Teaching symbolic play skills to children with autism using Pivotal Response Training

Used Pivotal Response Training (PRT) to teach 7 children with autism to engage in symbolic play behaviors. Symbolic play, complexity of play behavior, and creativity of play were assessed. In addition, generalization measures were obtained across settings, toys, and play partners. Interaction with the play partners and comparison with typical controls were also examined. Results indicated that children with autism rarely exhibited symbolic play before training or after a control condition. After specific symbolic play training using PRT, all of the children learned to perform complex and creative symbolic play actions at levels similar to that of language-matched typical controls. In most cases the children generalized their play to new toys, environments, and play partners and continued to engage in symbolic play behavior after a 3-month follow-up period. In addition, interaction skills improved after training. Treatment implications for these findings are discussed.     

Cognitive deficits and symbolic play in preschoolers with autism

This study investigated symbolic play in 12 children with autism and 12 children with typical development and compared theories that consider either theory of mind, executive function or central coherence to be causally involved in the development of symbolic play in autism. Children with autism demonstrated significantly less symbolic play than their typically developing peers and had significant deficits in theory of mind and central coherence measures but not executive function measures. A tentative conclusion is that symbolic play deficits in autism are more associated with theory of mind and weak central coherence.     

Symbolic play in autism: A review

Experimental research into the symbolic play of autistic children is reviewed in an attempt to outline the nature of their deficit in this area. While many studies can be criticized on methodological grounds, there is good evidence for an impairment in the spontaneous symbolic play of autistic children, an impairment that appears to extend to cover spontaneous functional play also. However studies that have investigated elicited and instructed play have indicated that autistic children may have a capacity for symbolic play that they do not spontaneously exhibit. The implications of these findings for various hypotheses concerning a symbolic play deficit in autism are considered and directions for future research are outlined.     

Teaching play skills to young children with autism

Abstract

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.     

Effects of sociodramatic play training on children with autism

We assessed the effects of teaching sociodramatic play to three children with autism. The training was conducted using a variation of Pivotal Response Training (PRT), a program traditionally used to teach language to children with autism. Measures of play skills, social behavior, and language skills were obtained before treatment, after treatment, and at a followup period. The correlation between language and pretend play was explored, as was the relationship between sociodramatic play and social competence. Positive changes were observed in play, language, and social skills. These changes generalized across toys and settings, although little generalization to other play partners occurred. Effects of play training with children with autism and maintenance of behavior change is discussed.This research was supported by U. S. Public Health Service research grants MH39434 (Laura Schreibman, Principal Investigator) and MH28210 (Robert L. Koegel, Principal Investigator) from the National Institute of Mental Health. The authors thank Tami Schiern, Jay Goldschmidt, and Stacy Amano for assistance in data collection and reliability; Karen Pierce and Doug Anderson for reviewing an earlier draft of the paper, and in particular the families and teachers who participated in the project.     

The nature of friendship in children with autism spectrum disorders: A systematic review

This paper provides a systematic review of 24 studies that addressed the characteristics of friendship in school-age children with a diagnosis of autism spectrum disorder (ASD). The following questions were addressed: who are the participants, what methodologies have been employed, and what is our understanding of friendship in children with ASD. The results of this review indicate important differences in the manifestation of friendships in individuals with ASD as compared to typical children. While there is consistent evidence for several topographical differences in friendship characteristics, a number of gaps in our knowledge are evident. These include limited data on children who have intellectual disability, and on the perspective of nominated friends as well as circumscribed data on satisfaction with friendship relationships. In addition, there are a number of methodological limitations that restrict interpretation of extant research. Implications for future studies are discussed.     

Brief report: Parent-guided movements during play with children with autism spectrum disorder

BackgroundChildren with autism spectrum disorder (ASD) demonstrate social and communication impairments from an early age. While researchers have long investigated parenting behaviors in relation to children’s social and communication development, fewer studies have examined the relevance of movement-based parenting behaviors to facilitating communication and social engagement with young children. The present study aimed to investigate: (1) parent-guided movements (PGMs) within dyads of parents and typically developing (TD) children and children with ASD; and (2) children’s ASD diagnostic and receptive language scores as predictors of PGM frequency.MethodVideo-recorded play interactions of 33 TD dyads (mean age: 20.4 months) and 31 dyads with ASD (mean age: 32.6 months) were matched on child’s expressive language. Data were obtained from a longitudinal study on developmental language trajectories in ASD and coded for PGMs.ResultsOverall, parents of children with ASD initiated PGMs more frequently than parents of TD children during play (U = 269.00, z = − 3.58, p < 0.001). PGM frequency was predicted by children’s ADOS scores (X² = 5.46, p = 0.02, OR = 1.26, 95% CI [1.04, 1.54]) and receptive language (X² = 4.15, p = 0.04, OR = 5.43, 95% CI [1.10, 27.67]).ConclusionsFindings suggest that parents of children with ASD and low receptive language may utilize more movement-based strategies to compensate for their children’s impaired social engagement and verbal comprehension. This study offers insight on a particular movement-based modality characterizing ASD dyads that can be used as a measure in parent-mediated interventions.     

The quality of life of parents of children with autism spectrum disorder: A systematic review

BackgroundPrevious research has raised concerns about the quality of life (QoL) of parents of children with autism spectrum disorder (ASD). A better understanding of parental QoL can inform clinicians and policymakers and lead to improved outcomes for both parents and children.AimsThis review aimed to systematically examine studies measuring the QoL among parents of children with ASD (<18 years) and to investigate its parental, child-related and contextual associated factors.MethodologyAn electronic database search was conducted using Medline, Psycinfo, Embase, CINAHL, Biosis, ASSIA, Social Services Abstracts, Sociological Abstracts and Open grey.ResultsThis review indicated poorer QoL among parents of children with ASD compared to parents of typically developing children or to population norms. Variables associated with lower parental QoL within this group included child behavioural difficulties, unemployment, being a mother and lack of social support.ConclusionThis review verified previous reports on lower QoL among parents of children with ASD and highlighted potential areas of support. Implications for future research, policy and practice are discussed.     

Parent training: A review of methods for children with autism spectrum disorders

Autism Spectrum Disorders (ASD) are common in the general childhood population, and are both serious and lifelong. Tremendous strides have been made in the treatment of these ASD in recent years, particularly with respect to psychological interventions. Given the considerable amount of time and cost involved in providing these interventions, parent training and involvement is a particularly appealing intervention option. This paper is a review and status report on evidence based methods that are available for training parents of children with ASD as therapists. Current trends and future directions are discussed.     

Using video modeling for generalizing toy play in children with autism

The present study examined effects of video modeling on generalized independent toy play of two boys with autism. Appropriate and repetitive verbal and motor play were measured, and intermeasure relationships were examined. Two single-participant experiments with multiple baselines and withdrawals across toy play were used. One boy was presented with three physically unrelated toys, whereas the other was presented with three related toys. Video modeling produced increases in appropriate play and decreases in repetitive play, but generalized play was observed only with the related toys. Generalization may have resulted from variables including the toys' common physical characteristics and natural reinforcing properties and the increased correspondence between verbal and motor play.     

Methods for assessing sleep in children with autism spectrum disorders: A review

A literature review completed by Bauer and Blunden (2008) determined that compared to objective measures, subjective assessments of sleep for typically developing children (e.g., parental reports) were of limited utility. No comparable literature review has been undertaken to determine whether subjective measures are appropriate for assessing sleep in children with autism spectrum disorders (ASD). Such a review is necessary as children with ASD have more sleep problems than typically developing children and children's sleep difficulties can negatively affect the child and other family members. It is, therefore, important to have measures of sleep for children with ASD that can reliably detect sleep problems and track improvements in sleep. This literature review described frequently used measures of children's sleep and evaluated their utility for assessing sleep in children with ASD. It was determined that, with the exception of sleep latency, parents’ reports of children's sleep are not consistently associated with objective measures of children's sleep. This was true for single-item parent-reports and for a widely used multi-item parent-report measure of children's sleep. Limitations of objective sleep measures (e.g., polysomnography, actigraphy), including the inability of children with ASD to tolerate such methods, are described.     

Toilet training interventions for children with autism spectrum disorder: A systematic review

BackgroundChildren on the autism spectrum can often reach independence in toileting at a later age than nonautistic children, which impacts their health outcomes, independence and social participation. This study aimed to systematically review evidence-based toilet training interventions for children on the autism spectrum, and assess the quality of existing evidence.MethodGuided by the PRISMA statement, a search of scholarly databases was conducted and the study characteristics, methodological quality and intervention components of included studies were examined.ResultsThis systematic review identified 26 studies that evaluated toilet training interventions for children on the autism spectrum. Results identified that while Azrin and Foxx’s (1971) Rapid Toilet Training approach is most widely researched for children on the autism spectrum, investigating the effects of current toilet training approaches is limited by small sample sizes, low-level study designs and variable methods of reporting outcomes.ConclusionGreater consideration of parent-child communication, children’s developmental and toileting skill level may facilitate development of toileting approaches that better meet the needs of children on the autism spectrum and their families.     

The definition and prevalence of autism: A review

Sixteen studies of the prevalence of autism in childhood, using epidemiological methods in defined populations in Europe, the USA and Japan, in English or with English summaries, were found in the published literature. Age specific rates varied from 3.3 to 16.0 per 10,000. Eight studies gave rates for a sub-group of typical autism varying from 1.2 to 8.4. Reasons for variations were sought by examining geographic and demographic details of the populations screened, methods for initial screening and final examination of possibly autistic children, demographic and clinical details of children identified as autistic, and criteria used for diagnosis. There was evidence, independent of diagnostic criteria, of a higher prevalence among children of first generation immigrants to Europe from exotic countries. Apart from this, all differences could be due to variations in diagnostic practice and increasing awareness of the manifestations of autistic conditions throughout the range of intelligence, from severely retarded to average and above. However, it remains possible, though not proven, that rates do vary over place and/or time. The problems of defining a sub-group with typical autism among the wide spectrum of children with the triad of impairments of social interaction, communication and imagination are discussed and the value of such a sub-grouping questioned.

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Zusammenfassung In der englischsprachigen Fachliteratur (mindestens die Zusammenfassung in englischer Sprache) fanden sich 16 Prävalenzstudien zum Autismus im Kindesalter unter Anwendung von epidemiologischen Methoden in definierten Bevölkerungsstichproben aus Europa, USA, Kanada und Japan; die altersspezifischen Raten variierten zwischen 3,3 und 16,0/10.000. Acht Studien gaben Raten für typischen Autismus an: 1,2 bis 8,4/10.000. Nach Ursachen für die unterschiedlichen Prävalenzangaben wurden kritisch gesucht unter Prüfung der geographischen und demographischen Details der gescreenten Bevölkerungsstichproben, der Methoden des initialen Screenings und der endgültigen Untersuchung von möglicherweise autistischen Kindern, der demographischen und klinischen Details von Kindern, die aus autistisch identifiziert wurden, und der diagnostischen Kriterien. Es fanden sichunabhängig von diagnostischen Kriterien. Es fanden sichunabhängig von diagnostischen Kriterien-Hinweise für eine höhere Prävalenz unter Kindern von Eltern, die aus exotischen Ländern nach Europa eingewandert waren. Hiervon abgesehen, könnten alle Prävalenzunterschiede auf verschiedenen diagnostischen Vorgehensweisen und einem erhöhten Bewußtsein für die Manifestationen autistischer Störungen über die gesamte IQ-Verteilung (von schwer geistig behindert bis durchschnittlich bzw. überdurchschnittlich) beruhen. Es ist jedoch möglich, obgleich bislang nicht bewiesen, daß die Raten von der Zeit bzw. dem Ort abhängen. Die Probleme, die sich aus der Definition der Untergruppe typischer Autismus ergeben, werden diskutiert angesichts eines weiten Spektrums von Kindern mit Beeinträchtigungen der sozialen Interaktion, der Kommunikation und der Phantasie. Der Sinn dieser Untergruppenbildung wird in Frage gestellt.

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Résumé 16 études de prévalence de l'autisme dans l'enfance faisant appel à des méthodes épidémiologiques sur populations définies en Europe, aux U.S.A., Canada et au Japon, en anglais ou avec des résumés anglais ont été relevées dans la littérature publiée. Les taux varient de 3.3 à 16.0 pour 10.000. 8 études donnent des taux pour un sous-groupe d'autisme typique de 1.2 à 8.4. Les raisons de ces variations ont été recherchées en examinant les données geographiques et démographiques de la population concernée, les méthodes de repérage initial et d'examen final des enfants possiblement autistes, les données démographiques et cliniques des enfants identifiés comme autistes, et les critères utilisés pour le diagnostic. Il y avait à l'évidence, indépendamment des critères diagnostiques, une prévalence plus élevée parmi les enfants de première génération émigrant en Europe depuis des pays exotiques. A part cela toutes les différences pouvaient être dues aux variations dans la pratique diagnostique et la prise de conscience croissante des manifestations des conditions autistiques au travers des écarts d'intelligence, depuis les formes sévèrement retardées jusqu'à la moyenne et au-dessus. Cependant, il reste possible, bien que non prouvé, que les taux varient selon les lieux et l'époche. Les problèmes de définition d'un sous-groupe avec autisme typique parmi le spectre large des enfants avec la triade de défauts d'interaction sociale, de communication et d'imagination sont discutés ainsi que la valeur d'un tel sous-groupe.

     

Clinical effects of fenfluramine on children with autism: A review of the research

A review of research studies published to data on the effects of fenfluramine on children with autism is presented. The current status of the fenfluramine research on children with autism is assessed. The review analyzed the methodological aspects of the research, the toxicity of fenfluramine, and the relationship between fenfluramine, neurotransmitter activity, cognitive ability, and subsequent behavioral change. The review of published data indicated that fenfluramine had positive effects on the reduction of hyperactivity and stereotypic behaviors in 33% of the subjects. The best responders were children with the highest baseline IQs. The conclusions address the need for appropriate subgrouping of autistic syndromes, which may lead to identification of responders to pharmacological treatments. The need for further study of the possible long-term adverse side effects of flenfluramine is noted. Further experimental research on the effects of fenfluramine on children with autism is endorsed.     

Parent-implemented natural language paradigm to increase language and play in children with autism

Three parents of children with autism were taught to implement the Natural Language Paradigm (NLP). Data were collected on parent implementation, multiple measures of child language, and play. The parents were able to learn to implement the NLP procedures quickly and accurately with beneficial results for their children. Increases in the overall rate of vocalizations were observed for all three children with a shift from imitative language at the beginning of intervention to spontaneous language at the end of intervention. Clear improvements in play were observed for two of three children while ceiling effects were observed for a third child who already played effectively. In response to a social validity questionnaire, parents indicated that they found the study useful and the NLP procedures simple to implement and that that they would continue to use NLP at home following the conclusion of the study.     

Teaching typically developing children to promote social play with their siblings with autism

Siblings are important “peers” for children. Unfortunately, children with autism often do not play or interact often with their typically developing siblings. The purpose of this study was to teach three typically developing children (ages 4-6) skills that were likely to increase the amount and quality of social play interactions with their brothers who have autism. A teacher used the teaching interaction procedure to teach typically developing children to provide clear instructions and prompt and reinforce appropriate play behavior such as joining into a play activity, sharing toys, and engaging in appropriate toy play. All three typically developing children learned the targeted skills during role-plays with a teacher and, to a large part, generalized the skills when they played with their brothers with autism. In addition, some children who learned these skills increased their positive interactions and decreased negative interactions during a free-play period with their sibling with autism.     

Neural and cortisol responses during play with human and computer partners in children with autism

Children with autism spectrum disorder (ASD) exhibit impairment in reciprocal social interactions, including play, which can manifest as failure to show social preference or discrimination between social and nonsocial stimuli. To explore mechanisms underlying these deficits, we collected salivary cortisol from 42 children 8–12 years with ASD or typical development during a playground interaction with a confederate child. Participants underwent functional MRI during a prisoner’s dilemma game requiring cooperation or defection with a human (confederate) or computer partner. Search region of interest analyses were based on previous research (e.g. insula, amygdala, temporal parietal junction—TPJ). There were significant group differences in neural activation based on partner and response pattern. When playing with a human partner, children with ASD showed limited engagement of a social salience brain circuit during defection. Reduced insula activation during defection in the ASD children relative to TD children, regardless of partner type, was also a prominent finding. Insula and TPJ BOLD during defection was also associated with stress responsivity and behavior in the ASD group under playground conditions. Children with ASD engage social salience networks less than TD children during conditions of social salience, supporting a fundamental disturbance of social engagement.