The Relation Between Joint Attention, Pretend Play, and Imitation in Younger Siblings of Children with ASD

Background: Children with ASD (autism spectrum disorders) demonstrate early deficits in responding to joint attention (RJA), imitation, and spontaneous pretend play. These early abilities are of particular importance in early development, as empirical and theoretical evidence suggest that they are developmental precursors of subsequent deficits in ASD such as theory of mind. Parallel development of RJA, pretend play, and imitation in ASD and TD (typically developing) children is evidenced by the correlations in level of ability of these skills. While relations among RJA, pretend play, and imitation have been found in both TD and ASD, they have not yet been examined in younger siblings of children with ASD, who are at a higher risk for ASD and autism-related symptomology.
Objectives: To examine the relation between RJA, imitation, and spontaneous pretend play in younger siblings of children with ASD (SIBS-ASD).
Methods: The Screening Tool for Autism in Two-Year-Olds (STAT) and an RJA research measure were administered to 65 SIBS-ASD (Mean CA=15.4 mos., range 12-24 mos.). Items from the STAT designed to assess imitation and spontaneous pretend play were used in analyses.
Results: RJA, pretend play, and imitation were significantly related (imitation and pretend play: r=.28, p<.05; imitation and RJA: r=.43, p<.01; pretend play and RJA: r=.40, p<.01) in this sample of SIBS-ASD.
Conclusions: The same relation between RJA, imitation, and pretend play found in ASD and TD is also present in SIBS-ASD. The finding that these three proposed precursors to theory of mind ability are related in SIBS-ASD may be valuable in future theory of mind research.