The Influence of Functional Play on the Development of Executive Functioning Skills and Aberrant Behaviors in Children with Autism

Background: Reports of deficits in spontaneous and varied types of play are reported in autism and findings from several studies support impoverished play as evidenced by reduced complexity, flexibility, and frequency of play behaviors. Play provides opportunities for the mastery of skills in the cognitive, executive functioning, motor, and emotional domains (Ginsberg, 2007). The current study proposes that early play provides a rewarding activity in which executive functioning skills can be practiced and improved, and through improved executive functioning skills appropriate behaviors can be developed and enhanced.

Objectives: The objective of the current study was to use a longitudinal design to test the hypothesis that functional and imaginative play influences the development of executive functioning skills and aberrant behaviors in children with autism.

Methods: Participants included 58 children with autism spectrum disorder (aged 34-52 months; 47M, 11F) and 26 mental age-matched children with other developmental disorders (aged 33-57 months; 15M and 11F) participating in a larger longitudinal study of development. At time 1, functional play was assessed through a behavioral play assessment measure using dolls and objects and through ADOS codes of functional and imaginative play. Executive functioning (EF) abilities were measured 36 months later at Time 2 through an A not B task and a Spatial Reversal task. At time 3, when the participants were approximately 9 years old, the Aberrant Behavior Checklist, a parent report measure, was administered to assess current autism symptomology.  Relations between play skills, executive functioning skills, and autism symptoms were examined.

Results: The ASD group performed more poorly on measures of play than the DD group at all time points. After controlling for verbal IQ, correlations were found between play at Time 1, EF at Time 2, and stereotyped behaviors at Time 3 for children with ASD.  For this group, functional play at Time 1 correlated with measures of EF at Time 2 on both an “A not B” task (r = .262, p<.05) and a Spatial Reversal task (r = .453, p<.001), as well as the Stereotyped Behaviors domain of the ABC at Time 3 (r = -.352, p<.01). However, no relationship between EF skills and behavior was observed. In contrast, for the DD group play at Time 1 did not correlate with EF at Time 2, but correlated with ABC domains of Irritability (r = -.454, p<.05), Hyperactivity (r = -.613, p=.001), and Inappropriate Speech (r = -.427, p<.05) at Time 3.

Conclusions: The current study shows that functional play skills may influence subsequent cognitive and behavioral development for children with autism, specifically EF abilities and stereotyped behaviors. However, the relationship between play and stereotyped behaviors is not mediated by executive functioning skills.  Additionally, this developmental trajectory may be autism-specific, in that children with developmental disabilities matched on mental age showed no relationship between functional play and later EF skills or stereotyped behaviors. Instead, functional play was correlated with later development of other aberrant behaviors not specific to autism.