Pretend play and communication in children with autism : about dysregulation

Background: Autism is a severe developmental disorder characterized by social withdrawal, disorders of communication and symbolic play, resistance to change, and bizarre, stereotyped behaviors. We hypothesized that the difficulties of autistic child displays originate from basic disorders of organisation and regulation of actions according to environmental changes. Defined by difficulties in spontaneous production of actions and in maintaining and breaking off actions intentionally, this disorder impoverishes general mental representation skills, which are the basis of symbolic play and of development of communication.

Objectives: The main aim of this study was to investigate the regulation of actions involved in a symbolic activity, i.e.pretend play, in children with autism by comparing them to children with mental retardation and with normal development, strictly matched on developmental levels. A further aim was to investigate the relationship between the development and functioning of pretend play and the development of communication.

Methods: 21 children with autism were compared with 14 children with mental retardation and 15 normal children matched on overall and verbal developmental ages. Regulation of play activities was studied using original and appropriate clinical tools and from the assessment of two types of activity, one spontaneous and the other semi-directed. Communication development was assessed using ECSP.

Results: The results showed that regulation of play activities was very disordered in children with autism compared to the other groups, with breaking off, dissociation and instability of actions. However, in directed play their actions were more structured and corresponded to a better developmental level. In addition, dysregulation was associated with delayed, heterogeneous development of communication skills.

Conclusions: The results of this study are in line with our hypotheses and emphasize the role of the assessment of symbolic play for a differential diagnostic approach and the value for the therapeutic strategies based on regulation processes and symbolic play.