The relation between social engagement and pretend play in autism.

The focus of this study is the nature and concomitants of pretend play among young children with autism. Age- and language-matched children with autism (n= 27), autism spectrum disorder (n= 14), and developmental disorders without autism (n= 16) were administered the Test of Pretend Play (ToPP; Lewis & Boucher, 1997), with an additional rating of 'playful pretence'. As predicted, children with autism showed less playful pretend than participants with developmental disorders who did not have autism. Across the groups, playful pretence was correlated with individual differences in communication and social interaction, even when scores on the ToPP were taken into account. Limitations in creative, playful pretend among children with autism relate to their restricted interpersonal communication and engagement.

How mothers with borderline personality disorder relate to their year-old infants.

BACKGROUND: Women with borderline personality disorder have conflictual interpersonal relations that may extend to disrupted patterns of interaction with their infants. AIMS: To assess how women with borderline personality disorder engage with their 12 to 18-month-old infants in separation-reunion episodes. METHOD: We videotaped mother-infant interactions in separation-reunion episodes of the Strange Situation test. The mothers were women with borderline personality disorder, with depression, or without psychopathological disorder. Masked ratings of maternal behaviour were made with the Atypical Maternal Behavior Instrument for Assessment and Classification. RESULTS: As predicted, a higher proportion (85%) of women with borderline personality disorder than women in the comparison groups showed disrupted affective communication with their infants. They were also distinguished by the prevalence of frightened/disoriented behaviour. CONCLUSIONS: Maternal borderline personality disorder is associated with dysregulated mother-infant communication.

Anticipatory concern: a study in autism.

There has been substantial research on children's empathic responsiveness towards distressed people, and on the limited responsiveness of children with autism. To date, however, there have not been experimental studies to test how far children show concern towards someone who might be expected to feel badly, when that person has not (yet) expressed any negative feelings. We tested matched groups of children with autism and learning disability, and typically developing children of similar verbal mental age (approximately 6 years), with a novel procedure in which participants witnessed one person (E1) tearing the drawing of another (E2). In a comparison condition, a blank card was torn. In the torn-drawing condition, as predicted, fewer participants with autism orientated towards E2 with an immediate look, and as a group, they were rated as showing less concern for, and fewer concerned looks towards, E2. We discuss possible implications for theoretical perspectives on the early development of empathy in typically as well as atypically developing children.

Qualities of symbolic play among children with autism: a social-developmental perspective.

We hypothesized that the qualities of play shown by children with autism reflect their impoverished experience of identifying with other people's attitudes and moving among person-anchored perspectives. On this basis, we predicted their play should manifest a relative lack of the social-developmental hallmarks that typify creative symbolic functioning. We videotaped the spontaneous and modelled symbolic play of matched groups of children with and without autism. The two groups were similar in the mechanics of play, for example in making one thing stand for another and using materials flexibly. By contrast, and as predicted, children with autism were rated as showing less playful pretend involving self-conscious awareness of pretending, investment in the symbolic meanings given to play materials, creativity, and fun.

Sensory sensitivities and performance on sensory perceptual tasks in high-functioning individuals with autism.

Most reports of sensory symptoms in autism are second hand or observational, and there is little evidence of a neurological basis. Sixty individuals with high-functioning autism and 61 matched typical participants were administered a sensory questionnaire and neuropsychological tests of elementary and higher cortical sensory perception. Thirty-two percent of autism participants endorsed more sensory sensitivity items than any control participants. Both groups made few errors on elementary sensory perception items. Controls made few errors on higher cortical sensory perception items, but 30% of the autism participants made high numbers of errors. These findings support the common occurrence of sensory symptoms in high functioning autism based on first person report, and the presence of neurological abnormalities in higher cortical sensory perception.

Dissociable aspects of imitation: a study in autism.

What does it mean for a child to imitate someone else? We tested matched groups of children with and without autism (n=16 for each group, with a mean chronological age of 11 years and a mean verbal mental age of 6 years) to investigate two potentially dissociable aspects of imitation: copying goal-directed actions, on the one hand, and imitating the "style" with which a person demonstrates those actions, on the other. Our hypothesis was that the latter, but not necessarily the former, kind of imitation reflects a special quality of interpersonal engagement in which one person identifies with another, and that the propensity to identify with others is specifically weak in autism. As predicted, participants with and without autism were similar in their ability to copy six relatively complex goal-directed actions but were significantly different in imitating the style with which six simpler goal-directed actions were executed, especially when style was incidental to accomplishing a goal. We interpret the findings in terms of a link among children's capacities for intersubjective engagement, imitation, and learning new ways to relate to objects.

The Relation between Severity of Autism and Caregiver-Child Interaction: a Study in the Context of Relationship Development Intervention.

The aim of this study was to examine the relations between severity of children's autism and qualities of parent-child interaction. We studied these variables at two points of time in children receiving a treatment that has a focus on social engagement, Relationship Development Intervention (RDI; Gutstein 2009). Participants were 18 parent-child dyads where the child (16 boys, 2 girls) had a diagnosis of autism and was between the ages of 2 and 12 years. The severity of the children's autism was assessed at baseline and later in treatment using the autism severity metric of the Autism Diagnostic Observation Schedule (ADOS; Gotham et al. Journal of Autism and Developmental Disorders, 39, 693-705 2009). Although the ADOS was designed as a diagnostic measure, ADOS calibrated severity scores (CSS) are increasingly used as one index of change (e.g., Locke et al. Autism, 18, 370-375 2014). Videotapes of parent-child interaction at baseline and later in treatment were rated by independent coders, for a) overall qualities of interpersonal relatedness using the Dyadic Coding Scales (DCS; Humber and Moss The American Journal of Orthopsychiatry, 75, 128-141 2005), and b) second-by-second parent-child Co-Regulation and Intersubjective Engagement (processes targeted by the treatment approach of RDI). Severity of autism was correlated with lower quality of parent-child interaction. Ratings on each of these variables changed over the course of treatment, and there was evidence that improvement was specifically related to the quality of parent-child interaction at baseline.

The relationship development assessment - research version: preliminary validation of a clinical tool and coding schemes to measure parent-child interaction in autism.

The aim of this project was to replicate and extend findings from two recent studies on parent-child relatedness in autism (Beurkens, Hobson, & Hobson, 2013; Hobson, Tarver, Beurkens, & Hobson, 2013, under review) by adapting an observational assessment and coding schemes of parent-child relatedness for the clinical context and examining their validity and reliability. The coding schemes focussed on three aspects of relatedness: joint attentional focus (Adamson, Bakeman, & Deckner, 2004), the capacity to co-regulate an interaction and the capacity to share emotional experiences. The participants were 40 children (20 with autism, 20 without autism) aged 6-14, and their parents. Parent-child dyads took part in the observational assessment and were coded on these schemes. Comparisons were made with standardised measures of autism severity (Autism Diagnostic Observation Schedule, ADOS: Lord, Rutter, DiLavore, & Risi, 2001; Social Responsiveness Scale, SRS: Constantino & Gruber, 2005), relationship quality (Parent Child Relationship Inventory, PCRI: Gerard, 1994) and quality of parent-child interaction (Dyadic Coding Scales, DCS: Humber & Moss, 2005). Inter-rater reliability was very good and, as predicted, codes both diverged from the measure of parent-child relationship and converged with a separate measure of parent-child interaction quality. A detailed profile review revealed nuanced areas of group and individual differences which may be specific to verbally-able school-age children. The results support the utility of the Relationship Development Assessment - Research Version for clinical practice.

Symbolizing as interpersonally grounded shifts in meaning: social play in children with and without autism.

The aim of this study was to examine the relation between symbolic play and communicative engagement among children with and without autism. Our predictions were firstly, that in moment-by-moment interactions during semi-structured interactive play with an adult, children with and without autism would tend to show shifts in meanings in symbolic play when engaged in coordinated states of joint engagement (events involving 'sharing-of-meaning'); secondly, that across atypically developing participants, sharing-of-meaning would (a) correlate with scores on a standardized test of pretend play, and (b) be inversely correlated with scores on the Autism Diagnostic Observation Schedule; and finally, that participants with autism would contrast with matched developmentally delayed participants in manifesting lower levels of joint engagement, lower levels of symbolic play, and fewer shifts in symbolic meaning. Each of these predictions was borne out. The intimate developmental relation between social engagement and symbolic play appears to be important for explaining the developmental psychopathology of autism.

Autism severity and qualities of parent-child relations.

The aim of this study was to examine how severity of autism affects children's interactions (relatedness) and relationships with their parents. Participants were 25 parent-child dyads that included offspring who were children with autism aged from 4 to 14 years. The severity of the children's autism was assessed using the calibrated severity metric of the Autism Diagnostic Observation Schedule (Gotham et al. in J Autism Dev Disord 39:693-705, 2009). Parent-child dyads were videotaped in 10-min semi-structured play interactions, and qualities of interpersonal relatedness were rated with the Dyadic Coding Scales (Humber and Moss in Am J Orthopsychiatr 75(1):128-141, 2005). Quality of relationships between parents and children were evaluated with a parent self-report measure, the Parent Child Relationship Inventory (Gerard in Parent-Child Relationship Inventory (PCRI) manual. WPS, Los Angeles, 1994). Multivariate regression analysis revealed that severity of autism was inversely related to patterns of parent-child interaction but not to reported quality of parent-child relationship. We consider the implications for thinking about relatedness and relationships among children with autism, and opportunities for intervention.

Dialogic linkage and resonance in autism.

We evaluated how children with autism make linguistic adjustments when talking with someone else. We devised two novel measures to assess (a) overall conversational linkage and (b) utterance-by-utterance resonance within dialogue between an adult and matched participants with and without autism (n = 12 per group). Participants with autism were less able to establish 'cognitive linkage' with an interlocutor. As predicted, only among children with autism was there a positive correlation between the ability to link in with speaker's meanings and ratings of emotional connectedness with the conversational partner. Participants with autism were not less likely to show a basic form of dialogic resonance across successive utterances (the 'frame grab'), but more often elaborated their responses in an atypical manner.

Infant responding to joint attention, executive processes, and self-regulation in preschool children.

Infant joint attention is related to behavioral and social outcomes, as well as language in childhood. Recent research and theory suggests that the relations between joint attention and social-behavioral outcomes may reflect the role of executive self-regulatory processes in the development of joint attention. To test this hypothesis two studies were conducted. The first, cross-sectional study examined the development of responding to joint attention (RJA) skill in terms of increasing executive efficiency of responding between 9 and 18 months of age. The results indicated that development of RJA was characterized by a decreased latency to shift attention in following another person's gaze and head turn, as well as an increase in the proportion of correct RJA responses exhibited by older infants. The second study examined the longitudinal relations between 12-month measures of responding to joint attention and 36-month attention regulation in a delay of gratification task. The results indicated that responding to joint attention at 12-months was significantly related to children's use of three types of self-regulation behaviors while waiting for a snack reward at 36 months of age. These observations are discussed in light of a developmental theory of attention regulation and joint attention in infancy.

Personal pronouns and communicative engagement in autism.

In three experimental conditions, we tested matched children with and without autism (n = 15 per group) for their comprehension and use of first person plural ('we') and third person singular ('he') pronouns, and examined whether such linguistic functioning related to their social interaction. The groups were indistinguishable in their comprehension and use of 'we' pronouns, although within each group, such usage was correlated with ratings of interpersonal connectedness with the collaborator. On the other hand, participants with autism were less likely to use third person pronouns or to show patterns of eye gaze reflecting engagement with an interlocutor's stance vis-à-vis a third person. In these settings, atypical third person pronoun usage seemed to reflect limited communicative engagement, but first person pronouns were relatively spared.

Identification: the missing link between joint attention and imitation?

In this paper we outline our hypothesis that human intersubjective engagement entails identifying with other people. We tested a prediction derived from this hypothesis that concerned the relation between a component of joint attention and a specific form of imitation. The empirical investigation involved "blind" ratings of videotapes from a recent study in which we tested matched children with and without autism for their propensity to imitate the self-/other-orientated aspects of another person's actions. The results were in keeping with three a priori predictions, as follows: (a) children with autism contrasted with control participants in spending more time looking at the objects acted upon and less time looking at the tester; (b) participants with autism showed fewer "sharing" looks toward the tester, and although they also showed fewer "checking" and "orientating" looks, they were specifically less likely to show any sharing looks; and, critically, (c) within each group, individual differences in sharing looks (only) were associated with imitation of self-other orientation. We suggest that the propensity to adopt the bodily anchored psychological stance of another person is essential to certain forms of joint attention and imitation, and that a weak tendency to identify with others is pivotal for the developmental psychopathology of autism.

Only connect? Communication, identification, and autism.

In this paper, we elaborate a theoretical position and report an empirical study on a specific form of interpersonal engagement: the propensity to identify with the subjective orientation of another person. On the basis of a hypothesis that individuals with autism have a relative lack of this form of intersubjective connectedness (Hobson, 1993, 2002), we predicted that children and adolescents with autism would contrast with matched participants without autism (n=12 per group) in specific aspects of communication when someone requested them to "Get Pete to do this" and demonstrated actions in Pete's absence. As predicted, on blind ratings of videotapes of participants' communication, those with autism achieved lower scores on four indices of identification that were selected a priori: emotional engagement, sharing experience in joint attention, communication of style, and shifting in communicative role. The two groups were almost completely separate on a composite measure of identification. We consider the implications of these findings for typical and atypical development.