What Interests Young Autistic Children? Assessing Object Exploration and Repetitive Behaviors in a Stimulating Play Situation

Background:   Restricted and repetitive behaviors (RRBs) now play a more prominent role in autism diagnosis (APA, 2013), but remain understudied in young children. RRBs in autism range from repetitive movements to intense interests and are targeted in early interventions as barriers to progress (e.g., Rogers & DawsonG. 2010). However, studies in typical children suggest a positive relationship between intense interests and intelligence or expertise (DeLoache et al., 2007; Johnson et al. 2004; Krapp, 2002). Further, there are suggestions that autistics may learn well given access to materials related to their interests (DawsonM et al. 2008; Dunst et al. 2012). Thus one question about young autistic children is whether their repetitive behaviors limit or interfere with their object exploration. Another is whether they are interested only in simple sensory objects, or are also attracted to more complex materials such as those related to literacy.

Objectives:   To document object exploration and repetitive behaviors in young autistic and typical children, during periods of free and semi-free play in the Montreal Stimulating Play Situation (MSPS).

Methods:   53 autistic and 46 typical children were exposed to the MSPS. Autistic children were on average somewhat older (M=48.1 months, SD=11.5) than typical children (M=41.7 months, SD=16.0, p<0.05) but their mean MSEL composite standard scores (M=65.5, SD=20.0 vs M=110.3, SD=17.3, p<0.001) and language T-scores (expressive: M=25.9, SD=11.8 vs M=55.6, SD=12.7, p<0.001; and receptive: M=28.8, SD=12.8 vs M=53.3, SD=11.2, p<0.001) were dramatically lower. Using Noldus Observer, two naive raters coded 49 previously selected and defined repetitive behaviors in all children. They also coded the use of the 40 objects in the MSPS. 30% of the videos were double coded (K=0.47). 

Results:   Autistic children displayed a significantly greater overall number (p=0.02) and duration (p<0.001) of repetitive behaviors than typical children. Three specific repetitive behaviors were found in a greater proportion of autistic children, with higher frequency and greater duration: hand-flapping; arm movements; and the combination of close gaze, waving fingers, and lateral glances; all ps<0.05. In contrast, there were no significant differences between groups in duration (p=0.71) and frequency (p=0.24) of overall object exploration in the MSPS. For specific objects, exploration of mirror balls and books were observed in a greater proportion of autistic children, with higher frequency and longer duration (all ps< 0.05); whereas a greater proportion of typical children explored the roller caterpillar and remote-controlled car, with more frequent and longer explorations (all ps<0.05). With respect to literacy-related objects, proportion of autistic vs typical children who explored each was as follows: books 17% vs 6%; magnetic letters and numbers 59% vs 53%; picture dictionary 17% vs 17%; and regular dictionary 15% vs 6%.  

Conclusions:   Our results are preliminary but suggest that increased repetitive behaviors do not interfere with object exploration in young autistic children. In addition, these children showed equal or greater interest in literacy-related objects, in striking contrast to their low MSEL composite and language scores. These findings raise questions about popular assessments and interventions for young autistic children.