Examining the categorisation of imaginative play & repetitive behaviours in Autism Spectrum Disorders

Abstract

It is well established that Autism Spectrum Disorders (ASD) are characterised by impairments in social interaction, communication and imagination and that impaired imagination is associated with repetitive behaviours (Wing & Gould, 1979). Although this view has influenced research and clinical practice for more than 25 years, the connection between imagination and repetitive behaviour has been completely unexplored in research and not been fully recognised by International Classification of Diseases-10 (ICD-10, 1993; World Health Organization, 1994) criteria for autism. The purpose of this thesis was to examine associations between imagination and repetitive behaviour and to develop two new methods to assess these abilities. A review of the literature revealed that research on repetitive behaviours was limited and that while extensive research had been carried out on symbolic play in autism developmental considerations were lacking with research focusing instead upon the autistic nature of play i.e. its rigidity and flexibility. In order to first obtain a range of information about the association between these two abilities, a parent report questionnaire (Activities and Play Questionnaire-Revised) was developed and tested in a study of 141 typically developing children and children with ASD aged 2 to 8-years old. Results showed that children with ASD had more repetitive behaviours and less symbolic play than children of typical development (TD). Symbolic play in children with ASD was predicted by both expressive language ability and level of repetitive behaviours while symbolic play was predicted only by expressive language ability in TD children. As the questionnaire method had limitations in its ability to fully test language and symbolic play, observational methods were used in subsequent studies. The repetitive behaviours and symbolic play of young children with ASD of limited verbal ability (N=75) were assessed using the Autism Diagnostic Observation Schedule 一 Generic (Lord, Rutter & DiLavore, 1996). Results confirmed associations found in Study 2 between level of repetitive behaviours and the level of symbolic play and showed that level of symbolic play was primarily influenced by expressive language ability. Building upon these findings, a new rater-based observational method was developed using a model of typical play development. This measure allowed detailed examination of the sophistication of different aspects of symbolic play in ASD, something lacking in previous research and existing measures of play. The observational measure was found to be valid and reliable when used with typical and atypical populations. Subsequent use of the measure revealed that young children with ASD (N=60) had specific difficulties in engaging in play spontaneously and in using objects in play although play could be improved by an adult's use of prompts. This study confirmed the previous evidence of an association between repetitive behaviours and symbolic play in the ASD population and that this association is influenced by language ability. This research has produced two new measures which may be used in future clinical and research work into repetitive behaviour and symbolic play in typical and atypical populations. The finding of an association between imaginative play impairments and repetitive behaviours in children with ASD supports Wing & Gould (1979) and suggests