Play and Autism
I. Introduction
"Many handicaps are known to derive from a specific condition and in these cases treatments can be diverse and implemented. However, there exists many devastating handicaps for which there is no cure or even an exact diagnosis of where the problem lies. This is especially true of the condition called Autism. The one thing that we all would hope to peruse is the early intervention of children that suffer from autism and to assist them in skills that can carry over into aspects of life. One area that can help professional diagnose, analyze and therapeutically treat autistic children is in the area of play. Many of the stereotypical behaviors that autistic-like children display seems to manifest during play activities in young children. For this reason much research has been done in the domain of play in autistic-like children to analyze what exactly the deficits that these individuals have. The majority of the research only leads to theories of psychological states of mind. No formal and inconclusive definition has been given for the cause of autism." "Cures have been proclaimed, but not one of them has been backed by evidence" (Frith, 1993, p. 108).
Questions:
1. The stereotypical play behavior of autistic-like children (2 through 7 years) while in home and school settings can help to explain their cognitive and social development and their lack of symbolic or imaginative play, social interaction and limited joint attention.
2. Classroom adaptations in the educational setting have been found to help these children adjust their behavioral traits by increasing social interaction between students.
II. Data Collection
"The data collected was compiled from twelve research journals in the areas of medicine, psychology, psychoanalysis, child development, education and mental retardation. These journals were selected from a pool of tens of thousands of possible sources in the area of childhood autism. This was limited to the area of play in children two through seven years of age that suffer from autistic-like conditions. The source literature was sought out at four college libraries and three community libraries throughout the greater Cleveland area. (NOTE: The "autism" "autistic" will stand for "autistic-like" throughout this paper)"
III. Data Analysis
Stereotypical Traits
"For normally developing young children, play skills help them integrate their perceptual abilities and mechanical skills in relation to the environment, and this practice helps them anticipate future circumstances when they occur. In this integration of senses and evaluation of the world is a prerequisite to proper development during play. "...play assists children in mastering developmental tasks. These tasks include the development of habits necessary to assume complex roles in society...(Restall&Evans, 1994,p.113). In order for this to occur, children must formulate an accurate understanding of their own actions and those of others. They achieve a competent ability to understand others thoughts, communicate, and play in a variety of ways in relation to social interaction with individual during play activities. This has been seen to not be the case with autistic children."
"The stereotypical trait behaviors of autistic children (2-7 years) are narrowed to five characteristics in play and in life. Even outside of the recreational area of autistic children these traits are apparent in most everything they do. There limited abilities are then manifested in their playing skills, which helps us understand the real dilemma which exists. Frith (1993)) states that autistic children have a three-tiered handicap which diminishes their ability during play and other activities. He says that communication, imagination and social forms of interaction form a "distinct triad in which the autistic child's ability to play in ways that are seen as normal are extremely hampered" (p.111)."
"The autistic child plays most of the time by themselves, even if others initiate play. "...Children with autism spent a greater amount of time in solitary play than their normally developing peers"(Evans&Restall,1`994,p.113). By not receiving the important interaction with others, play becomes repetitive. Autistic children have repetitive nature in that their favoritism for variety is deficient. They play with very few toys. When they discover an item, they will continuously play with it and become extremely attached to it. Frith(1993) tells us: "The impairment in imagination appears in young autistic children as repetitive play with objects"(p.111)."
"Autistic children are impaired in social and imaginative skills, in that their symbolic and or imaginative play is non-existent. Hughes&Russell(1993) imply that imaginative play is replaced by functional play ability, where as the manipulation of an object is done for that action and not for a secondary or imaginative purpose (p.506). Restall&Evans (1994) found that autistic children are very good in games and activities that are highly structured and repetitive, with some sort of object manipulation in which the child can use it for some sort of a constructive use (p.114). Hughes&Russell (1993) discovered that "autistic children are relatively unimpaired on search tasks, tool use, and categorization by color, form, and function""(p.506). Still, this impairment in communication, socialization and imagination hinder upon each other to effect the autistic child's ability to understand what they perceive and how they understand what other's are thinking. Frith states that this "deficit" is believed to affect the autistic child's ability to evaluate their own thoughts and to clearly perceive what could be going on in another person's mind (p.111)."
"In most cases, autistic children are also impaired in higher order play acts that most mentally retarded children can achieve. This was found during an experiment on the comparison of higher order play acts that most mentally retarded children can achieve. This was found during an experiment on the comparison of higher order play acts of autistic children compared to mentally retarded children. "The autistic children showed fewer different functional play acts than either control group and fewer symbolic play acts, as well as fewer integrated sequences of play, than the mentally retarded children. "The differences were greatest in terms of object-directed and doll-directed play acts"(Sigman&Mundy,1987,p.34). Young autistic children cannot grasp multiple uses for an object, or using one object to stand for another. For this involved representation or symbolization. "Insofar as they cannot differentiate themselves from other people and things, autistic children's capacity to symbolize is compromised"(Hobson,1990,p331)."
"The only way for us to understand why autistic children lack in the play skills of symbolization or imitation, diversity, social integration and appropriate play is to analyze their cognitive abilities. In other words, why these social skills are extremely hard for them. Only after evaluating the origin of the deficits, can we understand why they have these troubles."
Cognitive Understanding of Stereotypical Behavior
"It would seem that abstract thought is the core of the deficits in these children. How one perceives the world and other people leads to a better understanding of ourselves, and it would seem that autistic children do not have this ability. Many hypothesis can be made in this realm on a variety of areas, but the most relevant to this cause is to focus on the concept of understanding abstract thought, such as fantasy, imagination and affective feelings of others."
"These are common in that they are invisible bodies, which are elusive and non-tangible. They make up the very existence of thought, in which we can perceive the environment and evaluate events before they happen. Frith(1993) believes if we did not have this ability, we would be limited in virtually every aspect of social recognition including imitative or symbolic thought, which requires second-order representation (p.113). Most psychoanalysts believe that the deficits in autism are centered around a cognitive handicap of some kind (Losche,1990,p749). This cognitive impairment is not locatable, but is thought that the lack of the ability to communicate, imagine, and socialize during play or another activity in autistic children is hypothesized as a singular cognitive mechanism(Frith,p.113)."
"This mechanism helps us make sense of thought and imagine what others are thinking about (Frith,p112). Without this ability, autistic children find tasks in play activities that require deception and competition very difficult. "Playing the role of guesser was not difficult for the autistic children, but they had severe problems being the hider"(Hughes&Russel,1993,p.502). In this, being the deceiver is difficult, for the autistic child's ability to implant a false belief in the competitors mind is of an abstract and oblivious nature to them. If they can see it as tangible (Such as a hand hiding a coin) then this is possible, but deceiving is a multiple level thought process, where by one would functioning on a second-order representation. "..this deficit is due to fundamental and inherent impairments in affective or cognitive understanding of others"(Lewy&Dawson,1992,p.556). This is the most crucial in understanding why autistic children do not play symbolically or imitate others and why they act repetitively in toy activities and limited in their variety of use. Some have hypothesized that studying Piaget's model of sensorimotor development we would be able to evaluate autistic child's cognitive development by observing their sensorimotor abilities."
"To understand sensorimotor we must refer to the fourth, fifth, and sixth levels of Piaget's theory of sensorimotor development. All children must develop through the six stages of sensorimotor development by the age of two years. The most important to understanding of the representational abilities of children and their goal directed behaviors and the understanding of others is in these stages (Losche,1990,p750).
"Stage 4: From 8 to 12 months of age the infant coordinates secondary circular reactions in goal-directed sequ3ences.
Stage 5: From 12 to 18 months is the stage of tertiary circular creation. The child begins to search for novelty and is curious about the world around him/her.
Stage 6: The period about 18 to 23 months of age, Piaget terms the "Beginning of thought." (Losche, 1990,p.750)."
"These three stages are important to many specialists that deal with autistic children. They feel stages 4, 5, and 6, represent the most crucial development in representational and object permanence (the ability to know that objects exist even when it is not present). Sigman&Mundy (1987) state that the abilities during the 5th and 6th stages require "representation" abilities. In the 5th stage, normally developing infants become competent of seeking solutions to problems by choosing a variety of new ways to achieve goals. In the last stage, the infant develops strategic plans in thought, without the use of trial and error to evaluate if a process works or not. Also, by stage six, infants have matured to understand that objects continue to exist even if they cannot be seen(p.35). If this theory is true, it would seem that autistic children would not be able to achieve even the fourth level of development. This is exactly what most of the experimentation's have dealt with, or in other words 'What is the highest level of development autistic children achieve and to what extent do they develop object permanence, end-means relationships, and imitative or symbolic ability'."
Losche(1990) states that most autistic children 31 to 42 months seem to show less behavior beyond stage 4, or more or less regress compared to their previous age range. She concluded: "..they were overly involved with practicing and repeating well known means to achieve well known outcomes"(p.758). Other experiments have been found to be contradictory in that higher order thought has been found to be in some autistic children.
"..Autistic children do not seem to have specific limitations in their knowledge of means-ends relationships, object permanence, or object categories. The deficit in representational thought seems to emerge only in terms of symbolic play. Thus, the general skill or capacity for representing knowledge does not appear to be a core deficit in autism. The deficit in representation appears to emerge when the child is required to represent concepts developed in the context of social interaction. The most salient differences in the play of autistic children are that they rarely direct play outward to other people and dolls and almost never attribute animate characteristics to dolls"(Sigman&Mundy, `1987,p.37-38).
"This lack of representational ability of attaching symbols to objects (such as a doll) the autistic child's use of imagination is void. Restall&Evens(1994) imply that being restricted in the lack of imagination by this cognitive impairment increase the autistic child to an attachment to preferred objects(p.114). This would mean that the only major deficit that autistic children seem to have is in the area of the affect-cognitive ability and symbolic or imaginative ability."
Symbolic Play
"This single trait stands out as the most substantial fact all professionals in the realm of autism agree upon. "Such is the acceptance of this standpoint the National Autistic Society itself cites a "Lack of creative pretend play"as one of the features characteristic of the syndrome"(Jarrold,Boucher,&Smith,1993,p.281). Frith(1993) hypothesize that in order to pretend in play, this a complicated or three party system. This would involve computing an actual situation in relation to an imaginary event, and the child that does the pretending(p.113). Others agree that we must focus in this area to understand autism in children. "The investigation of symbolic processes in young autistic children is crucial for understanding the syndrome of autism"(Sigman&Mundy,1987,p.31)."
"In order for a child to pretend or to use their symbolic abilities, the child must have the ability to understand that what they are doing is signifying an object to stand for another. This symbolization is only in their mind, and as soon as they do not want to pretend anymore, that thought vanishes. Remember that an autistic child has a very difficult time conceptualizing invisible bodies, such as thoughts about what other are thinking, for this involves second-order thinking. This means that pretending evolves pretense."Symbolic play involves pretense for the use of one object to stand for or represent another object"(Sigman&Mundy,1987,p.33). Others have found this to be true also in comparison with normally functioning children." "In the second year of life, a particularly dramatic manifestation of the critical component can be seen in normal children: the emergence of pretense, or the ability to engage in fantasy and pretend play. Autistic children cannot understand pretense and do not pretend when they are playing"(Frith,1993,p112).
"Some think that the ability to symbolize is learned early in life through the interaction we receive with others. Jarrold, Baucher&Smith(1993) reiterate this point. The symbolic nature of play or pretending when at play is only the result of learned behaviors taught by parents and teachers(p.286). This would mean that to grasp symbolism a child must have the ability to socialize, conceptualize and internalize this interaction accurately. If children with autism can not socialize normally then it would seem feasible to say their symbolization abilities would be lacking (Jarrold, Baucher&Smith,1993p.282). This was an important hypothesis that many studies wanted to find out. Namely, does social interaction determine the symbolic abilities of autistic children?"
Social Interaction
"Autistic children have a disruption in their ability to interpret others and the ability to symbolize, these two items are similar in that they both have a social qualities that involve learning and interaction. Autistic children are impaired in imitating and symbolizing for they are deficit in social interaction. "Autistic children suffer from deficits in social understanding and symbolic representations of other individuals. This core deficit appears to lie at the intersection of representational abilities and social experience...Thus, we are arguing that the core deficit at this developmental level is in social cognition"(Sigman&Mundy,1987,p.44). Similar conclusions have also been made that cognitive and symbolic deficiencies are caused by the lack of social practice. "One might speculate that the deficiencies demonstrated are not much a result of basic cognitive deficiencies, but rater secondary to limited social experience"(Wolfberg&Schular,1993,p.486). The autistic child can not understand or interpret others thoughts, this overwhelms the child for they can not integrate this cognitively. In this, autistic children will have difficulty. "Because dealing with novelty and making decisions are two prerequisites for successful social interaction, a child who was congenitally handicapped in this regard would fail to develop normal social relations"(Hughes&Russell,1993,p.508). Autistic children do not receive the practice in social relation that reflect their behavioral traits, this is why it hard for them to have meaningful friendships. "The impairment in socialization includes ineptness and inappropriate behavior in a wide range of reciprocal social interactions, such as the ability to make and keep friends"(Frith,p.111). This would mean that the autistic child's behavior during play and other activity lies in the lack of appropriate social interaction with others, and more importantly, other normally functioning children."
Joint Attention
"Many psychologists have stated that the main reason for the autistic child's lack of participation and other with them is from their inability to respond to joint-attention. This term is stated as: that other people have an individual point of view and have some interest in sharing this point of view"(Sigman&Mundy,1987,p.42). The reason autistic children's lack of joint attention have been found to be correlated with the cognitive impairments that they have."
"At least three possible inherent factors may play a role in autistic children's joint attention deficit. First is the sharing of positive affect ...which is a prerequisite to inter subjectivity ...second is the difficulty sustaining attention to social stimulation ...which is often unpredictable and novel...And third that autistic children are unable to attend simultaneously to, or switch attention between, the two sources of information (person and object) necessary to successfully show coordinated joint engagement"(Lewy&Dawson,1992,p.564).
Other studies have shown inconclusive evidence to support the inability of autistic children to engage in joint shared attention. "The autistic children exhibited lower frequencies on all of the behaviors aimed at initiating joint attention, regardless of the developmental level of the behaviors"{(Sigman&Mundy, 1987m,p.38). Even when compared to mentally retarded children this was also found. "...children with autism were less likely to initiate joint attention with their play partner than were children with mental retardation or children without dysfunction" (Restall&Evans,1993,p.113). Autistic children during physical play with others do not become fully involved in the social joint attention of play."When playing with adults the autistic children appeared "being played with" rather than playing with them. In other words they were the objects of interaction rather than being dynamically involved"(Losche,1990,p758).
Interaction in the social realm of play is important for these children to somehow formulate concepts of others and of themselves, to conceptualize feelings, and the reasons for such feelings. Without this ability some have implied this effects the symbolic ability of autistic children. "Therefore, it is likely that both cognitive and affective realms are disordered and that both contribute the deficits in joint attention and symbolic representation..."(Sigman&Mundy,1987,p.44). With this, all of the painstaking analysis has converged upon this aspect. That autistic Children (2-7 years) do not receive the appropriate amount of social experiences that are gauged for them during activities involving play. Their behavioral traits are correlated to cognitive abilities and these intellectual abilities are extremely diminished by their inactive social participation which is related to their social understanding of others The key for helping these children is to increase their social opportunities, for the enrichment of their lives.
IV. Data Collection
Intervention Strategies to Increase Social Opportunities
"Autistic children do not receive that same amount of social interaction, consistently and at the same level as their normally functioning peers. Their cognitive and sensorimotor ability are left neglected without the social stimulation and practice at socializing that their young minds desperately need. Their stereotypical trait behaviors have all been implicated as perpetuation's of the larger picture that results from the inactive social mind of the autistic child.
To change this lack of social progress, intervention strategies must concentrate on socialization for autistic children. This does not just mean socialization in play groups, but all curriculum, to give multiple chances and dimension of interaction for the autistic child."
Social Skills Instruction
This would be best with normally functioning children. "These findings support the use of social skills instruction in small-group formats that include non handicapped peers and students with autism"(Kamps&et al,m1992,p287). Social skills training not only has been found to enhance the appropriate behavior that some autistic have difficulty in but more importantly, to increase the attention span. "The findings indicated that social skills training for students with autism conducted concurrently with non handicapped peers was a viable procedure for increasing the frequency of, time engaged in, and duration of social interaction for children in play groups"(Kamps,&et al, 1992, p.286-287).
Integrated Play Groups
The most promising finding to help autistic children are working in integrated play groups. "The integrated play groups model as whole is effective in enhancing play...evience was presented of remarkable qualitative changes in play and related behaviors across school and home settings. These changes include attachment to socially appropriate toys (i.e., dolls, stuffed animals) and pretend play, as well as decreases in aberrant behaviors"(Wolfberg&Shuler,1992,p.484). This simple strategy of mainstreaming has been the most promising tactic at curving the social inactivity these children face."
Peer Mediated Intervention
Case studies conducted have shown that autistic children seem to lack the practice in social skills not primarily for they are not integrated into the classroom, but more importantly their normally functioning peers are not initiating social interaction with them(Goldstein,Pennington&Shafer,1992,p.301). Peer mediated intervention focuses on giving the autistic child more multiple chances of interacting with their normal functioning peers and for the peers to initiating interaction more frequently. "A peer-intervention package that focused on attending to, commenting on and acknowledging the behavior of children with disabilities was effective in promoting improved social interaction among typical preschoolers and their classmates with autism"(Goldstein,Pennington&Shafer,1992,p.301).
Computer Assisted Instruction
It has been found now that computer assisted instruction has helped autistic children with their behavior without neglecting interaction with other students. "With regard to behavior problems, pilot data have indicated that children with autism are more enthusiastic when working with computers that in a regular toy situation." (Chen&Bernard-Opitz,1993,p369). More importantly, this case study gave evidence that small groups of autistic children work with each other productively, while not only interacting with the computer but more importantly, between themselves by turn-taking and verbal interaction. "Computer-based instruction promoted verbal interaction between students with autism, as this mode of instruction allowed peer-prompting. These improved social skills generalized to other situations" (Chen&Berneard-Opitz,1993,p368). Computer assisted instruction is the new wave of innovative ideas that are just the tip of the iceberg of ways to assist autistic children in social progress and communication.
Structuring and Behavior Modification
Simple techniques in the homes and classrooms have been seen to improve behavior. "..well-structured behavior modification programs have often helped families in the management of autistic children"(Frith,1993,p111). Restall&Evans(1993) state that play must be a vehicle in which occupational therapists use to foster social development in your autistic children (p.118). They also state (Evans&Restall) that modeling and reinforcement along wit guidance and teaching self-management skills to young autistic children increases the child's play behavior or the ability of staying on task (p.114).
Thus, the intervention task is to promote social development of autistic children, that should not be a singular and limited to only the classroom or home environment, but is must promoted through-out the child's multiple settings. This intervention must also be interacted into the curriculum and not simply at play, though recreation has been found to be very appealing to young children. It's primary focus must be social play development and not isolated play.
II. Conclusion
"In reviewing this literature of autistic-like children (2-7 years), I thought that their would be some highly scientific, and costly means in which to help these children to achieve a greater competence of affective-cognitive social interaction. It was extremely surprising to learn that the simplicity of inclusion of these children into the mainstream setting is the "magic point" that has been found to alleviate the handicaps that make educating these children so difficult for many of us.
We now know what must be done to help young autistic children, the dilemma is for parents and educators to become knowledgeable in this dimension of condition and activity. To be acutely aware of special consideration that must be standardized into the structure of teaching autistic children. Too many individuals teach autistic children with no patience or foresight to understand that there are qualities these children do have to achieve tasks in recreation and there are areas in which they simply do not connect. Educators and parents must find what works for them but at the same time find new and innovative ways at helping these children, because the child may have more ability than what they have made available to them, such as social play and practice.
By offering as many social opportunities autistic children may prosper. Even if some do not progress as much as we would hope, it is beneficial for the child to be included in the mainstream classroom with other normally functioning children. Both can help each other by trying to understand that to help someone when they are in need only helps us understand more about ourselves. To help someone, even if this cause may in time become futile, this may be the greatest lesson that we will learn, which is compassion, patience, and understanding."
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