Dr. Smith explains the subtle differences evident when an examiner invites a typically developing child and a child on the spectrum to engage in a pretend birthday party. Whereas the typically developing child is receptive to the examiner's cues, demonstrating an interest and familiarity with the routine of a birthday party, the child with autism appears detached from the examiner, unresponsive to her cues and unable to follow the theme of the play.
The following clip demonstates the ease with which a typically developing child engages in pretend play with the examiner, feeding the baby doll after only a subtle cue: "The baby is hungry." By comparision, Tommy, a child with autism, struggles with the activity, requiring extensive effort from the examiner before he feeds the baby doll. Further, his understanding of the pretend play even after this action is completed is unclear. Commentary is provided by Dr. Christopher Smith.
Dr. Smith compares a typcial child to a child on the autism spectrum with a pretend play task. The typical child is totally engaged in the imaginary activity whereas the child on the spectrum does not respond to multiple cues and shows no interest in the activity.
In this clip, an examiner prompts two children, one typically developing (Cassidy) and one on the spectrum (Tommy), to use imitation and imaginative play. Dr. Christopher Smith compares the different levels of imaginative play demonstrated by Cassidy to Tommy's limited response and engagement in the task.
Lack of interest in pretend play is one of the warning signs of autism. Evaluator Connor Puleo tries to engage Ryan, who has autism, in a pretend birthday party. Ryan, for the most part, shows little interest in this pretend play and actively tries to avoid the interaction. By contrast, Ryan's two typically developing siblings demonstrate their interest, understanding and participation in the game by cutting the cake, cleaning up the plates and singing a birthday song.
Lack of interest in pretend play is a possible sign of autism. In this observation, Connor Puleo assesses Ryan's ability to imitate and engage in basic pretend play. Though Ryan imitates Connor's actions, he does not elaborate on this imitation or appear interested in pretending.
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.
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.
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 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).
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).