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A Longitudinal Study of Pretend Play in Autism

Abstract

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.

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Fig. 1

Notes

  1. 1.

    The same analyses done using play scores at time 1 as a true covariate (i.e., entered into the model even before group diagnosis) yielded the same results, albeit with the expected drop in power when using additional variables).

  2. 2.

    It should be noted however, that for the AD group, when analyzed separately, there was a significant relationship between JA and Imitation (r = .44, P = .03).

  3. 3.

    Note that in a hierarchical regression in which MA, imitation and spatial reversal are forced in before JA, JA still predicts a significant amount of variance in spontaneous pretend play development (P = .002) whereas no other predictor, while forced in ahead of JA, predicts a significant amount of variance.

References

  1. Astington, J., Harris, P. L., & Olson, D. R. (1988). Developing theories of mind. New York, USA: Cambridge University Press.

    Google Scholar 

  2. Baron-Cohen, S. (1987). Autism and symbolic play. British Journal of Developmental Psychology, 5, 139–148.

    Google Scholar 

  3. Baron-Cohen, S. (1989). Joint-attention deficits in autism: Towards a cognitive analysis. Development and Psychopathology, 1, 185–189.

    Google Scholar 

  4. Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21, 37–46.

    PubMed  Article  Google Scholar 

  5. Bernabei, P., Camaioni, L., & Levi, G. (1999). An evaluation of early development in children with autism and pervasive developmental disorders from home movies: Preliminary findings. Autism, 2, 243–258.

    Article  Google Scholar 

  6. Cantwell, D. P., Baker, L., Rutter, M., & Mawhood, L. (1989). Infantile autism and developmental receptive dysphasia: A comparative follow-up into middle childhood. Journal of Autism and Developmental Disorders, 19, 19–31.

    PubMed  Article  Google Scholar 

  7. Charman, T., Baron-Cohen, S., Swettenham, J., Baird, C., Drew, A., & Cox, A. (2003). Predicting language outcome in infants with autism and pervasive developmental disorder. International Journal of Language and Communication Disorders, 38, 265–285.

    PubMed  Article  Google Scholar 

  8. Chung, S. Y., Luk, S. L., & Lee, P. W. (1990). A follow-up study of infantile autism in Hong Kong. Journal of Autism and Developmental Disorders, 20, 221–232.

    PubMed  Article  Google Scholar 

  9. Curcio, F. (1978). Sensorimotor functioning and communication in mute autistic children. Journal of Autism and Childhood Schizophrenia, 8, 281–292.

    PubMed  Article  Google Scholar 

  10. Dawson, G., Meltzoff, A., Osterling, J., Rinaldi, J., & Brown, E. (1998). Children with autism fail to orient to naturally occurring social stimuli. Journal of Autism and Developmental Disorders, 28, 479–485.

    PubMed  Article  Google Scholar 

  11. Dawson, G., Toth, K., Abbott, R., Osterling, J., Munson, J., & Estes, A. (2004). Defining the early social attention impairments in autism: Social orienting, joint attention, and responses to emotions. Developmental Psychology, 40, 271–283.

    PubMed  Article  Google Scholar 

  12. DeMyer, M. K., Barton, S., DeMyer, W. E., Norton, J. A., Allen, J., & Steel, R. (1973). Prognosis in autism: A follow-up study. Journal of Autism and Childhood Schizophrenia, 4, 42–60.

    Article  Google Scholar 

  13. Doherty, M. B., & Rosenfeld, A. A. (1984). Play assessment in the differential diagnosis of autism and other causes of severe language disorder. Journal of Developmental and Behavioral Pediatrics, 5, 26–29.

    PubMed  Article  Google Scholar 

  14. Eisenberg, L. (1956). The autistic child in adolescence. American Journal of Psychiatry, 112, 607–612.

    PubMed  Google Scholar 

  15. Fein, G. G. (1981). Pretend play in childhood: An integrative review. Child Development, 52, 1095–1118.

    Article  Google Scholar 

  16. Fewell, R. R., & Rich, J. S. (1987). Play assessment as a procedure for examining cognitive, communication, and social skills in multihandicapped children. Journal of Psychoeducational Assessment, 5, 107–118.

    Article  Google Scholar 

  17. Fidell, L. S., & Tabachnick, B. G. (2003). Preparatory data analysis. In J. A. Schinka, & W. F. Velicer (Eds.), Handbook of psychology: Research methods in psychology (pp. 115–141). New York: John Wiley & Sons.

    Google Scholar 

  18. Garvey, C. (1991). Play. (2nd ed.) London: Fontana Press.

    Google Scholar 

  19. Gillberg, C., & Steffenburg, S. (1987). Outcome and prognostic factors in infantile autism and similar conditions: A population-based study of 46 cases followed through puberty. Journal of Autism and Developmental Disorders, 17, 273–288.

    PubMed  Article  Google Scholar 

  20. Gould, J. (1986). The Lowe and Costello Symbolic Play Test in socially impaired children. Journal of Autism and Developmental Disorders, 16, 199–213.

    PubMed  Article  Google Scholar 

  21. Haight, W., & Miller, P. J. (1992). The development of everyday pretend play: A longitudinal study of mothers’ participation. Merrill-Palmer Quarterly, 38, 331–349.

    Google Scholar 

  22. Hobson, R. P. (1993). Autism and the development of mind. Hove: Lawrence Erlbaum.

    Google Scholar 

  23. Hughes, C., & Russell, J. (1993). Autistic children’s difficulty with mental disengagement from an object: Its implications for theories of autism. Developmental Psychology, 29, 498–510.

    Article  Google Scholar 

  24. Hughes, C., Russell, J., & Robbins, T. W. (1994). Evidence for executive dysfunction in autism. Neuropsychologia, 32, 477–492.

    PubMed  Article  Google Scholar 

  25. Jarrold, C., Boucher, J., & Smith, P. K. (1994). Executive function deficits and the pretend play of children with autism: A research note. Journal of Child Psychology and Psychiatry and Allied Disciplines, 35, 1473–1482.

    Google Scholar 

  26. Jarrold, C., Boucher, J., & Smith, P. K. (1996). Generativity defects in pretend play in autism. British Journal of Developmental Psychology, 14, 275–300.

    Google Scholar 

  27. Kanner, L. (1971). Follow-up study of eleven autistic children originally reported in 1943. Journal of Autism and Childhood Schizophrenia, 1, 119–145.

    PubMed  Article  Google Scholar 

  28. Kanner, L. (1992). Follow-up study of eleven autistic children originally reported in 1943. Focus on Autistic Behavior, 7, 1–11.

    Google Scholar 

  29. Kaufman, P., Leckman, J., & Ort, S. (1989). Delayed response performance in males with Fragile X. Journal of Clinical and Experimental Neuropsychology, 12, 69.

    Google Scholar 

  30. Leekam, S. R., Hunnisett, E., & Moore, C. (1998). Targets and cues: Gaze-following in children with autism. Journal of Child Psychology & Psychiatry & Allied Disciplines, 39, 951–962.

    Google Scholar 

  31. Leslie, A. M. (1987). Pretense and representation: The origins of “theory of mind”. Psychological Review, 94, 412–426.

    Article  Google Scholar 

  32. Lewis, V., & Boucher, J. (1988). Spontaneous, instructed and elicited play in relatively able autistic children. British Journal of Developmental Psychology, 6, 325–339.

    Google Scholar 

  33. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C. et al. (2000). The Autism Diagnostic Observation Schedule–Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.

    PubMed  Article  Google Scholar 

  34. Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism Diagnostic Interview–Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659–685.

    PubMed  Article  Google Scholar 

  35. Lord, C., & Schopler, E. (1989). Stability of assessment results of autistic and non-autistic language-impaired children from preschool years to early school age. Journal of Child Psychology and Psychiatry and Allied Disciplines, 30, 575–590.

    Google Scholar 

  36. Lotter, V. (1978). Follow-up studies. In M. Rutter, & E. Schopler (Eds.), Autism: A reappraisal of concepts and treatment (pp. 475–495). New York: Plenum Press.

    Google Scholar 

  37. Malone, D. M., & Langone, J. (1998). Variability in the play of preschoolers with cognitive delays across different toy sets. International Journal of Disability, Development and Education, 15, 177–188.

    Google Scholar 

  38. McCune, L., Dipane, D., Fireoved, R., & Fleck, M. (1994). Play: A context for mutual regulation within mother-child interaction. In A. Slade, & D. P. Wolff (Eds.), Children at play: Clinical and developmental approaches to meaning and representation (pp. 148–166). London: Oxford University Press.

    Google Scholar 

  39. McCune-Nicolich, L. (1981). Toward symbolic functioning: Structure of early pretend games and potential parallels with language. Child Development, 52, 785–797.

    Article  Google Scholar 

  40. McEvoy, R. E., Roger, S. J., & Pennington, B. F. (1993). Executive function and social communication deficits in young autistic children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 34, 563–578.

    Google Scholar 

  41. Meltzoff, A. N., & Moore, M. K. (1977). Imitation of facial and manual gestures by human neonates. Science, 198, 75–78.

    Article  PubMed  Google Scholar 

  42. Morgan, B., Maybery, M., & Durkin, K. (2003). Weak central coherence, poor joint attention, and low verbal ability: Independent deficits in early autism. Developmental Psychology, 39, 646–656.

    PubMed  Article  Google Scholar 

  43. Moyles, J. R. (1994). The excellence of play. Buckingham, UK: Open University Press.

    Google Scholar 

  44. Mullen, E. (1989). Mullen scales of early learning Cranston, RI: T.O.T.A.L. Child, Inc.

    Google Scholar 

  45. Mundy, P., Hogan, A., & Doehring, P. (1996). A preliminary manual for the abridged Early Social Communication Scales. Miami, FL, USA: University of Florida.

    Google Scholar 

  46. Mundy, P., & Neal, R. A. (2001). Neural plasticity, joint attention, and a transactional social-orienting model of autism. In L. M. Glidden (Ed.), International review of research in mental retardation: Autism (pp. 139–168). San Diego, CA, USA: Academic Press.

    Google Scholar 

  47. Mundy, P., Sigman, M., Ungerer, J., & Sherman, T. (1986). Defining the social deficits of autism: The contribution of non-verbal communication measures. Journal of Child Psychology & Psychiatry & Allied Disciplines, 27, 657–669.

    Google Scholar 

  48. Ozonoff, S., & McEvoy, R. E. (1994). A longitudinal study of executive function and theory of mind development in autism. Development and Psychopathology, 6, 415–431.

    Google Scholar 

  49. Ozonoff, S., Pennington, B. F., & Roger, S. J. (1991). Executive function deficits in high-functioning autistic individuals: Relationship to theory of mind. Journal of Child Psychology and Psychiatry and Allied Disciplines, 32, 1081–1105.

    Google Scholar 

  50. Pennington, B., Rogers, S., Bennetto, L., Griffith, E. M., Reed, D. T., & Shyu, V. (1997). Validity tests of the executive dysfunction hypothesis of autism. In J. Russell (Ed.), Autism as an executive disorder (pp. 143–178). London: Oxford University Press.

    Google Scholar 

  51. Piaget, J. (1952). Play, dreams and imitation in childhood. New York, USA: W.W. Norton and Company, Inc.

    Google Scholar 

  52. Ricks, D. M., & Wing, L. (1975). Language, communication, and the use of symbols in normal and autistic children. Journal of Autism and Childhood Schizophrenia, 5, 191–221.

    PubMed  Article  Google Scholar 

  53. Riguet, C. B., Taylor, N. D., Benaroya, S., & Klein, L. S. (1981). Symbolic play in autistic, Down’s, and normal children of equivalent mental age. Journal of Autism and Developmental Disorders, 11, 439–448.

    PubMed  Article  Google Scholar 

  54. Rochat, P., & Stiano, T. (1999). Social-cognitive development in the first year. In P. Rochat (Ed.), Early social cognition: Understanding others in the first months of life (pp. 3–34). Mahwah, NJ, USA: Lawrence Erlbaum Associates.

    Google Scholar 

  55. Rogers, S. J. & Pennington, B. F. (1991). A theoretical approach to the deficits in infantile autism. Development and Psychopathology, 3, 137–162.

    Google Scholar 

  56. Rogers, S. J., Hepburn, S. L., Stackhouse, T. & Wehner, E. (2003) Imitation performance in toddlers with autism and those with other developmental disorders. Journal of Child Psychology and Psychiatry, 44 (5), 763–781.

    PubMed  Article  Google Scholar 

  57. Russ, S. W., Robins, A. L., & Christiano, B. A. (1999). Pretend play: Longitudinal prediction of creativity and affect in fantasy in children. Creative Research Journal, 12, 129–139.

    Article  Google Scholar 

  58. Russell, J., Mauthner, N., Sharpe, S., & Tidswell, T. (1991). The “windows task” as a measure of strategic deception in preschoolers and autistic subjects. British Journal of Developmental Psychology, 9, 331–349.

    Google Scholar 

  59. Rutherford, M. D., & Rogers, S. J. (2003). The cognitive underpinnings of pretend play in autism. Journal of Autism and Developmental Disorders, 33, 289–302.

    PubMed  Article  Google Scholar 

  60. Sigman, M. (1998). The Emanuel Miller Memorial Lecture 1997: Change and continuity in the development of children with autism. Journal of Child Psychology & Psychiatry & Allied Disciplines, 39, 817–827.

    Google Scholar 

  61. Sigman, M., & Ruskin, E. (1999). Continuity and change in the social competence of children with autism, Down syndrome, and developmental delays. Monographs of the Society for Research in Child Development, 64, v-114.

    Google Scholar 

  62. Sigman, M., & Ungerer, J. (1984). Cognitive and language skills in autistic, mentally retarded, and normal children. Developmental Psychology, 20, 293–302.

    Article  Google Scholar 

  63. Sutton-Smith, B. (1976). The psychology of play. New York: Arno Press.

    Google Scholar 

  64. Tomasello, M., & Rakoczy, H. (2003). What makes human cognition unique? From individual to shared to collective intentionality. Mind and Language, 18, 121–147.

    Article  Google Scholar 

  65. Ungerer, J., & Sigman, M. (1981). Symbolic play and language comprehension in autistic children. Journal of the American Academy of Child Psychiatry, 20, 318–337.

    PubMed  Article  Google Scholar 

  66. Venter, A., Lord, C., & Schopler, E. (1992). A follow-up study of high-functioning autistic children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 33, 489–507.

    Google Scholar 

  67. Volkmar, F. R., Lord, C., Bailey, A., Schultz, R. T., & Klin, A. (2004). Autism and pervasive developmental disorders. Journal of Child Psychology and Psychiatry and Allied Disciplines, 45, 135–170.

    Google Scholar 

  68. Wimmer, H., & Perner, J. (1983). Beliefs about beliefs: Representation and constraining function of wrong beliefs in young children’s understanding of deception. Cognition, 13, 103–128.

    PubMed  Article  Google Scholar 

  69. Wing, L., Gould, J., Yeates, S. R., & Brierley, L. M. (1977). Symbolic play in severely mentally retarded and in autistic children. Journal of Child Psychology & Psychiatry & Allied Disciplines, 18, 167–178.

    Google Scholar 

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Acknowledgements

SJR and SH were partially supported by National Institute of Child Health and Human Development Grant #PO1HD35468. SJR was also supported by National Institute of Deafness and Communication Disorders NIDCD Grant #R21 DC05574. The support of the Developmental Psychobiology Research Group and the Collaborative Programs of Excellence in Autism are gratefully acknowledged.

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Correspondence to M. D. Rutherford.

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Rutherford, M.D., Young, G.S., Hepburn, S. et al. A Longitudinal Study of Pretend Play in Autism. J Autism Dev Disord 37, 1024–1039 (2007). https://doi.org/10.1007/s10803-006-0240-9

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Keywords

  • Autism
  • Pretend play
  • Longitudinal study