Joint Attention and Play of Nonverbal Children with Autism

Background:

Children with autism often demonstrate delays in both joint attention (Mundy & Newell, 2007) and play (Mundy, Sigman, Ungerer, & Sherman, 1986). Joint attention and symbolic play both have been linked to language  (Toth, Munson, Meltzoff, & Dawson, 2006) . Furthermore it has been shown that interventions that target symbolic play and interventions that target joint attention both increase the expressive language of this population (Kasari, Paparella, Freeman, & Jahromi, 2008).  

Objectives:

The current study seeks to research links between nonverbal communication and play abilities for young children with autism.  The children attended a non-public school.  In order to participate, each child had to have less than five spontaneous and functional words.

Methods:

Fourteen children diagnosed with autism participated in the study.  All children were between the ages of three and five years old at entry.  Participants completed assessments on their cognitive skills (Mullen Scales of Early Learning) as well as assessments of their spontaneous communication (Early Scales of Social Communication, or ESCS) and play abilities (Structured Play Assessment).  Diagnoses of autism were confirmed by the Autism Diagnostic Observation Schedule.              

The ESCS (Mundy, Hogan, & Doelring, 1996) was videotaped and later coded for spontaneous communication skills.  These skills included gestures such as a give to request help and pointing to share distant objects.  For this study, only unprompted skills were counted.  Communication skills can include both requesting and sharing functions.             

The Structured Play Assessment (Ungerer & Sigman, 1981)was also videotaped and coded for spontaneous play actions.  The assessment provided opportunities for a range of play actions from functional play (e.g., completing shape sorters) to symbolic play (playing house with dolls and furniture).  Only unprompted skills were included for this study.  The present study focused on play types (different actions within a given play level) rather than frequency of play actions (how many shapes were put in a shape sorter).  For example, completing a shape sorter would be counted as one type of play action and completing a puzzle would be a second type.  They represent the same level of play, but are different examples.

Results:

A one-tailed correlation analysis revealed that children who exhibited more gesture communication skills on the ESCS also demonstrated more types of functional play skills in the Structured Play Assessment (r = 0.5, p<0.05).  When self-stimulatory behaviors were excluded from the play skills, the same relationship was found (r=0.48, p<0.05).  Gesture communication skill usage also significantly correlated with symbolic play type (r = 0.55, p<0.05).

Conclusions:

Results of this study indicate that spontaneous gesture use for communication is correlated with play abilities for nonverbal children with autism.  This finding supports other research work targeting communication skills through play and vice-versa.  Future studies should continue to develop interventions that target these skills to effects in other developmental skills among nonverbal children with autism.