Spontaneous Pretend 1 Let’s Pretend: Predictors of Spontaneous Pretend Production in Children

This study examined predictors (autism spectrum disorder [ASD] symptoms; verbal ability, theory of mind [ToM]; interest in and familiarity with presented toys) of quantity of overall, and subtypes of observed spontaneous pretend play in typically-developing children. Participants were 31 children (ages 4 – 9; 21 male). Better ToM predicted more attribution of false properties to toys and more interest in the toys presented predicted more object substitution. While those with more interest in presented toys displayed more instances of object substitution, this relationship was strongest for those with a history of fewer ASD symptoms. Results support the importance of considering novel predictors and examining subtypes of pretend play. Implications for development of pretend ability among children with typical development with varying amounts of ASD symptoms are discussed. Spontaneous Pretend 4 Let’s Pretend: Predictors of Spontaneous Pretend Production in Children A common feature of childhood is playing. While exploring the world around them, children begin to play with everyday objects (i.e. pots and pans), more typical objects (i.e. dolls and toy cars), and eventually with their peers. By the time they are three years old, most typically developing (TD) children will independently and spontaneously engage in symbolic or pretend play, such as pretending a banana is a telephone (Lillard, 1993). Pretend play is a combination of play and pretense, or the “stretching (of) one reality over another” (p. 349, Lillard). The ability to pretend might also require a metarepresentational ability, or the ability to hold onto two mental representations in the mind (Leslie, 1987). The first reflects the state of the real world, or the perceived situation, and the second reflects the pretend situation. In order to engage in actions of pretend, one must take mental representations from the perceived situation (i.e. here is a cup, the cup is empty) and be able to map the pretend ideas onto the contexts of the real world (i.e. this cup that’s really empty contains tea; Leslie). Crucially, research suggests that engaging in actions of pretend is related to the development of verbal, social, and perspective-taking (Theory of Mind; ToM) abilities in TD children (Jenkins & Astington, 2000). While increasingly sophisticated pretend naturally emerges in TD children, there are children, such as those with autism spectrum disorder (ASD) – even those “high-functioning” children with intact verbal ability (HFASD) – for whom the development of pretend appears impaired (Jarrold, 2003). Even though children with ASD might pretend less and differently, research consistently suggests that many children with ASD do still pretend (Libby, Powell, Messer, & Jordan, 1998; Rutherford & Rogers, 2003; Baron-Cohen, 1987). Additionally, these children with ASD that can still pretend might show related benefits in other areas (i.e. ToM and verbal ability). Spontaneous Pretend 5 However, little work has carefully explored the factors that contribute to spontaneous pretend among children with varying levels of ASD symptoms, the consideration of which will help better illuminate the factors that contribute to the development of the ability to pretend. It is possible that certain symptoms of ASD might not contribute as a whole to deficits in the ability to pretend. However, it is difficult to separate out these symptoms when diagnostic criteria for ASD require deficits in domains of socialization, communication, and restrictive and repetitive behaviors according to the Diagnostic and Statistical Manual of Mental Disorders (4 th ed., text rev.; DSM-IV-TR, American Psychiatric Association, 2000). Indeed, while ASD symptoms necessarily cluster among ASD individuals, the symptoms themselves may be somewhat independent of one another (Russell-Smith, Maybery, Bayliss, & Sng, 2012). In order to determine how each symptom relates to the ability to pretend, it is helpful to separate out these ASD symptoms. Since individuals with ASD must meet criteria in all of these domains, one cannot easily separate out these symptoms among ASD individuals; thus, one must look to the presence of “ASD-like” traits that are distributed in the general population (Russell-Smith et al.). The Social Communication Questionnaire (SCQ; Rutter, Bailey, & Lord, 2005) is a widelyused parent-report questionnaire that screens for a history of these “ASD-like” traits within individuals and demonstrates some variance in TD populations. Thus, it may be a useful measure to index ASD traits and their relation to outcomes, such as pretend, that may be impaired in ASD populations. In addition to assessing how ASD symptoms might contribute to the ability to produce pretend, it is important to examine how various factors might directly influence different subtypes of pretend. Examining subtypes of pretend may provide deeper insight into which elements of pretend (and associated mental representations) might contribute to difficulties with Spontaneous Pretend 6 pretend among individuals with ASD. Actions of pretend play often fall under one of three categories: object substitution (OS; e.g., pretending a block is a car), attribution of false properties (AFP; e.g., pretending dishes are dirty), and reference to absent objects (RAO; e.g., pretending to read a book when there is no book present; Leslie, 1987). A small body of research suggests that it is not pretend as a whole, but certain types of pretend that are more challenging for individuals with ASDs. For instance, a study by Libby et al. (1998) demonstrated that children with ASD produced just as much OS as TD children, but produced significantly fewer acts of AFP and RAO. This finding suggests that although children with ASD engaged in fewer acts of overall pretend compared to TD children, this was in part due to difficulties with producing certain subtypes of pretend among children with ASD. It is plausible that each of these categories of pretend may require slightly different child capacities and experiences (e.g., knowledge and understanding that a doll represents a human might lead a child to attribute the false property of talking, while knowledge and understanding that a doll is a vertical object that you can bang against things might lead a child to engage in OS and substitute the doll for a hammer), and may therefore represent categorically different styles of pretend play. Thus, in order to gain a deeper understanding of which factors influence the ability to pretend, one must assess not only how certain predictors might influence pretend ability as a whole, but how they might influence these different subtypes of pretend. Pretend Play and ASD Individuals with ASD have been shown to produce fewer actions of pretend (BaronCohen, 1987) and different types of pretend (Libby et al., 1998) when compared to TD individuals. A review by Jarrold (2003) indicated that even when individuals with ASDs engage in actions of pretend, they do so less frequently than their peers. However, Jarrold (2003) noted Spontaneous Pretend 7 that individuals with ASD may have an underlying capacity to understand pretend, but struggle when expected to engage in spontaneous pretend. Several studies support the proposition of intact pretense comprehension in this population (Jarrold, Smith, Boucher, & Harris, 1994; Kavanaugh & Harris, 1994). These studies had an experimenter either ‘pour’, ‘drop’, ‘squirt’, or ‘paint’ non-existent substances onto toy animals (Jarrold, 2003; Jarrold et al., 1994; Kavanaugh & Harris, 1994). The findings showed that individuals with ASD were just as able as controls to correctly answer questions about the end result of the pretend sequence. For instance, the participants with ASD understood that the toy animal was made ‘wet’ with pretend tea (Jarrold, 2003; Jarrold et al., 1994; Kavanaugh & Harris, 1994). However, no work has yet examined whether differences in pretend play production vary as a function of ASD symptoms in TD populations. Libby et al. (1998) examined the differences in early symbolic play among TD children, children with ASD, and children with Down syndrome. Each child was given five minutes alone to play with a set of toys and these sessions were then analyzed for type of play (i.e. functional and pretend), and type of pretend play produced (Libby et al.). The authors found that while all children produced roughly the same number of OS, children with ASD produced no actions of RAO and significantly fewer actions of AFP compared to the TD and Down syndrome children. This finding suggests that while certain individuals with ASD are able to pretend, the pretend they produce is considerably different from TD children and even children with other disabilities (i.e. Down syndrome). Given these findings, one would expect that individuals with more ASD symptoms would similarly produce fewer actions of AFP and RAO, and possibly more actions of OS. However, research studies have not yet explored whether differences of pretend play Spontaneous Pretend 8 subtypes produced would replicate among TD individuals with varying levels of ASD symptoms. Overall, these findings (Jarrold, 2003; Jarrold et al, 1994; Kavanaugh & Harris, 1994; Baron-Cohen, 1987) suggest that production (including quantity) of pretend play remains impaired among certain individuals with ASDs (despite an underlying capacity to understand pretense). Furthermore, other studies (Libby et al., 1998) have provided insight into the different types of pretend produced by individuals with ASDs. However, no work has yet explored whether individual differences in ASD symptoms relate to the ability to pretend. Likewise, only little work has begun to explore whether predictors of pretend vary or are the same among youth with ASD and TD. Known Predictors of Pretend Play Research has often highlighted links between pretend play, ToM, and verbal ability (Taylor & Carlson, 1997; Bigham, 2010; Lewis, Boucher, Lupton, & Watson, 2000; Astington & Jenkins, 1995, 1999; Jenkins & Astington, 1996, 2000). Such links are helpful in understanding how pretend play normally develops. ToM is the ability to understand others’ mental states and how other individuals might perceive the world (Leslie, 1987; Baron-Cohen, 1995). Taylor and Carlson (1997) conducted a study looking at the relationship between ToM and individual differences in pretend play produced by TD preschoolers. Each participant’s ToM ability and developmental level of pretend play were assessed. Results of this study indicated a relationship between ToM ability and pretend play (Taylor & Carlson). This link between ToM ability and the ability to pretend among TD children suggests that TD children with greater ToM ability may be able to produce Spontaneous Pretend 9 more actions of pretend. That is, the ability to understand others’ perspectives may facilitate a greater ability to understand and produce pretend play. However, many individuals with ASD have difficulty understanding and interpreting others’ mental states, leading to a widely-cited hypothesis that impaired ToM may be the source of deficits in ASD (Baron-Cohen, 1995, 2001). Concurrently, while some children with ASD understand others’ actions of pretend, they still struggle to produce pretend (Jarrold, 2003). One explanation for these impaired abilities (ToM and pretend) among individuals with ASD might be that pretend play and ToM both reflect an underlying ability to abstract from the present reality, and that those with ASD have difficulty with this (Leslie, 1987). Although research supports a link between production of pretend and ToM ability (Taylor & Carlson, 1997) among TD children, this might represent a pathway typically used by TD individuals, and less often used by individuals with ASD. This might be because ToM ability does not develop naturally among individuals with ASD. Instead, individuals with ASD may deliberately engage in a “hacked together” ToM, rather than intuitively engaging in a more “automatic” ToM (Dissanayake & Macintosh, 2003). The hacking hypothesis explains how individuals with high functioning ASD may pass ToM tasks via this less efficient, more deliberate route. Furthermore, those with ASD may engage in a “hacked together” ToM by learning specific rules that allow them to pass ToM tasks, rather than using social understanding and an understanding of other’s perspectives (Dissanayake & Macintosh). Given that intuitive, “automatic” ToM might not develop naturally among those with ASDs, it is plausible that the presence of ASD symptoms may weaken the relationship between ToM and pretend. Bigham (2010) conducted a study on the relationship between understanding pretend and mentalizing (ToM) ability among children with ASD, TD children, and children with intellectual Spontaneous Pretend 10 disabilities (ID). Participants watched a series of pretend actions (i.e. writing) with either a real object (indicating functional play) or an imaginary object (indicating pretend play). In order to assess pretense comprehension, each participant was then asked to identify what the experimenter was doing, and what he or she was pretending the object to be. The ToM ability of each child was assessed using a false belief task. Bigham’s (2010) findings demonstrated a relationship between ToM ability and understanding actions of pretend. Additional findings revealed that individuals with ASD understood significantly fewer actions of pretend compared to TD and ID controls. While Bigham’s (2010) findings suggest that ToM ability is linked to understanding pretend among individuals with ASD, no research has explored whether this link also exists when looking at the production of spontaneous pretend among this population. Additionally, no one has directly tested whether there would be a weakened relationship between ToM ability and pretend play among individuals with more ASD symptoms compared to those with fewer symptoms. Furthermore, little research has explored differences in subtypes of pretend in relation to ToM ability. As with ToM, a link has also been suggested between verbal ability and pretend in TD youth (Bigham, 2010; Rutherford & Rogers, 2003; Lewis, Boucher, Lupton, & Watson, 2000). Lewis et al. (2000) looked at the relationship between language and conceptual ability and the relationship between language and pretend ability among verbal and non-verbal TD participants. The types of pretend assessed were object substitution, attribution of false properties, and reference to absent objects. Lewis et al.’s (2000) findings indicated a relationship between pretend play and language development, suggesting that both pretend play and verbal ability Spontaneous Pretend 11 involve a certain degree of conceptual knowledge. Although these findings suggest a link between verbal ability and pretend, this study only looked at the relationship among TD children. Rutherford and Rogers (2003), however, looked at verbal mental age as a possible factor influencing the ability to spontaneously pretend among children with ASD. This study examined spontaneous pretend production among children with ASD, and had children with other developmental disorders (DD) and TD children as controls. The verbal mental age of all participants was assessed and each participant was given the opportunity to spontaneously play with a set of toys (Rutherford & Rogers, 2003). Findings indicated that although verbal mental age was correlated with pretend play production for both control groups, it was not significantly correlated for participants with ASD. This finding suggests that the link between verbal ability and pretend might be a pathway typically used by TD individuals and individuals with other DD, but one that individuals with ASDs are less able to access. Individuals with ASDs might be less able to access this pathway due to developmental deficits in communication, a diagnostic feature required for having an ASD (DSM-IV-TR, 2000). Similarly, those with more ASD symptoms might also experience some deficits in communication that make this pathway between verbal ability and pretend less accessible. Furthermore, given Rutherford and Roger’s (2003) findings, one might predict that the relationship between verbal ability and pretend would be weaker among TD children with greater levels of ASD symptoms; however, this has not been directly tested. Additionally, little research has explored differences in subtypes of pretend in relation to verbal ability. If children with ASDs are less able to use more typical pathways to pretend, like ToM and verbal ability, it is possible that individuals with ASD that are able to pretend must use Spontaneous Pretend 12 alternate pathways. Next, we consider two novel predictors that might more strongly influence the ability to engage in actions of pretend among individuals with ASD. Novel Predictors of Pretend It is possible that different factors may predict patterns of pretend in youth with ASD relative to TD. Such factors might reflect the divergent developmental pathways used by children with ASD and TD children to arrive at the ability to produce actions of pretend. Two plausible factors are interest in and experience (familiarity) with specific toys. Although research studies have measured familiarity and interest to control for these factors when evaluating the effectiveness of pretend play interventions for youth with ASD (Murdock & Hobbs, 2010), little research has examined them as predictors of pretend play. A child’s interest in an object can be characterized by repeated voluntary engagement with that object, with no outside encouragement (Hidi, Renninger, & Krapp, 2004). Furthermore, interest can be described as having some increase in general curiosity towards an object or action. Interest in an object or activity may also motivate a person to engage with that object or in that activity. Indeed, research has demonstrated that interest appears to drive and motivate the behaviors in which TD individuals choose to engage and the objects with which they chose to play (Hidi et al., 2004). If TD children repeatedly engage with certain toys due to personal interest, they might be more likely to explore different ways that they can interact with and play with those toys. Pretend is one type of play that might result from repeatedly engaging with toys. Thus, interest in a toy might motivate TD children to engage in actions of pretend with that toy. However, these motivational aspects might play a minimal role in driving the pretend behavior of TD children, given its robust and seemingly spontaneous emergence in most TD children by Spontaneous Pretend 13 the age of three (i.e. they may not require higher levels of interest, since they will spontaneously pretend anyway; Lillard, 1993). Given that specialized interests (e.g., in toys or topics) are more common among individuals with ASDs (Baker, Koegel, & Koegel, 1998; Vismara & Lyons, 2007), interest and motivation may play an especially crucial role in the play behaviors of youth with ASD (Koegel & Mentis, 1985). In turn, interest might influence spontaneous pretend play behaviors more in this population. Even though children with ASD have been shown to engage in fewer actions of pretend and different subtypes of pretend (Libby et al., 1998), interest in objects might play an important role in initiating the actions of spontaneous pretend that these children can and do produce. For instance, a more heightened interest in a specific toy might motivate a child with ASD to repeatedly engage in actions of play with that toy. By already understanding the typical functions of the toy and playing with it frequently due to personal interest, they might be more readily able to try out novel uses, including pretend. Such experiences may, in turn, facilitate basic metarepresentational capacities in youth with ASD. Furthermore, familiarity with an object might also motivate a child with ASD to produce actions of pretend. A child’s level of familiarity with an object is based on how often that child has seen or been exposed to that object (Hidi et al., 2004). The more a child (either TD or ASD) is exposed to or sees a certain object, the more they begin to understand the characteristics of that object. Perhaps it is easier for a child with ASD to attribute abstract (pretend) characteristics to an object once they become more familiar with it. Conversely, as some youth with ASD tend to engage in repetitive behavioral routines with familiar objects (Leekam, Prior, & Uljarevic, 2011), they may in fact be more likely to engage in novel play routines (e.g. pretend) with less-familiar Spontaneous Pretend 14 objects. In this sense, familiarity could be seen to relate to more or less pretend in this population; crucially, though, it could plausibly be more related to pretend production in ASD relative to TD children. Despite the proposed relationship of interest in and familiarity with objects to spontaneous pretend play, and the theorized differences in this relationship between TD and ASD youth, no previous research has explored this connection directly. Furthermore, no research has explored differences in subtypes of pretend in relation to interest in and familiarity with toys.