Parent-child interaction in autism: play behavior

According to a recent study conducted by Freeman and Kasari of the Semel Institute for Neuroscience and Human Behavior, the importance of play and engagement in young children with autism is rooted in parental strategies. Due to the fact that parent-child interactions involving episodes of sustained play and engagement is critical in the development of autistic children, it is important to provide these parents with the necessary tools to properly stimulate engagement. 

Play behavior

The study examined the extent to which parents of young children with autism match and support their child’s play. The researchers concluded: “playing within the child’s zone of development (at or just above their mastered play level) resulted in greater engagement and increased children’s play level and diversity of play”.

Parents need to understand the level at which their child plays in order to either match or extend beyond their current level. Parents follow or match their child’s play behavior when they respond at the same level. Simply put, when a child brings an empty cup to their mouth to drink it is categorized as pretend play behavior.

A parent could match this behavior by pretending to eat a cookie or pretending to drink, etc. The researchers categorized the type of play-act using the Developmental Play Skills Levels (in Freeman and Kasari 2013, source: Kasari et al. (2006) and Lifter et al. (1988).), who carried out the act (parent or child), and how it was presented/the strategy the parent used (suggested, commanded, or imitated). Freeman and Kasari's study demonstrated that parents of autistic children found it more difficult to match or increase the level of play of their child compared to parents with typically developing children. 

Joint engagement

Another result the researchers presented was that periods of joint engagement were longer when the parent commanded and suggested less during playtime. The researchers explain that with this type of presentation (commanded, suggested) the interactions are not balanced between adult and child.

Understandably, for parents with autistic children, presenting a play scheme in a different way can be a challenge compared to parents with typically developing children who experience no need to command or suggest, because the child is more responsive to the engagement attempts of parents. Freeman and Kasari advise the implementation of particular strategies in early interventions with parents and their autistic children.

Parent-child interaction

To find these answers, Freeman and Kasari designed an observational study to be conducted in a laboratory setting, with an assessment room and an observation room. The study focused on the similarities and differences in play interactions between dyads with and without a child with autism. Parents of autistic children and parents with typically developing children were invited to the laboratory for the assessments.

In order to measure play level in children with and without autism, the children participated in a structured play assessment, during which the child and tester sat facing each other at a table. This play interaction lasted 15 to 20 minutes and was recorded on video.

In addition to this structured play assessment, parent-child free play sessions were analyzed. To observe and analyze this parent-child interaction, the parent and child were asked to play with a standard set of toys for 10 minutes, which were again recorded on video. As an example, one interaction which was coded was then transcribed in the publication (Freeman and Kasari, 2013).

The parent and child in this particular interaction pretended to drink tea together. The parent initiated play by putting a fork next to the bowl and a spoon next to the bowl, after which the child imitates this by repeating the same actions. Next the child initiates the next act by bringing his cup to his mouth which the parent then follows by also bringing his own cup to his mouth.  

Trained lab members coded parent and child behaviors displayed in the play session afterwards. The Observer XT software enabled the coding of:

• the play scheme (tea party or dinosaur battle)
• play act (the acts that make up the scheme)
• initiation
• the level of play according to the Developmental Play Skills Levels (in Freeman 2013 source Kasari et al. (2006) and Lifter et al. (1988))
• who carried out the act (play behavior)
• how the act was presented (suggested, commanded, or imitated)

The results of the study presented will guide further research and play intervention for parents with autistic children. 

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Reference

Freeman, S.; Kasari, C. (2013). Parent-child interaction in autism: Characteristics of play, Autism, doi 10.1177/1362361312469269.