A Stimulating Play Situation (SPS) Designed to Trigger Restricted Interests and Repetitive Behaviors In Young Autistic Children

Background:  The assessment of restricted interests and repetitive behaviors (RIRBs) in autism is based on direct observation combined with retrospective questionnaires and/or parental reports. Despite being a defining element of the autistic phenotype, RIRBs are allotted a lower diagnostic weight by currently used clinical instruments when compared to other behaviors, such as socio-communicative signs. Moreover, these instruments lead to the common conviction that RIRBs are not specific to autism, despite their important role in expert clinical judgments.  We are presently developing and evaluating the effectiveness of a novel stimulating play situation (SPS) as an alternative method for documenting RIRBs by observation, which when validated, could be used as part of diagnostic for younger autistic children.

Objectives:  1- To evaluate the effectiveness of using the SPS for discriminating between autistic and non-autistic participants based on RIRBs. 2- To document the presence and frequency of RIRBs within the context of SPS in groups of autistic and non autistic preschool-aged children.

Methods:  21 autistic and 24 non-autistic children, aged from 2 through 6 years, matched for chronological and non verbal developmental age (Mullen Scales of Early Learning), were exposed to the SPS, which consisted of three periods of free play, semi-free play, and semi-structured play (30 minutes in total). 35 objects triggering RIRBs and one object from the child’s home were displayed in a room. The presence and frequency of behaviors manifested during the SPS were coded on a grid that included 32 RIRBs (previously consented upon by 61 autism professionals; see Jacques et al, IMFAR 2009).

Results:  A greater proportion of autistic children presented 26 of the 32 RIRBs compared to non-autistic children, 5 of these RIRBs reaching statistical significance [hand flapping, hand or finger posturing, hopping, looking for the same objects, putting fingers in the mouth].  When present,28 RIRBs were manifested more frequently by autistic than non-autistic children, 8 of these RIRBs being statistically significant (the aforementioned 5 RIRBs, putting object in mouth, visual exploration and putting object in movement). ROC analyses demonstrated that the presence of more than 2 among these 8 RIRBs differentiated autistic from non-autistic children with a specificity of 82% and a sensitivity of 87%. Regarding which objects were explored, a greater proportion of autistic participants played with certain objects [hammer and balls toy [p<0,05], letters and numbers, action-reaction toy, mirror, sound blocks], and did so more frequently than non-autistics.

Conclusions:  The effectiveness of the SPS for differentiating between preschool-aged autistic and non-autistic children based on RIRBs is supported by the larger proportion of autistic children who displayed some RIRBs in the SPS, and the increased frequency of these RIRBs within each participant. In addition, the SPS is the only of its kind to identify real objects of interests for young autistic children. In conclusion, the SPS instrument is a useful measure for detecting RIRBs in young autistic children that can eventually be used as part of diagnostic assessment process with this population.