Assessment of Patterns of Play in Children with and without ASD and Their Relations with Maternal Behavior in Collaborative Play Interactions

Background:

Specific deficits in play distinguish children with autism from typically developing children. These include differences in type, level and duration (Kasari & Chang, 2014). Although symbolic play is significantly associated with later social (Sigman & Ruskin, 1999) and cognitive (Stanley & Konstantareas, 2007) development, equivocal findings regarding levels of play in children with ASD make it particularly important to characterize play patterns and investigate variables associated with better developmental outcomes.

Objectives:

By investigating play between mothers and their children in their homes with their own familiar toys, play can be evaluated naturalistically. Specifically, this study investigates the relationships between maternal sensitivity, maternal initiations and children’s level and duration of play in young children with and without ASD. The levels of children’s play included sensory manipulation, simple object manipulation, relational play, functional play and symbolic play.

Methods:

Ninety mother-child dyads participated in this study. Forty-five mother-child dyads involved children with ASD and 45 children with typical development, matched for mental age {ASD: M = 53.9 (20.20); TD: M = 56 (15.32)}. Mothers were asked to play with their children “as they typically would” and their play interaction was videotaped for later analysis. Play levels were assessed according to the coding system of Marcu, Oppenheim, Koren-Karie, Dolev, and Yirmiya (2009), with adaptations for home play, and emotional sensitivity was assessed using the Emotional Availability Scales – 4^th Edition (Biringen, 2008). Maternal initiations and play act duration were calculated from the videotaped sessions.

Results:

Children with ASD exhibited more play acts, (t[88]=1.92, p=0.05), of shorter duration (t[88]=-2.12, p=0.02). Their play was characterized by lower levels of play, including simple object manipulation (t[88]=2.39, p=0.02), relational play (t[88]=2.01, p=0.05), and functional play (t[88]=-1.82, p=0.035), than those with TD. Mothers of children with ASD initiated more frequently than mothers of children with TD (t[88]=2.71, p=0.008), and interestingly, in both groups when mothers initiated more, their children played on a lower level {ASD: (r=-0.33, p=0.04); TD: (r=-0.36, p=0.08)} and for a shorter time {ASD: (r=-0.42, p=0.007; TD: (r=-0.43, p=0.008)}. No differences in maternal sensitivity emerged between groups.

Conclusions:

By evaluating levels of play of young children with and without ASD, and studying the relationship between their play and maternal behavior, this study supports the importance of looking at both the child and the play partner when characterizing variables associated with better outcomes. In addition, the need to study play in familiar contexts with real-life partners is underscored. These findings can serve as a foundation for interventions with young children with ASD, which should focus on socially mediated play using naturalistic strategies.