Abstract | Summary | Original Article

Play Behavior and Attachment in Toddlers with Autism

Naber, F.B.A, Bakrmans-Kranenburg, M.J., van IJzendoorn, M.H., Swinkels, S.H.N., Buitelaar, J.K., Dietz, C., van Daalen, E.

Journal of Autism and Developmental Disorders (2008). 38:857-866.

Question: Does attachment quality influence the development of play behavior in toddlers with Autism Spectrum Disorder (ASD)?

Background: All children learn valuable skills when they play. Play provides a safe way for young children to practice doing everyday tasks and aids in the development of social and cognitive skills. Children mimic actual events, usually by the time they are 14 months old. They know that their toys are like actual objects, so they will use a spoon to feed a baby doll or pour “tea” from a small teapot into a cup. When they are around 2 years of age, they start to pretend by acting out the activities they witness around them. Play also helps children learn about the give and take needed to get along with others, which, in turn, enhances other aspects of their development.

At the toddler stage, the quality of the relationship they have with their parents and other caregivers is very important. Referred to as “Attachment” it is the affectionate, trusting relationship between child and adult in which they child feels safe and secure in exploring their environment and learning new things. Out of this relationship children develop a sense of how the world works – whether it is safe and welcoming or hostile and rejecting, whether their needs will be met consistently or not. Children with ASD experience attachment in much the same way as typically developing children do, even though they have problems with social interaction. Developing secure attachment is important for helping children with autism learn and grow, too. This study looked at play behavior in toddlers with ASD and how attachment status contributed to its development.

Participants: Forty-one children between the ages of 14 and 36 months participated in this study. Of the children with ASD, some had an intellectual handicaps or learning disabilities. There were two control groups: one composed of typically developing children and one composed of children with developmental concerns who did not have a diagnosable condition. All were under the age of 36 months.

Setting: A child and family centre in the Netherlands.

Design: A comparison study.

Methods: The play behavior of children with a diagnosis of ASD was compared to children who were typically developing and those with some developmental problems. As well, children with ASD with intellectual handicaps or learning disabilities were compared to children with ASD without these problems.

Outcome Measures: Tests were done to determine the mental age of each of the participants. Observations were made of the children interacting with their mother to determine their attachment status. The children’s play behavior was also recorded.

Main Results: In these chronological and mental age-matched children, there were no differences in play level between those with ASD and those without ASD. The major finding was that play level was predicted by the children’s attachment type. Among all groups of children, those who were insecurely attached, particularly those with disorganized attachment, had the poorest levels of play development.

Conclusion: In this study, it was attachment status, particularly disorganized attachment, and not a diagnosis of ASD that predicted poor play skills development, particularly social play.