Building a story: Efficacy of pretend play intervention for school-aged children with Autism Spectrum Disorder

• In Event: Poster Session 13
  In Poster Session: PS 13 Topic - Developmental Disabilities

Abstract

Background: Autism Spectrum Disorder (ASD) is marked by deficits in cognitive flexibility, executive functioning, and overall socio-emotional functioning that emerge early in life, and these challenges continue to greatly impact development throughout the lifespan. Pretend play abilities in childhood are indicative of adaptive functioning and emotion regulation skills in later life (Russ, 1998; 2014), and the use of a pretend play intervention with typically developing children has shown to significantly increase cognitive and affective skills in play (Hoffman and Russ, 2012). Research has demonstrated that preschool-aged children diagnosed with ASD have impaired play skills compared to typical peers, but following a play intervention are able to execute improvements in these skills that generalized to increased social functioning at follow-up (Kasari, 2006; 2012). The present pilot study implemented a pretend play intervention with school-aged children diagnosed with high-functioning ASD (HF-ASD), with the primary goal of increasing children’s cognitive skills in play (specifically imagination and organization of the narrative in play), and the secondary goal of examining of such changes generalized to gains in emotional understanding abilities.
Methods: Twenty-five children (ages 6 to 9) diagnosed with HF-ASD were recruited to participate in the present study (intervention (INV) group = 18, waitlist control (WC) group = 7). Baseline and outcome visits were completed to obtain measures of cognitive and affective play skills, and emotional understanding abilities, as measured by the Affect in Play Scale (APS; Russ, 1993;2014) and the Kusche Affective Inventory, Revised (KAI-R; Kusche et al., 1988), respectively. Intervention sessions were 15-20 minutes in length, administered once weekly for 5 weeks. The play intervention was adapted from a validated method for typically developing children (Russ, Moore, and Farber, 2004), wherein the play facilitator uses pretend story stems to play with the child individually, employing techniques such as modeling, scaffolding, praising, reflecting emotions, and following the child’s lead.
Results: A series of mixed factorial repeated measures ANOVAs were used to evaluate within and between group differences from baseline to outcome. Results indicated that children in the INV group significantly increased their cognitive skills in play, while the WC group made no changes on these variables. Specifically, the INV group made significant gains in their skills in imagination in play, and ability to organize the story in play. Additionally, the INV group significantly increased in their ability to describe personal emotional experiences, while the WC group did not demonstrate any changes.
Conclusions: Findings from the present pilot study demonstrate the positive impact of a play intervention on cognitive play skills and emotional understanding abilities in school-aged children with HF-ASD, demonstrating increases in their cognitive flexibility. Limitations included the small sample size for the comparison control group. Results have important implications for 1) the efficacy of a short, easily facilitated, accessible play intervention for children with HF-ASD to directly improve their imagination and organizational skills in play, and 2) the influence that increasing pretend play skills can have to generalize to increases in children’s emotional understanding abilities.

Authors

• Ellen Doernberg, Case Western Reserve University
  Presenting Author

• Anastasia Dimitropoulos, Case Western Reserve University
  Non-Presenting Author

• Sandra Russ, Case Western Reserve University
  Non-Presenting Author