Functional play in young children with autism and Williams syndrome: A cross-syndrome comparison

ABSTRACT

Functional play during early childhood paves the way to symbolic play and social communicative skills. However, functional play is surprisingly understudied in children with developmental disorders affecting social and communicative domains, such as Autism Spectrum Disorder (ASD) and Williams syndrome (WS). To address this issue and to evaluate both the quantity and quality of functional play in children with ASD and WS, we examined different play types using fine grained behavioral analysis with a group of age and IQ-matched developmentally delayed children with ASD (n = 14) and WS (n = 14) in comparison with 12 age-matched typically developing (TD) children. Significant differences were found in the quantity of functional play in the ASD and WS groups compared to TD children, with a limited breadth of object exploration found in children with ASD. While TD children engaged more frequently in functional versus nonfunctional play, this was not the case for children with ASD and WS, who showed the same amount of functional and nonfunctional play. Furthermore, functional play behavior was associated with intellectual and adaptive function in children with WS, but not ASD. These results point to the importance of intervention strategies that focus on functional play in improving developmental outcomes for children with ASD and WS.

KEYWORDS:

• Children
• Autism Spectrum Disorder
• Williams syndrome
• play types
• functional play

Acknowledgments

We would like to acknowledge the children and parents involved in the study, the Victorian Autism Specific Early Learning and Care Centre Team who facilitated recruitment and testing of the ASD sample, the Williams Syndrome Family Support Group (Victoria) and the Williams Syndrome Association Australia. We would also like to acknowledge the valuable contribution of A/Prof Melanie Porter, Stephanie Sievers, Anna Atkinson, Jessica Reeve, Simone Griffith, Jacqueline Maya, Melanie Muniandy and Cathriona Clarke.

Disclosure statement

The authors have declared that no competing interests exist.

Notes

¹ In this article, we will use the general term “play” in referring to unstructured or semi-structured play activities taking place in the physical world and requiring physical contact with toys or tools. Play activities involving digital devices (e.g. virtual reality, augmented reality) lay outside the scope of the present study (see Lai et al., 2018 for a clear distinction between digital vs. real life scenarios). Mostly we will be focusing on autonomous play scenarios (e.g. scenarios in which the child plays with one or more objects in presence of an adult who is not directly involved, but rather acts as a passive spectator).

² Distinctions between functional and symbolic play often differ in the literature, possibly due to the fact that the functional fitness of a pretend object is often a matter of degree (Szokolszky, 2016). In the present paper, we have taken a rather conservative approach, choosing to ascribe symbolic value only to actions in which toys or objects were clearly detached from their functional use (see Table 1 for comparisons with other classification systems). For example, if a child uses a peg as if drawing on paper, the functional component of drawing is lost and this becomes a case of symbolic play. But if the child draws with a marker on another surface, the function of the drawing tool is maintained and we are still in the realm of functional play albeit an unconventional one.

³ Given that reliable age of diagnosis for ASD is after 24 months, researchers attempting to capture behaviors occurring before this age have commonly relied on retrospective analyses of home videos or prospective studies of infants at high-risk for ASD (i.e. later-born infant siblings of children diagnosed with ASD with 18.7% recurrence risk) to capture emergence of play behaviors (Ozonoff et al., 2011).

⁴ Christensen et al. (2010) and Sigman and Ungerer (1984) defined functional play as including object-directed, self-directed and other directed actions, while symbolic play included using one object as another, attribution of pretend properties to actual objects/existence of pretend objects and doll-as-agent play.

⁵ Naber et al. (2008) report similar results in percentages of time spent in each play type (i.e. ASD group: 22.9% exploratory play, 32.2% functional play and TD group: 15.6% exploratory play, 56.3% functional play) to the ones found in the present study (i.e. ASD group: 24.5% exploratory play, 26.8% functional play; TD group: 18.9% exploratory play, 58.3% functional play).

Additional information

Funding

LS was supported by the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No. (660468). DRH was supported by an ARC Discovery Early Career Researcher Grant (DE160100042).