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Unable to Play with Toys
The following clip shows several of the social and play deficits characteristic of children with autism. In contrast to his classmates, who play with a variety of animal figures imaginatively, by animating and feeding them, Christian does not play with the figures appropriately. Instead he takes toys apart, bangs the pieces and quickly walks away. He uses several words, that, though appropriate to the context, do not seem truly communicative. Christian makes no eye contact with others while speaking, does not attempt to imitate or join in on the imaginative play and is unable to play imaginatively himself.
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Lack of Exploration
Dr. Christopher Smith considers the typical and atypical reactions of two 27 month old twins' reactions when they are given children's books.
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Playing with Toy Cars
Dr. Smith advises that odd or repetitive use of toys, a symptom of autism, can be difficult to detect as many typically devleoping children will engage in such activities briefly or as part of more functional play. Autism related, odd or nonfunctional sctions can be distinguished from these more typical behaviors by their highly repetitive, prolonged quality, their preoccupation of the child's attention and time, and their relation to sensory interests.
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Playing with Toys: Emotional Tone
Children at risk for autism may show minimal interest in toys or struggle to play with them in an appropriate manner. In this clip, Sajid requires constant prompting and guidance from his therapist to play appropriately with a variety of toys. Further, he frequently shows absent or odd facial expressions. While manipulating the toys he vacilates between a blank expression and inexplicable laughter, neither of which appear tied to his play.
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Group Play Time
Many children with autism lack appropriate play skills. In this clip, Sajid, a young boy with autism, needs guidance from a therapist to play with toys and acknowledge his classmates. When left to his own devices, Sajid appears unaware of his classmates and is more interested in repetitively pushing bikes and toy cars, than riding around and playing with his classmates.
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Mom Tries to Teach Lucas Play Skills
Lucas's mother tries unsuccessfully to engage Lucas in a game of legos. Lucas does not show an interest in this age appropriate toy or the prospect of interacting with his mother; rather, he disengages from her, focusing instead on some stray coins, staring at the wheels of a truck and eventually wandering off. Both Lucas' repetition of the word "coins" and his fixation on the truck wheels may reflect an intense sensory interest.
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Response to Toys
Children with autism may play with their toys in an atypical, inappropriate or repetitive manner. We see Evan, a boy on the autism spectrum, repeatedly throwing his blocks over a gate rather than stacking them as many typcially developing children might.
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Some Response to Toy Plane, No Response to Name
Often children imitate the actions of others to learn a new skill or participate in an interaction. Spontaneous imitation is thus socially motivated, and not simply a means of getting something or following a command. Children at risk for an autism spectrum disorder may have a deficit in this behavior. Connor, the evaluator, tries to get Evan to imitate her actions of flying a plane through the air without success. Rather than engaging with the evaluator, Evan isolates himself, moving away from both the examiner and his mother.
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Lack of Interest in the Jack in the Box
Children with autism may demonstrate a lack of interest in toys that other children find intriguing. They may also be less likley to share or communicate their enjoyment or needs to others. Ethan exhibits no emotional reaction when the clown pops out of the box. Though Ethan shows some interest in the toy, he never verbally or nonverbally shares this interest with the examiner by smiling, vocalizing or encouraging her to continue. Similarly, he does not request help when the toy becomes stuck.
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No Response to Name (Throws Toy Rabbit)
Many children on the autism spectrum do not respond when a parent calls their name. Lauren, the evaluator, tries to get Evan's attention by calling his name repeatedly without success. Instead, Evan becomes distracted by throwing a toy bunny to the ground multiple times, an example of the inappropriate, seemingly purposeless play seen in some children with autism. He does not respond to his name and rarely makes eye contact with the examiner or his mother.
Social Communication and Social Interaction
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
Non-verbal Communicative Behaviors
Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Flattened affect (lack of facial expressions)10
- Inability to follow a point1
- Lack of attention to voice4
- Lack of expressive language17
- Lack of eye contact16
- Lack of gesturing1
- Lack of pointing to request2
- Lack of pointing to show1
- Lack of receptive language2
- Lack of response to name11
- Unusual Point1
Understanding & Maintaining Relationships
Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
Restricted and Repetitive Patterns of Behavior
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history
Stereotyped Motor Movements and Speech
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
Preoccupations -Interests or Objects
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).