants were allowed to engage in stereotypy freely before beginning the play skills intervention (AOC condition) to a second condition without this free access period (No AOC condition). Across 4 participants with autism spectrum disorders (ASD), levels of stereotypy and challenging behavior were lower and functional play was higher during play intervention sessions that followed the AOC. These data provided support for the inclusion of an AOC in interventions aimed at increasing the play skills of children with ASD who present with stereotypy.

Using video modeling to teach reciprocal pretend play to children with autism

The purpose of the present study was to use video modeling to teach children with autism to engage in reciprocal pretend play with typically developing peers. Scripted play scenarios involving various verbalizations and play actions with adults as models were videotaped. Two children with autism were each paired with a typically developing child, and a multiple-probe design across three play sets was used to evaluate the effects of the video modeling procedure. Results indicated that both children with autism and the typically developing peers acquired the sequences of scripted verbalizations and play actions quickly and maintained this performance during follow-up probes. In addition, probes indicated an increase in the mean number of unscripted verbalizations as well as reciprocal verbal interactions and cooperative play. These findings are discussed as they relate to the development of reciprocal pretend-play repertoires in young children with autism.

Using blended and guided technologies in a university course for scientist-practitioners: teaching applied behaviour analysis to autism professionals

Although the incidence of autism spectrum disorders is increasing worldwide, there is a shortage of professionals trained to provide effective interventions. The article describes an advanced university course in Applied Behaviour Analysis (ABA) and autism tailored to meet the needs of Swedish professionals from multiple disciplines. The course implemented both blended-learning technologies (web, telecommunication, and in vivo) and guided-design (problem-solving) exercises to promote the scientist-practitioner model. Overall, students advanced their skills related to identifying extant scientific literature, choosing appropriate single-subject design evaluation methods, and critically analysing the effects of attempted interventions. Students rated the course as having high social validity and predicted the course content would positively affect their professional practice. The relevance of the course and future directions are discussed in the context of meeting the global need for effective autism intervention professionals.

The effects of orbital frontal cortex damage on the modulation of defensive responses by rats in playful and nonplayful social contexts

In a series of 3 experiments on rats, 2 hypotheses were tested: (a) that damage to the orbital frontal cortex (OFC) would alter the socially relevant context for executing defensive responses but not their performance and (b) that damage done to the OFC in early infancy would produce more deficits in social behavior than similar damage occurring in adulthood. Bilateral or unilateral OFC damage in adult males did not impair their ability to defend themselves during play fighting and when protecting their food but did impair their ability to modify the pattern of defense in response to different partners. Rats that sustained bilateral damage at 3 days of age not only had deficits in partner-related modulation of defense but also exhibited hyperactivity in their play. The findings thus supported the proposed hypotheses.