Inflexible Behavior in ASD and Typically Developing Children in Age-Appropriate Play Activities
Restricted, repetitive behavior is a defining feature of ASD, and includes behaviors that reflect an insistence on sameness or resistance to change. Children with ASD often follow fixed routines, show unusual preoccupation with objects, exhibit intense, circumscribed interests, perseverate in use of language, and are intolerant of new situations. It is not clear, however, whether ASD children differ from typically developing (TD) children in how rigid or inflexible they are in engaging in age appropriate everyday activities. Generating clear evidence for such differences in ASD and TD children will provide a solid rationale for a shift in treatment to include attempts to increase general variability and flexibility in behavior. This study is part of a larger research agenda designed to address the core problem of rigid and inflexible behavior in ASD.
The primary aim of this study was to assess restricted inflexible behavior in ASD and TD children using direct observations of behavior in a standardized environment with age appropriate activities.
Six activities were selected for two different age groups, younger children (ages 6-11 years old) and older children (ages 12-16 year old). Activities included computer time, watching a video, coloring, and other age appropriate activities. Participants included 19 ASD and 19 TD children matched on age, sex, and IQ. Participants were observed throughout two, 30-min sessions. In session one, children were told to play with any of the activities available. In session two, the same initial instruction was given and a prompt to switch activities was delivered if the subject was engaged with the same activity continuously for 2 minutes. Primary dependent measures included the number and duration of activities engaged with, transitions from one activity to another, and compliance to the prompts to switch. Additionally, any measures of idiosyncratic motor and vocal repetitive behavior also were scored.
Two distinct response patterns emerged from the data. First, in session one, we found overall more variability in the number of activities and transitions in the TD children compared to the ASD group. As expected, however, there were a number of ASD children and TD children that demonstrated similar response patterns, which consisted of only engaging with one item throughout the entire 30-min session. The difference among was the two groups was most apparent in session 2. On average, the TD group made 18 activity transitions compared to an average of 10 transitions in the ASD group. The average compliance to the prompt to switch was 77% in the TD group and 28% in the ASD group.
Though outcomes of session one appeared similar for many of the ASD and TD subjects, differences between the ASD and TD groups were most apparent in session two. Overall, the results demonstrated that restricted, inflexible behavior was characteristic of ASD children in interacting with play activities in a standardized environment. Moreover, transitions in these participants were limited even when prompted. These results represent the first such systematic comparison of observable inflexible behavior in ASD versus TD children.