Core Features of Autism - Play and Behaviour
by Dr Avril Brereton
Restricted, repetitive and stereotyped
patterns of behaviour and interests are present in all
children with autism. It is one of the core symptoms that must be
present if a child is given the diagnosis of autism. However the
nature of these behaviours and interests varies widely across
individual children.
The DSM–IV criteria for restricted
repetitive and stereotyped patterns of behaviour, interests, and
activities in autism are:
Restricted repetitive and stereotyped
patterns of behaviour, interests, and activities, as manifested by
at least one of the following:
- Encompassing preoccupation with
one or more stereotyped and restricted patterns of interest that
is abnormal either in intensity or focus;
- Apparently compulsive adherence
to specific non-functional routines or rituals;
- Stereotyped and repetitive motor
mannerisms (e.g., hand or finger flapping or twisting, or
complex whole-body movements);
- Persistent preoccupation with
parts of objects.
(American Psychiatric Association:
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition, Text Revision. Washington, DC, American Psychiatric
Association, 2000)
Restricted patterns of interest
Children with autism have restricted
interests. Many children with autism have unusual preoccupations
that they follow to the exclusion of other activities.
Pre-schoolers may have fixations on certain toys or characters, such
as Thomas the Tank Engine or Buzz Lightyear and simply manipulate
these toys or watch TV or videos about them even though many other
toys or videos are available. If access to the favoured toy or
video is restricted or removed the child may become very
distressed. In middle to late childhood, verbal children with
autism are more likely to have a fascination with a particular
subject, such as train timetables or the Titanic. The child may
collect information and talk incessantly to others about this topic
or may repeatedly ask questions about it.
Routines and rituals
Many children with autism insist on
maintaining certain routines and/or rituals that seem to outsiders
to have no purpose. Some examples of this include drinking only one
type of drink from a specific cup, needing to have three spoons set
at their place at the table despite only using one or having to
follow a particular route to certain places. There is often an
associated resistance to change in routine or the environment so
that the child may become extremely distressed if, for example, a
new route is taken going to school, the furniture in the house is
rearranged, or the child is asked to wear new clothes.
Motor mannerisms
Most children with autism exhibit
motor mannerisms. Hand/arm flapping, finger twiddling, tip-toe
walking or twirling are common. Many children have their own unique
repetitive body or facial movements that they regularly engage in.
Some children become so preoccupied with these stereotyped
behaviours that they have very few other play interests.
Preoccupation with parts
Many children with autism are more
interested in parts of objects rather than the object as a whole.
For example, they may be fascinated with the wheels on toy cars and
may spin them but may not play with the car in any other way. There
is often a fascination with movement of objects and children with
autism may spin objects such as plates, balls or wheels. They may
also closely watch a spinning fan. Visual scrutiny of the fine
detail of an object such as the edge of a table, or pattern of
spokes on a wheel is also common, as is the collection of objects,
such as buttons or twigs.
Children with autism must exhibit
behaviours from at least one of these categories to
meet the criteria of a diagnosis of autism in DSM-IV (American
Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Text Revision. Washington, DC, American
Psychiatric Association, 2000), however some children may exhibit
all of them.
Play Skills
Another behaviour that is affected in
children with autism is the ability to play. An important aspect of
each child’s development is the ability to fill in their day with
useful activity and social contact. For typically developing young
children, the day is spent in a combination of activities involving
relating to other children and adults in their world, eating,
resting and for many hours each day, playing. This range of daily
activities is not typical for the young child who has autism.
Lack of creative and imaginative play
is one of the diagnostic features of autism and the ability to play
generally has to be taught to children with autism. Imaginative
play is particularly difficult for children with autism. In a way,
play becomes work for children with autism who would probably prefer
to spend their time engaged in rituals and repetitive routines that
exclude social contact and interest in what is going on around
them. These behaviours (as described above) can become so
entrenched that there is no time left for more useful, social and
educational play activities.
It is known that the earlier play
skills can be taught to young children, the better the chance that
rituals and routines may decrease. It is also known that intrusion
on the child’s isolation is an important way of establishing
contact. This can be achieved by offering toys and objects and
establishing play routines/games that the child finds enjoyable.
Teaching the child to play, by themselves and with others, serves a
number of important functions:
-
Children learn about their world through play.
-
A
child’s ability to communicate relates to their ability to play
symbolically. Improved play skills can lead to improved
communication skills.
-
As
play skills increase, rituals and routines tend to decrease.
-
Interactive play can increase social skills, such as learning to
take turns, sharing and co-operating.
-
Play
with toys provides an opportunity to teach the child new skills
that are important for later formal education. Some examples
are attending to others, attention to task, turn-taking,
following instructions and opportunities and topics for
conversation.
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