Imitation and Play in Autism - Wiley: Home

382

Over the past 20 years, the developmental as-pects of autism have been a central focus ofresearch activities. This developmental lensfor viewing autism focuses attention on theevolving symptoms of autism, influenced bythe interplay of biology and experience. Thisinteractive, developmental framework has sev-eral implications that strongly affect currentresearch ideas: (1) There is some plasticity inthe evolution of the symptoms, (2) individualdifferences in course and outcomes will be af-fected by an individual’s experiences as wellas the individual biology of the disorder, and(3) early developmental course will have asubstantially greater impact on outcomes thanlater events. In contrast to research in the pe-riod between 1960 and 1980 and in responseto this developmental orientation, the past 20years have seen much more emphasis on un-derstanding autism as early in life as possibleand searching for autism-specific deviationsin the early developmental processes that leadto language, social, and cognitive develop-ment, both to understand the developmentalprocesses involved in the disorder and to con-ceptualize treatment strategies for maximiz-ing outcomes.

Strongly influenced by Piaget’s model ofcognitive development, the developmental stud-ies of autism of the past 20 years have carefullydissected early development. In the first majorpapers reflecting this approach, Marian Sigmanand her colleagues (Sigman & Ungerer, 1984;Ungerer & Sigman, 1981) found that of the mul-tiple areas of sensorimotor development that

Piaget delineated, children with autism showedsyndrome-specific impairments in only two:imitation and play. Furthermore, Piaget (1962)suggested that symbolic play developed fromimitation, particularly deferred imitation, aschildren developed the ability to representmentally events they had experienced and re-produce them at a later time. This theoreticallinkage between imitation and pretend playgains support from the symptom pattern seen inearly autism, and this chapter focuses on re-search findings in these two areas.

Thus, this chapter reviews what is currentlyknown about imitative abilities and play char-acteristics that distinguish autism from otherdisorders. We also examine the nature of indi-vidual differences in play and imitation skillsamong children with autism. Finally, we con-sider the proposed mechanisms thought to un-derlie the autism impairments in imitation andplay. For the purposes of this chapter, play isdefined as play with objects, rather than socialplay with people.

IMITATION

Roles of Imitation in Development

In normal infant and early childhood develop-ment, imitative ability is considered to be a keymechanism for cultural transmission of skillsand knowledge, serving an apprenticeship, orlearning function, helping young children learncomplex, goal-directed behavior patterns fromothers (Baldwin, 1906; Bruner, 1972; Piaget,

CHAPTER 14

Imitation and Play in Autism

SALLY J. ROGERS, IAN COOK, AND ADRIENNE MERYL

The authors were partially supported by NICHD U19 HD35468. Dr. Rogers also received support fromNIDCD R21 05574. The help of Debbie Schilling and Huanh Meyer is gratefully acknowledged.

volk_c14.qxd 2/28/05 9:51 AM Page 382

Imitation and Play in Autism 383

1962; Rogoff, Mistry, Goncu, & Mosier, 1993;Tomasello, Kruger, & Ratner, 1993; Uzgiris,1999). A less emphasized function of imitationinvolves social interpersonal communication.Imitation of body movements and postures, fa-cial expressions, and vocal behavior permeatesocial and emotional exchanges, providing akey mechanism for emotional synchrony andcommunication between social partners, fromearly infancy throughout the lifespan (Gopnik& Meltzoff, 1994; Hatfield, Cacioppo, & Rap-son, 1994; Uzgiris, 1981).

How imitation is defined is crucial whenreviewing imitative studies, since there aremany nonimitative ways in which behavior ac-quisition can be socially influenced. The re-search on social behavior acquisition inanimals has delineated these processes in thefollowing way (see Byrne & Russon, 1998;Heyes & Galef, 1996; Tomasello et al., 1993;Want & Harris, 2002): Stimulus enhancementis the tendency to pay attention to or aimresponses toward a particular object or placeafter observing a conspecific’s actions. In thecase of stimulus enhancement, the observer’sactions on the object are generated throughtrial and error learning as opposed to reenact-ing the model’s behavior, but the chance thatthe trial and error learning will take place withthe object is elevated as a result of the model’sbehavior. Emulation is a process in which thegoal of the other is made overt as a result ofthe other’s actions and that goal becomes agoal for the observer also. The observer thenattempts to reproduce the completed goal bywhatever means he or she comes up with fromhis or her own behavioral repertoire. While thepreceding processes do not reflect direct acqui-sition of another’s behavior through observa-tion and thus are not truly imitative, responsefacilitation is an increase in the frequency of abehavior already in an individual’s repertoireas a result of seeing it performed by another.This kind of performance is considered to re-flect imitation by most infant researchers. Ac-tion level imitation occurs when the observerfully demonstrates the behavior of another, in-cluding novel acts, and acts that match theminor details and the style of the model’s ac-tion. There is disagreement in the field aboutwhether this should involve a reproduction ofthe goals of the model, as well as the behav-

ioral means, or whether “mimicry” of bodymovements by themselves should be consideredimitation (see Tomasello et al., 1993). Giventhe definition of imitation that pervades theautism studies, we define imitation as the pur-poseful reproduction of another’s body move-ments, whether novel or familiar.

While the view of imitation as a powerfultool for learning instrumental actions fromothers has been present in developmental psy-chology for many years, Meltzoff and Moore’s(1977) discovery of oral imitation in infants inthe first days and weeks of life required con-siderable revision of the view of the role ofimitation in development. While the evolution-ary utility of imitation in older infants andchildren as a powerful learning tool is clear(Rogoff et al., 1993), what might the evolution-ary role of neonatal oral imitations serve? Uz-giris (1981) was the first to suggest that inearly infancy, imitation may primarily servesocial communication and interpersonal devel-opment. Trevarthen, Kokkinaki, and Fiamenghi(1999) have extended this view, suggesting thatthe core function of human imitation is thesharing of motives or intentions, which is at theheart of its other functions, including but notlimited to sharing emotional states, instrumen-tal learning, and continuing interactions.

Rogers and Pennington (1991), followingStern’s (1985) model of interpersonal develop-ment, suggested that early deficits in imitationcould lead to impaired metarepresentation abil-ities characteristic of children with autism.Meltzoff and Gopnik (1993) took this idea fur-ther, suggesting that imitation serves socialdevelopment by providing a mechanism for ac-quiring mental state understanding. Gopnik andMeltzoff (1994) proposed that early imitationinitially provides the infant with shared experi-ences of interpersonal connectedness via bod-ies and movements. In the next few months oflife, imitation of facial expressions leads to ashared experience of emotional expressions andinner sensations, and then to a shared sense ofmotives and intentions underlying communica-tion in the 9- to 12-month period, thus layingthe groundwork for intersubjectivity and devel-oping theory of minds.

Is there supportive evidence for the role ofearly imitation in social relations? In line withGopnik and Meltzoff (1994), Kugiumutzakis

volk_c14.qxd 2/28/05 9:51 AM Page 383

384 Development and Behavior

(1999) suggested that the crucial social elementin early imitation is sharing affect via facial,vocal, and physical matchings. Heimann andcolleagues have provided the only longitudinaldata that address this hypothesis. Their find-ings demonstrate: (1) relationships betweenneonatal imitative ability and social responsesto the mother in 3-month-olds and (2) positiverelationships between 3-month-old imitationand 12-month-old imitation (Heimann, 1998;Heimann & Ullstadius, 1999). Nor is this lim-ited to infancy. The research on emotional con-tagion has provided a body of evidence on therole of facial and postural imitation in rapidsharing of emotional states between peopleacross the lifespan (as reviewed in Hatfieldet al., 1994).

Imitation Performance in Autism

Difficulty imitating other people’s movementshas been reported in autism in a variety ofstudies across the past 30 years. The studiesreviewed all involve autism versus matchedclinical comparison groups in order to examinethe question of specificity of the imitationproblem in autism. These studies used a vari-ety of imitative tasks: actions on objects, imi-tation of body movements, and imitation offacial movements.

Actions on Objects

Studies in this area provide the most mixedfindings and the strongest developmental rela-tions of the three areas. An investigation ofthe youngest sample of children with autismdocumented an autism-specific deficit in imita-tion of simple actions on objects (Charmanet al., 1997). The 20-month-old subjects withautism performed significantly worse than amatched clinical comparison group on tasks in-volving imitation of simple actions on familiarobjects. Several other comparative studies ofpreschoolers with autism have demonstratedobject imitation deficits, using both conven-tional and nonconventional acts (Dawson, Melt-zoff, Osterling, & Rinaldi, 1998; DeMyer et al.,1972; Rogers, Stackhouse, Hepburn, & Wehner,2003; Stone, Ousley, & Littleford, 1997). Incontrast, several other groups have not identi-fied such difficulties. McDonough, Stahmer,Schreibman, and Thompson (1997) failed to

find significant group differences in perfor-mance on tasks of both immediate and deferredimitation of familiar actions with realistic ob-jects in a sample with a mean age just under 5years old. In a sample of older children (meanage 8.1 years), Hammes and Langdell (1981)found that although imitation of actions withimaginary objects (pantomime) and imitationof actions with a counterconventional object(e.g., using a cup as a hat) distinguished thechildren with autism from children with mentalretardation matched on language abilities, per-formance on the imitation of actions with realobjects did not differentiate the two groups. Ina sample of adolescents, Hobson and Lee (1999)did not find an autism-specific deficit in imita-tion when movements were analyzed in termsof functional actions on objects, This differ-ence in the performance of older and youngerage groups may be due to maturing imitativeabilities in autism or to methodological issuesinvolving coding systems or choices of tasksthat are too simple, resulting in ceiling effects(as seen in a study by Charman and Baron-Cohen in 1994, which used a task designed for7-month-old infants with subjects with a meanchronological age [CA] close to 12 years).

Imitation of Body Movements(Intransitive Acts)

An autism-specific deficit in imitating bodymovements has been consistently, but not uni-versally supported. Of all the tasks analyzedin the first study of imitation in autism (De-Myer et al., 1972), imitation of body move-ments generated the most robust effects ofall the imitation tasks. Ohta (1987) found sig-nificant differences between high functioningchildren with autism and nonverbal IQ-matchedtypical preschoolers on imitation of simplehand movements. Rogers, Bennetto, McEvoy,and Pennington (1996) found an autism-specific deficit on single and sequential non-meaningful hand movements in high-functioningadolescents. Dawson et al. (1998) found anautism deficit relative to developmentally de-layed and typical control children on familiarand novel hand movements. Aldridge, Stone,Sweeney, and Bower (2000) found an autismdeficit in gestural imitation in a sample of 2- to4-year-olds relative to cognitively matched nor-mally developing infants. Smith and Bryson

volk_c14.qxd 2/28/05 9:51 AM 84


(1998) found an autism deficit on single handpostures for high-functioning children withautism. Bennetto (1999) also found body imita-tion deficits among a group of high-functioningolder children compared to clinical controls andisolated the difficulty to the kinesthetic repro-ductions of limb postures. Two comparativestudies that did not find any autism-specificdeficits used very infantile tasks and hadceiling effects that may have accounted fortheir null results (see Charman & Baron-Cohen, 1994; Morgan, Cutrer, Coplin, & Ro-drigue, 1989). In summary, in contrast to thefindings on imitation of actions on objects,studies of imitation of body movements haverepeatedly yielded autism-specific deficitsacross a wide range of IQ and language levelsand across all ages studied. (While it may seemcounterintuitive, the presence of echolalia doesnot indicate preserved imitative abilities. Cur-cio [1978] found that children with echolaliacould produce almost no abstract forms of pan-tomime. Rogers and Pennington [1991] sug-gested that echolalia was part of the auditoryrehearsal loop, a distinct system from the motorprocesses involved in action imitations. Thus,echolalia should not be considered an exampleof motor imitation.)

Oral-Facial Imitations

Like body movements, oral-motor movementsare consistently reported to be severely af-fected in autism, though this area has beenmuch less well studied. Rogers et al. (2003)found that oral-motor imitation was more im-paired than imitation of body movements intoddlers with autism compared to clinical andtypical controls. Rapin (1996) reported greateroral-motor impairment in both high- and lowerfunctioning children with autism than withclinical comparison groups. In a small compar-ative study, Adams (1998) reported a greaterlevel of oral-motor difficulty in children withautism than in the CA-matched typical com-parison group. Rogers et al. (1996) found anoverall deficit in facial imitation for their high-functioning adolescent subjects with autismrelative to a CA- and verbal IQ VIQ-matchedclinical control group, as did Dawson et al.(1998) with a much younger sample. Loveland,Tunali-Kotoski, Pearson, and Brelsford (1994)found that although their subjects with autism

did not differ significantly in the number ofidentifiable imitations of emotional facial ex-pressions, the autism group made significantlymore unusual and mechanical expressions thanthe control group. Given the consistency of thefindings in the literature, oral-facial imitationappears to be specifically impaired in autism.

While it is well established that a signifi-cant percentage of people with autism donot acquire speech, we have few explanationsfor this phenomenon (see Rodier, 2000, for amodel based on brain differences affectingcranial nerve function). Lord and colleagueshave demonstrated that level of retardationdoes not fully explain the lack of speech inautism (Lord & Pickles, 1996). The consis-tently replicated finding of autism-specificdifficulties with oral-facial imitation (seealso Rogers et al., 2003; Sigman & Ungerer,1984) and the strong relationship of oral-facial imitation to speech (both in autism andin typical development) have led to the sug-gestion that a specific oral-motor or speechdyspraxia might underlie lack of speech devel-opment for a subgroup of children with autism(DeMyer, Hingtgen, & Jackson, 1981; Page &Boucher, 1998; Rogers, 1999; Rogers et al.,1996).

Relations among the ThreeKinds of Tasks

Is imitation across the three kinds of tasks aunitary phenomenon? So far the evidence is con-tradictory. While Stone and colleagues (1997)reported a dissociation between imitation of ac-tions on objects and imitation of body/facialactions in young children with autism, Rogerset al. (1996, 2003) found all three differenttypes of imitations to be significantly related intoddlers with autism, and they found hand andface imitations to be significantly related inadults (no object imitations were tested in thatstudy). However, the correlations are in the .40to .70 range, demonstrating that these are not to-tally overlapping phenomena.

Developmental Correlates of Imitation

Several studies of normal development ininfancy have specifically linked early infantmotor imitation skills to later social responsiv-ity to a parent. As reported earlier, Heimann

volk_c14.qxd 2/28/05 9:51 AM Page 385


and Ullstadius (1999) reported relationshipsbetween frequency of imitation in newbornsand frequency of gaze aversion to the otherthree months later. Furthermore, the same au-thors reported consistencies between facial im-itation in 3-month-olds and both manual andvocal imitation at 12 months. Finally, Formanand Kochanska (2001) reported a longitudinalstudy of toddlers seen at 14 and 22 months thatdemonstrated stability between imitation ofthe mother and cooperation with her requestsboth concurrently and predictively. There isalso evidence of concurrent relationships be-tween imitation skills and social responsivity.Uzgiris (1999) reported a study demonstratingrelationships between 12-month-olds’ amountof affective imitation with their mothers andthe emotionally congruent expressions sharedwith other people. The research of Asendorpfand Baudonniere (1993) and Nadel and Peze(1993) have demonstrated toddlers’ use of syn-chronous imitations as a main vehicle for re-ciprocal peer interactions, demonstrated incomplex rounds of nonverbal imitations. Thus,several different findings attest to the socialimpact of infant imitation.

In Autism

While the directionality of the effects fromimitation to social engagement are clearly laidout in theories of typical development, it isless clear in developmental theories of autism.Rogers (1999) has hypothesized the same di-rectionality in autism: That early imitationproblems contribute to impaired social devel-opment in autism. However, Hobson (1989),among others, has suggested that a more gen-eral early social impairment leads to lessenedimitation of other people.

While directionality is not yet established,relationships between imitation and delayed ordisordered development of several social andcommunicative abilities have been described.In one of the earliest studies of imitation, Cur-cio (1978) reported concurrent relationshipsbetween imitation and social communication ina group of nonverbal children with autism. Thisrelationship has been reported by others as well(Dawson & Galpert, 1990; Rogers et al., 2003;Sigman & Ungerer, 1984; Stone et al., 1997).Stone and Yoder (2001) found that, after con-trolling for language skills, at age 2, only motor

imitation and speech therapy hours predictedlanguage ability at age 4 whereas SES, age 2play skills, and joint attention did not.

Only one study has directly tested the ef-fects of imitation on social responsivity inautism. Dawson and Adams (1984) demon-strated that imitation differentially facilitatedother kinds of social engagement for more se-verely impaired young children with autism,but this did not hold true for young, higher func-tioning children. Two longitudinal studies alsosupport the hypothesis that imitation affectssocial functioning in autism. Stone et al. (1997)reported that early imitation predicted laterlanguage development and play abilities. Rogersand colleagues (2003) found that early imita-tion was a better predictor of outcomes in lan-guage, IQ, and social skills than dyadic socialbehavior.

Delay versus Deviance

Though some have proposed that the imitationdeficit in autism marks a delayed as opposed todeviant course of development (Stone et al.,1997), Carpenter, Pennington, and Rogers(2002) found that children with autism differfrom typically developing children in terms ofthe sequence in which imitation and other so-cial cognitive skills develop across the infancyperiod. Whereas joint engagement and attentionfollowing skills emerged prior to imitativelearning in the developmentally delayed group(a pattern also seen in normal development),imitative learning preceded the developmentof the other social-cognitive skills for thesubjects with autism. Their results suggestthat the role of imitation in the developmentof social-communicative abilities differs inautism and that the course of development diverges from the normal path around the in-teraction of joint attention and imitation. Car-penter et al. suggested that the use of imitationwithout joint attention (or with diminished jointattention skills) may explain the atypical lin-guistic features observed in autism such asecholalia, “metaphorical speech,” pronoun reversal, and the abnormal use of questioningintonation for statements. In addition to thesefindings, the previously reviewed reports ofcontinuing imitation impairments in high-functioning adolescents and adults with

volk_c14.qxd 2/28/05 9:51 AM Page 386


autism support deviance, rather than delay, inimitative development in autism.

Possible Mechanisms Underlying theImitation Problem

Praxis and Body Mapping

The idea that the imitation problem in autismmight be due to dyspraxia was first suggested byDeMyer et al. (1981). They suggested thatdyspraxia in autism was of sufficient severityto prevent the child with autism from participat-ing in everyday nonverbal communication, con-tributing to the inability to learn the meaningand use of nonverbal communicative acts. Dys-praxia and its adult counterpart, apraxia, referto impairments in the ability to plan and executemovements in the absence of other motor symp-toms (Ayres, 2000). The dyspraxia hypothesis inautism has been suggested by others as well,both to explain autism-specific difficulties withimitation and pantomime tasks (Bennetto, 1999;Jones & Prior, 1985; Rogers et al., 1996) andto explain nonimitative problems with motorplanning and sequencing (Hill & Leary, 1993;Hughes, 1996; Minshew, Goldstein, & Siegel,1997). Clinicians have long suggested that chil-dren with autism have poor body awareness,which might contribute to their difficulties withpraxis in terms of planning and executing animitative movement (Hill & Leary, 1993). Thefindings of the Rogers et al. (1996) study in-volved widespread deficits in imitation and pan-tomime, classic tests of praxis.

Bennetto (1999) examined several aspectsof praxis in autism, including body mapping,visual representation of the movement, andmotor execution. Examining high-functioningolder children with autism and well-matchedclinical controls, she found no group differ-ences in the ability to map locations onto thebody and no differences in visual recognitionmemory for the movements, even after delay.The group differences in this study involvedone specific aspect of motor execution: limbpostures. She also demonstrated that perfor-mance on a standard motor test revealed sig-nificant group differences and accounted formuch, but not all, of the variability in imita-tion performance in the subjects with autism,findings also reported by Smith and Bryson

(1998). Thus, while problems in praxis havebeen supported in autism studies, they appearconfounded with general motor problems.

Motor Problems in Autism

Motor problems have frequently been reportedin autism. Damasio and Maurer (1978) care-fully described the many motor symptomsseen in autism in an early report. Kohen-Raz,Volkmar, and Cohen (1992) reported strikingdifferences in children with autism on tasks in-volving standing balance on unstable surfaces.Lack of typical hand dominance has beendemonstrated (Hauck & Dewey, 2001). Manjiv-iona and Prior (1995) reported clinically signif-icant levels of general motor impairments in amajority of children with diagnoses of autismor Asperger syndrome compared to test norms.Rapin (1996) reported that hypotonia, limbdyspraxia, and stereotypies were all more fre-quent in a group of children with autism thanthose with other communication problems. Insome of the most intriguing reports, home videostudies of infants later diagnosed with autismsuggest that some motor differences may bepresent in autism before the first birthday(Baranek, 1999; Osterling, Dawson, & Munson,2002; Teitelbaum, Teitelbaum, Ney, Fryman, &Maurer, 1998).

However, in a direct test of the dyspraxiahypothesis, no autism-specific motor difficul-ties were found by Rogers et al. (2003) on finemotor, gross motor, and nonimitative praxisperformance in a comparative study of a groupof toddlers with autism compared to both de-velopmentally matched clinical controls andtypically developing children. Yet, the childrenwith autism demonstrated an imitation deficit.Thus, even though motor functioning accountedfor a significant amount of the variance in imi-tation scores in this study (a finding also re-ported by Bennetto, 1999, and Smith & Bryson,1998), the evidence did not support a general-ized dyspraxia as the main mechanism underly-ing overall imitation deficits in autism.

The age and functioning level of the subjectsappear to influence findings of motor deficitsin groups with autism. Comparative studiesthat report autism-specific motor differenceshave involved high-functioning children withautism compared to clinical controls (Bennetto,1999; Smith & Bryson, 1998). However, when

volk_c14.qxd 2/28/05 9:51 AM Page 387


younger or lower functioning subjects are ex-amined, different findings emerge. Severalstudies have compared children with autism toa group with mental retardation matched onCA and mental age (MA) (Hauck & Dewey,2001; Kohen-Raz et al., 1992; Rapin, 1996;Rogers et al., 2003), and all have reported es-sentially equivalent levels of motor perfor-mance (though in Hauck & Dewey, 2001, thegroups differed on established handednesspreference). Thus, the general motor problemin autism may not differ in kind or severityfrom that seen in other groups with motor dif-ficulties, such as children with retardation. Ifa nonspecific praxis deficit reflects a general-ized central nervous system impairment ratherthan an autism-specific motor problem, then itcannot explain the imitation impairment inautism.

Executive Functions: Sequencing andWorking Memory

Rogers and Pennington (1991) proposed that anexecutive function deficit might lead to prob-lems with imitation, given that imitation mayhave a working memory component. The neu-rological literature has demonstrated thatpatients with frontal lesions have motor se-quencing deficits (Kimberg & Farah, 1993).An executive function deficit has been consis-tently reported in studies of older childrenand adults with autism (Bennetto, Pennington,& Rogers, 1996; Ozonoff & McEvoy, 1994;Ozonoff, Pennington, & Rogers, 1991; Prior &Hoffman, 1990; Rumsey & Hamburger, 1988;Russell, 1997). However, the evidence for anexecutive function component in imitationproblems is mixed. Rogers et al. (1996) demon-strated that imitating manual sequences wasmore impaired for the group with autism than aclinical comparison group. However, autism-specific deficits in single movements appear tobe as marked as deficits in sequential move-ments. Smith and Bryson (1998) and Bennetto(1999) also reported that adding the sequenc-ing element to the nonmeaningful hand imita-tion task did not lead to a decline in the autismgroup’s performance. Finally, several studieshave explicitly examined working memory forthe stimuli (Bennetto, 1999; Rogers et al.,1996; Smith & Bryson, 1998). No study hasreported any group difference involving the

ability of subjects with autism to remember thetasks correctly over time.

Dawson et al. (1998) demonstrated signifi-cant correlations between executive functiontasks and infant imitation tasks in preschoolerswith autism. However, the size of the correla-tions revealed that much of the variability inimitation scores was not accounted for by ex-ecutive function performance. The executivefunction hypothesis lacks some face validity inexplaining difficulty with imitation in youngchildren with autism as several recent pub-lished studies have demonstrated unimpairedexecutive function performance in young chil-dren with autism compared to controls (Daw-son et al., 2002; Griffith, Pennington, Wehner,& Rogers, 1999). Thus, while executive func-tions may play some role in imitative skill, theevidence does not support this as a primarymechanism for explaining the imitation diffi-culties in autism.

Symbolic Content

In a study by Rogers and colleagues (1996)in which actions with symbolic content werecompared with nonmeaningful actions, subjectswith autism never performed differentiallyworse on the meaningful conditions. Of foursignificant group differences found on the handand face tasks, only one was on a meaningfultask whereas three were found on nonmeaning-ful tasks. Furthermore, autism-specific differ-ences on nonsymbolic tasks have been reportedfrom several studies (Bennetto, 1999; Smith &Bryson, 1998). Thus, difficulties with symboliccontent do not appear to explain the imitationdeficit in autism.

Kinesthesia

Perceptual-motor studies by Hermelin andO’Connor (1970) led to the suggestion that chil-dren with autism may express abnormalities inthe integration of visual and kinesthetic input,which could certainly impair imitation of bodymovements. One method for highlighting therole of kinesthesia in imitation is to prevent thesubject from viewing his or her movements.Studies that have manipulated the imitator’sview of his or her movement copying attemptshave found that the nonvisible gesture imita-tion items tend to differentiate autism and con-trol groups more than any other kind of task

volk_c14.qxd 2/28/05 9:51 AM Page 388


(Roeyers, Van Oost, & Bothuyne, 1998). How-ever, nonvisible presentations increase the errorrate in typical and developmentally delayedparticipants as well as individuals with autism(Smith & Bryson, 1998). Bennetto (1999)identified reproduction of limb postures—kinesthesia—as the most affected componentof imitation in her subjects with autism. Con-vergence of these findings makes kinesthesiaan area that should be investigated further.

Cross-Modal Matching and Body Mapping

Difficulties with cross-modal matching andbody mapping might impair imitative abilitybut have been examined in only one imitationstudy. Bennetto (1999) tested this explicitlyusing a task that examined body awareness. Thegroup with autism showed no differences fromcomparison subjects in accurately identifyingspecific locations on their own bodies in re-sponse to a line drawing of a body profile withcertain locations highlighted (also see Hobson,Ouston, & Lee, 1989). This is an understudiedarea that should be investigated further, butthus far, we have no evidence that cross-modaltransfer is the impaired function responsiblefor imitation impairments in autism.

Neural Mechanisms

The information processing models of imitationunderlying several of the preceding studieshave been severely challenged by the discoveryof specialized neurons in the superior temporalsulcus (STS) of monkeys that appear to be ded-icated to the processing of visual informationabout the actions of others (Rizzolatti, Fadiga,Fogassi, & Gallese, 2003). Some of these neu-rons appear to code basic postures of the face,limbs, or whole body, whereas others appear tobe involved in coding the movement of bodyparts in relation to objects or goals. A subset ofthese neurons, identified in the prefrontal cor-tex in monkeys, fires when a specific action(such as reach and grasp) has been performedby the monkey as well as when the monkeyobserves another monkey performing the samespecific action. These neurons have been la-beled “mirror neurons” and are located inBrodmann area 44, which corresponds toBroca’s area in the human brain. This findingsuggests potential connections among observa-

tions of another’s acts, imitation, and commu-nication of meaning, with critical links to lan-guage (Rizzolatti & Arbib, 1998).

Recent functional imaging studies in hu-mans have identified parallel networks of cellsin frontal regions of humans that fire duringobservation of finger movements and firemore rapidly when the observation is accom-panied by performance of the same action bythe observer (Rizzolatti et al., 2003). Observa-tion of hand actions has been shown to resultin activity in the premotor cortex and Broca’sarea in humans (Iacoboni et al., 1999). Thisarea of premotor cortex has shown some evi-dence of mirror neuron activity and has beenimplicated in reading facial emotion in anormal population (Nakamura et al., 1999). J. H. Williams, Whiten, Suddendorf, and Per-rett (2001) propose that mirror neurons mayfacilitate understanding of others’ actions andintentions and that they may be involved in thedevelopment of language, executive function,and theory of mind abilities. Failure to de-velop an intact mirror neuron system (or alter-natively, failure to develop the mechanismsnecessary for proper regulation of such a sys-tem) could impair the development of these ca-pabilities in humans. Williams and colleaguessuggest this as a model for autism.

Two studies have examined mirror neuronfunctioning in autism. Individuals with autismshowed less involvement in this mirror neuronregion during emotional interpretation (Naka-mura et al., 1999). A very small study of imita-tion in Asperger syndrome did not reveal groupdifferences, but power problems may have beenpresent (Avikainen, Kulomaki, & Hari, 1999).Mirror neurons have also been suggested as theneural mechanism by which we understand theintent of others’ actions. Several studies of in-tentionality in autism have demonstrated thatchildren with autism do not show difficultieson a simple intentionality task (Aldridge et al.,2000; Carpenter, Pennington, & Rogers, 2001)although mechanisms other than reading inten-tionality may underlie this task (see Huang,Heyes, & Charman, 2002). Thus, the existenceof this mirror neuron system and its role in fa-cilitating imitation (and other synchronous be-haviors between people) may provide us withnew understanding of brain-behavior relationsinvolved in imitation, but this line of research

volk_c14.qxd 2/28/05 9:51 AM Page 389


is in its infancy and needs to be fully exploredin both typical and atypical groups.

Methodological Issues

Methodological issues may underlie the dis-crepancies in findings across imitation studies,which have occurred most often on tasks in-volving actions on objects and in studies assess-ing older and higher functioning subjects. Taskcharacteristics that appear to influence resultsinclude the novelty, difficulty level, and con-ventionality of the movement. One difficulty inmany of the methods used in these studies hasto do with task affordances and conventionalactions. When people are asked to imitate con-ventional actions on common objects that tapspecific affordances of the object (rolling a car,marking with a pen, hitting a drum with a stick,etc.), you must question to what extent imita-tion of the precise movements of the model isrequired. A simpler and nonimitative process,such as stimulus enhancement or repetition ofpreviously learned and automatic actions, couldsuffice. To control for other interpretations, itis important that object imitation tasks involvenovel acts that are not directly elicited by theobject’s unique features.

The effect of the type of task chosen for im-itation of actions on objects was illustrated byRoeyers et al. (1998). The group of 18 youngchildren with autism in their study performedsignificantly worse than a well-matched groupof children with retardation on imitation ofgestures and on imitation of actions on objects,with the imitation of gestures more impairedthan imitation of actions on objects. However,the causal effect of the action on the objectseemed to have an impact on the magnitude ofthe difference in group performance. The ac-tion task that best served to discriminate thetwo groups involved an object that did notproduce a sensorimotor effect. This brings up arelated methodological issue: How do we beginto examine the different functions of imita-tion? While on the surface, all imitation tasksseem inherently social, Tomasello (1998)has argued that, in an instrumental, goal-directed, and object-oriented act, the focus ofthe imitative behavior may be on the means-ends relations inherent in the act, rather than

on imitating the other person as a person. Theobserver may reproduce the model’s actionsbecause the actions invoke a representation ofan outcome in the environment, creating an in-tention in the imitator to carry out the intendedact, rather than to imitate the model’s motormovements. Tomasello’s distinction betweenemulation learning and cultural learning maybe relevant here. In emulation learning, the in-dividual’s goal is to create a specific result inthe environment. In cultural learning, the ob-server not only directs attention to the other’sactivity and to the objects involved but also at-tempts to be like the other person, to perceivethe situation the way the other sees it.

How can these be teased apart? Hobson,Lee, and Brown (1999) provide a helpful ex-ample. The tasks given to the subjects hadboth an instrumental function and an affec-tive quality to them, and the accuracy of theinstrumental function and the stylistic qualitywere rated separately. Both the participantswith autism and those with other developmen-tal disorders could perform the instrumentalaspects of the tasks accurately. However,those with autism were much poorer than thecontrols at imitating the affective quality ofthe movement. The authors proposed thatwhat distinguished their subjects with autismfrom the clinical comparison group was not somuch their inability to imitate the actionsmodeled but rather their deficiency in their at-tempts to imitate the person who modeledthem. They suggested further that in typicallydeveloping infants, it may be these goal-irrele-vant aspects of imitation such as the imitationof affective tone and body language that con-tribute to establishing the intersubjective con-tact, or the “like me” experience with others(Meltzoff & Gopnik, 1993). To understandthe imitation problems in autism, we musttend to these distinctions.

A final methodological issue concerns scor-ing practices. Those studies that have reporteddifferences on body imitations in older andhigher functioning persons have tended to usemore detailed scoring systems that involveanalysis of the movements on videotape. How-ever, the typical scoring system used in manystudies involves live ratings of “correct, partial,or fail.” While the differences among younger

volk_c14.qxd 2/28/05 9:51 AM Page 390


subjects may be extensive enough to be cap-tured in live ratings, such scoring systems maynot be sensitive to imitation differences inolder and higher functioning persons, whichmay be more subtle and require a more fine-grained analysis.

Summary of Imitation

The imitation studies in autism appear to haveestablished that imitation is specifically im-paired in autism, from the earliest time atwhich autism can be diagnosed, persisting intoadulthood, in both higher functioning and lowerfunctioning groups. More than most other neu-ropsychological areas of impairment in autism,imitation thus appears to meet the four criteriafor a primary psychological deficit in autism:universality, specificity, precedence, and per-sistence (Pennington & Ozonoff, 1991). Severalmechanisms hypothesized to account for theimitation deficit in autism, such as symboliccontent, visual representation, cross-modaltransfer, and working memory, have been ex-amined and rejected. The mechanism with thegreatest support is motor planning/execution,which accounts for some, but not all, of thevariance in imitation performance in autism.However, general motor problems do not appearto be specific to autism, as similar levels ofmotor impairment are also found in childrenwith mental retardation who do not haveautism. Thus, motor difficulties (or dyspraxia)certainly contribute to the imitation problemsin autism, but are not necessarily a primarymechanism underlying imitation problems inautism. An exception to this may involve oralimitation. For the few studies that have specifi-cally examined oral-facial movements, thereis consistent evidence of dysfunction and devia-tion from typical patterns. Furthermore, therelationships between oral-facial imitationsand speech development have been repeatedlyfound to be large and significant. Thus, a spe-cific oral-motor dysfunction may be involved inautism, leading directly in its severe form toimpairments in speech development specific toautism and perhaps to imitation of facial ex-pressions as well.

Neither the various types of imitation nor the various functions of imitation may be

uniformly affected in autism. Functions in-volving instrumental learning of meaningfulactions on objects may be less affected thanthe function of imitation in facilitating socialinteractions. Oral-facial and body imitationmay particularly subserve the social aspect,while imitations of acts on objects may par-ticularly serve the instrumental aspect. Therehas been little examination of relationshipsbetween imitative ability and social behaviorin autism. In addition to continued investiga-tion into possible mechanisms underlying theimitation deficit and brain-behavior relationsrelated to imitative behavior, future researchshould consider the possibility that differentfunctions of imitation may be differentiallyaffected in autism.

PLAY IN AUTISM

For the purposes of this chapter, play is definedas the purposeful manipulation of objects inwhich exploration and practice of effects appearto be the child’s goals. Play is considered a pow-erful means by which the young of many speciesmaster skills that will eventually be importantfor their development and survival (Bruner,1972). Piaget (1962) considered play to be anintrinsically motivated activity, in which carry-ing out the activity is pleasurable. He distin-guished between sensorimotor play, involvingobject manipulation as a means for practice andmastery of action schemas, and symbolic, orpretend play, which grows out of the child’s de-veloping ability for mental representation andprovides a means of practicing and understand-ing the events of the social world.

Symbolic play is generally defined as playin which absent elements are representedthrough objects, gestures, and language in theplay. This may take the form of animating theplay characters or by representing absent ob-jects through object substitution or pantomime(pantomime would seem to play a very impor-tant role in bridging between imitation andsymbolic play, since pantomime fuses the con-cepts of deferred imitation and pretending).Pretend play generally appears in a toddler’srepertoire by 18 months and becomes increas-ingly elaborated over the preschool period(McCune-Nicholich, 1977).

volk_c14.qxd 2/28/05 9:51 AM Page 391


Autism-Specific Findings inPretend Play

In 1975, Ricks and Wing reviewed what wasknown about communication, conceptual de-velopment, and play in autism. “The centralproblem, present in even the most mildly hand-icapped autistic people, appears to be a spe-cific difficulty in handling symbols, whichaffects language, nonverbal communication,and many other aspects of cognitive and socialactivity” (p. 214). Lack of symbolic playwas considered to be one of the main symp-toms of this inner lack of symbolic capacity. In1977, Wing, Gould, Yeates, and Brierley pub-lished the first major research paper on sym-bolic play in autism. The group documentedtwo original findings that would stand thetest of time: (1) There is a paucity of sponta-neous symbolic play in children with autismwhose developmental functioning level ap-pears mature enough to support symbolic play;and (2) for those who demonstrated symbolicplay acts, their play appeared repetitive andstereotypic, lacking the typical variety of dif-fering play acts seen in comparison groups ofsimilar mental ages.

This paper was followed in 1981 by twoimportant comparative papers that used adultscaffolded conditions to stimulate symbolicplay. Hammes and Langdell (1981) comparedpretend play acts using increasingly abstractprops imitated from video models of eight chil-dren with autism who had little or no languageand eight children with mental retardation,matched for mental and chronological age. Theyreported that children with autism imitated theplay acts with real objects similarly to compar-ison children, but differed in their lack of useof pantomimed or symbolically transformedacts. In contrast to Wing et al.’s (1977) view,they suggested that the children’s difficultywas not due to a problem with symbol forma-tion, but rather with f lexible manipulation ofsymbols. Riguet, Taylor, Benaroya, and Klein(1981) compared three groups of children infree play and modeling conditions, with thefindings of better performance of all childrenin scaffolded conditions and poorer imitationand lower levels of symbolic play in scaf-folded conditions for children with autismthan language-matched clinical or typical con-

trols. In these early papers arises anothertheme that reoccurs throughout the symbolicplay literature in autism—the improved abilityof children with autism to carry out pretendplay in scaffolded conditions. These two pa-pers, examined together, highlight issues thatare not yet resolved: (1) methodological issuesconcerning appropriate methods for elicitingsymbolic play in children with autism and (2) conceptual concerns involving the cognitiveprocesses involved in imitating and sponta-neously producing symbolic play schemas.

A number of papers in the 1980s replicatedfindings from these two papers, with increas-ing attention to methodological issues involvedin administration and rating of play schemas,as well as matching of clinical populations.Sigman and Ungerer (1984) and Mundy, Sig-man, Ungerer, and Sherman (1986) replicatedWing’s earlier findings of autism-specificdeficits in three related areas: frequency ofspontaneous pretend play acts, frequency andcomplexity of symbolic sequences, and fre-quency of different symbolic acts. These find-ings were obtained for both spontaneous playacts and for play that occurred in response toan adult model. However, in a finding that hascome to have large repercussions, these authorsalso reported that the children’s nonsymbolicplay was similarly affected. Under spontaneousplay conditions, children with autism demon-strated fewer functional and sensorimotor playacts and fewer dif ferent play acts. However, un-like their symbolic play, adult modeling andprompting resulted in normalizing the fre-quency of functional play. These studies con-tinued to emphasize symbolic deficits as a corepart of the autism picture.

Symbolic Play as Metarepresentation

There were conceptual problems with thisearly view of autism as a problem of symbolicabilities. From the Piagetian standpoint, whilesymbolic play and symbolic language involvemental representation, so do stage 6 object per-manence, means end relations, and spatial rela-tions, which also require the child to operatefrom internalized, mental models of the world(Piaget, 1962), and which do not present spe-cial problems for children with autism (Morganet al., 1989; Sigman & Ungerer, 1984).

volk_c14.qxd 2/28/05 9:51 AM Page 392


Alan Leslie’s (1987) landmark paper pro-vided a new interpretation of pretend play. Hesuggested that, unlike other acts that requirerepresentational thought, pretend play in-volves a more complex representationalstance. The child needs to simultaneouslyhold two representations in mind: the primary,or veridical representation, and the newly as-signed pretend identity (a state of doubleknowledge; McCune-Nicholich, 1981), bothduring his or her own play and when facedwith pretend play of others. The child decou-ples the representations from his or her real-world roles and assigns his or her new pretendidentities, representing the pretend worldalongside the real world. Leslie suggested thataspects of pretend representations were simi-lar to those seen in mental state representa-tions in that reference, truth, and existencerelations among primary representations aresuspended. Defining pretend play as a meta-representational act drew parallels betweenthe cognitive processes involved in theory ofmind tasks and those involved in pretend play.Leslie suggested that the poor performance ofchildren with autism on both tasks was due toa difficulty in cognitive decoupling necessaryfor metarepresentation.

Building on Leslie’s theory, Baron-Cohen(1987) reported a very carefully constructedstudy of spontaneous play, in which he set out tocorrect earlier methodological inconsistencies,laid out a clear rationale for matching groups,and suggested tight definitions of symbolic andfunctional play. He also pointed out the prob-lems of using adult modeling and the resultingconfusion between imitation and symbolic actsin previous studies. In a study of completelyspontaneous play using junk props, miniatures,and dolls, he compared 10 verbal children withautism, 10 with mental retardation, and 10 typi-cal children, all matched for verbal ability of4 years. This study thus involved higher func-tioning children with autism than had been pre-viously reported on. The children with autismproduced much less symbolic play than com-parison groups, but no differences in functionalplay. Supporting Leslie’s hypothesis, Baron-Cohen suggested the symbolic play deficit inautism reflected an impairment in metarepre-sentation, which he believed to be the primarypsychological impairment in autism.

Challenges to theMetarepresentational Account

While the metarepresentational account ofsymbolic play problems in autism was theoret-ically satisfying, several challenges to this in-terpretation arose out of findings over the nextdecade, involving: (1) new evidence of sym-bolic play abilities in autism, (2) evidence ofproblems with nonsymbolic play in autism, and(3) symbolic immaturities in typical children.

Evidence of Intact Symbolic Abilities

The uniformity of findings in symbolic playdeficits in autism was severely challengedwhen Lewis and Boucher (1988) published apaper demonstrating equivalent performance ofchildren with autism and controls under condi-tions that involved no modeling. In an effort toisolate the cognitive deficit underlying childrenwith autism’s performance problems in sym-bolic play, these authors developed a methodfor separating symbolic play competence fromperformance. The task involved dolls and cars,miniature objects, and junk objects in two con-ditions: spontaneous and elicited. Unlike otherstudies, in the elicited condition, the symbolicidea was verbally suggested, but not modeled,by the adult, who asked the children, “Show mehow you would make a . . .”

Using the strict definitions of symbolic playsuggested by Leslie and measures of quantity,quality, and duration, the authors demonstratedthat there was the expected autism-specificproblem in the spontaneous condition. However,there was no autism difference in the use ofsubstitute or imaginary objects in the elicitedcondition, which the authors interpreted as sug-gesting that children with autism did not have aproblem with the representational aspects ofplay, but rather with generation of play ideas—an executive problem involving generativityrather than a representational problem.

This paper created great controversy, but theseveral replications that followed (Charman &Baron-Cohen, 1997; Jarrold, Boucher, & Smith,1996; Lewis & Boucher, 1995; McDonoughet al., 1997) all supported the initial findings.Additionally, Lewis and Boucher’s replicationspecifically put in a direct test of generativity:a condition that examined the number of differ-ent ideas a child could generate in a specific

volk_c14.qxd 2/28/05 9:51 AM Page 393


time period. They found autism-specific dif-ferences in the generativity task, but not inthe elicited play condition—findings they inter-preted as supporting the idea that the symbolicplay problem in autism is a production problemstemming from (1) a lack of generativity ofideas and (2) difficulty shifting attention froma current behavior to a new behavior.

Other papers published in the 1990s alsodemonstrated intact skills in children withautism in certain kinds of symbolic play tasks.Kavanaugh and Harris (1994) tested Leslie’s(1987) suggestion that understanding another’spretend play required the same metarepresenta-tional decoupling that production requiredanother way of separating competence fromperformance. Children were shown pretendacts with six different small animals (e.g., theexperimenter held a teapot over the animal andsaid he or she was pretending to pour tea on it).Children were then asked, “How does the . . .look now?” and were asked to select one ofthree pictures showing the animal in variousphysical states, including the real state, the pre-tend state, and another transformed state. Thechildren with autism performed better thanthe comparison group on these tasks, whichwere also completed by typically developingchildren age 30 months. The authors inter-preted the findings as supporting the idea thatthe symbolic play problem is one of production,not one of understanding, as supported also bytreatment studies in autism that have demon-strated improved symbolic play after modeling(Goldstein, Wickstrom, Hoyson, Jamieson, &Odom, 1988; Rogers & Lewis, 1989; Thorp,Stahmer, & Schreibman, 1995). While a repli-cation of this study also demonstrated no groupdifferences (Jarrold, Smith, Boucher, & Harris,1994), f loor effects for both groups madefurther interpretation of results difficult. Fi-nally, Jarrold et al. demonstrated that childrenwith autism were as able to use ambiguous andcounterconventional props to enact pretend se-quences as well as comparison groups. Further-more, the children with autism did not havetrouble switching sets from the real to the pre-tend identity of these objects.

These various studies of symbolic playdemonstrated that children with autism couldform and manipulate symbols associated withplay acts when the symbol was suggested by

another. They could represent absent objectsin play, assign new identities to existing ob-jects, and ignore the salience of the object’strue identity while representing a differentidentity. These findings of preserved functionand the competence/performance contrast thuschallenged Leslie’s metarepresentational ac-count of the symbolic play problem in autism.

Evidence of Impaired Sensorimotor andFunctional Play

A second crucial challenge to the metarepre-sentational explanation of play deficits inautism concerns autism-specific differences inplay that had no symbolic aspects to it. Non-symbolic play can be categorized as sensorimo-tor or functional. Sensorimotor play involvesmanipulation of the objects for their sensori-motor properties, and functional play involvescombining objects and forming play acts inways that reflect social conventions—using ob-jects in the way they are typically used (eatingand drinking from plates, cups, and utensils) orcombining objects in socially conventionalways (placing cups on saucers).

The findings about nonsymbolic play dif-ferences in autism are somewhat mixed.Baron-Cohen (1987) reported that 8-year-oldchildren with autism did not differ from care-fully matched comparison groups in theirfunctional play. Sigman and Ruskin (1999)similarly reported no autism-specific differ-ences in functional play skills in their sampleof 70 preschoolers with autism.

However, the majority of studies examiningfunctional and sensorimotor play have reportedgroup differences. Tilton and Ottinger (1964)found that children with autism differed frommentally retarded and normal children in theirorganization of play behaviors. Using verycareful definitions of play, Sigman and Ungerer(1984) reported that in spontaneous play condi-tions, young children with autism with lowverbal mental ages produced fewer functionalplay acts, especially with dolls, fewer differentfunctional play acts, and fewer sequences thana comparison group of children with mentalretardation. However, in an adult modeling andprompting condition, the group differenceswere no longer present. Similar findings havebeen reported by Mundy et al. (1986), Lewisand Boucher (1988), Blanc et al. (2000), and

volk_c14.qxd 2/28/05 9:51 AM Page 394


McDonough et al. (1997). E. Williams, Reddy,and Costall (2001) found striking qualitativedifferences in both functional and sensorimotorplay of children with autism, In addition toabnormalities in rates and levels of sensorimo-tor and functional play, the proportion of imma-ture to more mature play appears affected inautism. Sigman and Ungerer and Libby et al.documented that children with autism spentequivalent amounts of time playing in immaturetypes of play as well as more mature types ofplay, while comparison children spent the ma-jority of their play time in more mature play.

Thus, there is considerable evidence thatchildren with autism exhibit qualitative dif-ferences compared to typically developing,developmentally delayed, and other clinicalpopulations in their nonsymbolic play skillsand that the differences somewhat mirror thedifferences seen in their symbolic play: morerepetition, less novelty, and less diversity ofplay schemas, with immature patterns predom-inating. These differences are not well ac-counted for by the metarepresentational model.

Symbolic Difficulties in Typical Children

The final challenge to the metarepresentationaltheory of pretend play covered here comesfrom other cognitive theorists. There is a basicdevelopmental problem in the metarepresenta-tional account. How can pretend play, whichis developing in 18-month-olds, involve the samemetarepresentational abilities as theory ofmind, which in typical development, does notdevelop until age 4? Several theorists suggestthat early pretend play can be accounted for bysimpler processes than metarepresentation. Pi-aget (1962), distinguishing between mental rep-resentations and the mental manipulation ofsymbols, suggested that neither early words norearly pretend play was synonymous with symboluse. He believed that early words, early pretendplay, and deferred imitation all demonstratedthe formation and use of mental representa-tions of previous experiences. He suggested thatmanipulation of symbols in thought was a lateraccomplishment of the 2- to 4-year-old preoper-ational period.

Other theorists share somewhat similarviews. Perner (1991) suggests that the onset ofpretend play, object permanence, language,and the other representational milestones in

the toddler period demonstrates the infant’snew ability to generate multiple representa-tions of reality. The infant can use multiplemodels to substitute for each other and, indoing so, represent past events, coming events,and as-if events. To Perner, acting as-if doesnot require metarepresentation. Substitution ofrepresentations does not require metarepresen-tation; it instead requires the use of multiplemodels, which young children mark in theirplay. The capacity for metarepresentation de-velops slowly across the preschool period andis later reflected by much more advanced pre-tend play, especially role play, with others.

Perner’s view is nicely supported by workof Tomasello, Striano, and Rochat (1999),who also question the symbolic interpretationof early pretend play, both from their own andDeLoache’s (1995) findings concerning youngpreschoolers’ difficulties in understandingwhat miniatures represent. In two studies of 18-to 35-month-old children’s understanding andproduction of symbols as representations of anabsent object, Tomasello and his colleaguesfound that this ability gradually developed overthis age period, virtually absent at 18 months,well developed and integrated at 35 months,and spotty in 26-month-olds. The authors sug-gest that early pretend play of the sort seen in18- to 24-month-olds and older is heavily scaf-folded by either adult language or through de-ferred imitation of previously seen events. Onlygradually can children go on to use symbolsthat are socially acquired, as well as newly in-vented, in individually creative ways.

Development of theGenerativity Hypothesis

The preceding findings represent powerfulchallenges to the metarepresentational hypoth-esis and led Christopher Jarrold and colleaguesto focus on the competence/performance ques-tion. In a 1996 paper, they reported threeexperiments, each exploring one or more di-mensions of symbolic understanding of chil-dren with autism. Two of these, replications ofKavanaugh and Harris (1994) and of Lewis andBoucher (1988), have already been described(Jarrold et al., 1996). The third experiment ex-amined generativity. The children were firstasked to generate as many pretend acts as they

volk_c14.qxd 2/28/05 9:51 AM Page 395


could, first without props, then with props (aruler, a scarf, candle, etc.). In both conditions,children with autism generated fewer pretendacts than controls in both conditions.

In an integration of the findings of compe-tences and difficulties of children with autismin pretend play studies, Jarrold consideredproblems both with inhibition and with genera-tivity as possible obstacles to pretend play forchildren with autism (Jarrold, 1997; Jarroldet al., 1996). A problem with inhibition couldimpair symbolic play by making it difficult toinhibit the true nature of an object and shift toa hypothetical identity (Harris, 1993). Fromthe empirical evidence, Jarrold concluded thatthere was little support for the idea that chil-dren with autism had difficulty inhibiting thereal use of a prop in order to assign a substituteuse. In contrast, difficulties with generativityof play ideas had considerable support acrossstudies. He suggested that this generativitydeficit occurred in many areas of functioning,citing research by others in word f luency, freerecall, and drawing studies that demonstratedparallel results. In a detailed analysis of thekinds of executive problems seen in autism, Jar-rold suggests that difficulties generating newbehavior and difficulties in maintaining goalsin working memory could account for both thepatterns of reduced generativity and impulsivebehavior seen in children with autism in theirplay and in many other situations (Jarrold,1997; see also Harris & Leevers, 2000).

Tests of the ExecutiveFunction/Generativity Hypothesis

Very few studies have examined relations be-tween any executive function measures andsymbolic play abilities. Rutherford and Rogers(in press) examined the relationship among playmaturity, joint attention, and executive func-tion in a study of 28 very young children withautism and both delayed and typical compari-son groups. Two executive function tasks wereused: spatial reversal, which tests set shifting,and a generativity task, which examined num-ber of different play acts generated to singletoys without any particular function. Childrenwith autism were equivalent to both compari-son groups on both executive function tasks.However, for the entire group of children, bothexecutive function tasks were strongly associ-

ated with pretend play but not with sensorimo-tor play. Generativity accounted for 27% of thevariance in pretend play scores in the totalgroup and correlated significantly with sensori-motor play scores, even when verbal ability waspartialled out. (See Blanc et al., 2000 for a sim-ilar report on a small n study.)

However, in a somewhat contradictory find-ing, Dawson and colleagues (Dawson et al.,1998) used both a spontaneous and an elicitedparadigm to stimulate pretend play in a groupof 20 preschoolers with autism and with clini-cal and typical comparisons. While the ex-pected symbolic play deficit was present in thechildren with autism, symbolic play scores didnot correlate with performance on an executivefunction measure tapping working memory andinhibition—the delayed response task. Instead,it correlated at .72 with scores from a measureof orbital prefrontal cortex—the delayed non-match to sample (DNMS) task, which taps pri-mary medial temporal lobe functions.

While the arguments supporting the execu-tive function/generativity hypothesis are wellreasoned and databased, the field has justbegun to examine relationships between gener-ativity (or, more broadly, executive functions)and performance on symbolic play tasks. Theusefulness of this theory will be determinedby the findings of additional studies that di-rectly explore these relationships.

Specificity of Symbolic PlayDeficits to Autism

Wing et al.’s (1977) study suggested that sym-bolic play problems were unique to autism. Asseen from the review thus far, this finding hasbeen universally supported among studies ofspontaneous symbolic play. While it has beensuggested that blind children have similarkinds of difficulties developing symbolic play(Fraiberg, 1977), there is evidence that sym-bolic play may develop better than was initiallyexpected in blind children. Rogers and Puchal-ski (1984) documented the presence of pretendplay acts in a group of blind children at age 25months and found expected associations withlanguage development and sensorimotor abili-ties. Hobson et al. (1999) compared the sym-bolic play of a group of blind children and agroup of children with autism, matched on age

volk_c14.qxd 2/28/05 9:51 AM Page 396


and language level. The blind children demon-strated many more symbolic play acts thanthe children with autism, though the play wasnot complex. Thus, the current data suggestthat the degree of difficulty that children withautism have producing symbolic play is unique.

Brain Behavior Correlates

We have no neuroimaging studies of pretendplay, or even pantomime, at this time and veryfew neuropsychological models of pretendplay. While the preceding generativity theorywould emphasize frontal lobe contributions,Dawson et al. (1998) demonstrated a correla-tion between symbolic play and medial tempo-ral lobe tasks rather than executive functiontasks. This area is in great need of attention.

Individual Differences and DevelopmentalCorrelates of Symbolic Play in Autism

There are clearly large differences in perfor-mances of individual children with autism onboth functional and pretend play tasks. IQ andlanguage level (which are themselves closelyrelated in autism) demonstrate associationswith symbolic play skills. Baron-Cohen (1987)reported that children with autism who coulddemonstrate pretend play acts had significantlyhigher verbal and nonverbal IQs than non-pretenders. Sigman and Ungerer (1984) alsoreported correlations between language devel-opment and pretend play in autism, though notwith sensorimotor play. However, Sigman andRuskin (1999) reported that both functionalplay and symbolic play were related to concur-rent language abilities. They also reported sig-nificant correlations between play and jointattention behavior in preschoolers with autism,but these were mediated by general develop-mental age, a precursor of language develop-ment, or with attention switching, which hasimplications for executive function.

However, two groups studying very youngchildren with autism report an absence of corre-lations between pretend play and verbal lan-guage. Charman (2003) reported no relationshipbetween play and language either concurrentlyor predictively from age 20 to age 42 months.Similarly, Rutherford and Rogers (2003) re-ported no relationship between either verbal or

nonverbal mental ages and elicited pretend playskills in a sample of 2-year-olds with autism,90% of which had not yet developed speech. Theabsence of relationships between language andplay in these two studies may be due to the veryyoung ages and essentially nonverbal status ofthese toddlers with autism (the children withother diagnoses the same age and language levelshared the expected relations).

The relationship of pretend play to languagedevelopment is interesting in light of the vary-ing theories concerning the nature of the pre-tend play problem. It was the presence of bothplay and language problems in autism that ledto the early symbolic deficit hypothesis. Mindtheory would also expect language and play tobe related, given that a main purpose of lan-guage is sharing of mental states and learninglanguage requires awareness of the contents ofthe speaker’s mind. However, the generativityhypothesis would not necessarily predict thatlanguage and symbolic play should be related.This is further complicated by the studies thatraise questions about how “symbolic” earlypretend play really is (or, for that matter, howsymbolic early language is). It is important toremember the modeling or imitation procedureused in most of the symbolic play procedures.Imitation is correlated with various develop-mental skills, including language developmentin autism and in normal development. Thus, itis possible that the relationships between sym-bolic play and language may be mediated bythe imitation skills in play studies that provideplay models for the children to imitate. The na-ture of the relationship between pretend playand language development in autism needs fur-ther study.

Delay versus Deficit

As Libby and colleagues pointed out (1998),the relationships between symbolic play devel-opment and language development in autismwould suggest that symbolic play is delayed buteventually develops in those children with thecognitive abilities to acquire it. However, theunusual pattern of differences in symbolic andfunctional play—the lack of f luency, the repet-itiveness of the play, the continuing use of veryimmature sensorimotor patterns as well ashigher level patterns, and other aberrations in

volk_c14.qxd 2/28/05 9:51 AM Page 397


the expression of play—indicates that play isqualitatively different in autism, a deficit aswell as a delay.

Experiential Effects on Pretend Play andthe Ecological Model of Autism

In addition to developmental maturity, child-hood experiences affect symbolic play de-velopment in typically developing children.While the tendency of developmentalists is toview symbolic play as a universal developmen-tal accomplishment, cross-cultural studies donot support this view. Symbolic play as definedhere seems to be to some extent a phenomenonof middle-class Western cultures. In other cul-tures, there may be much rough and tumbleplay or practice play, and there may be roleplay in which the children act out adult rolesbut without symbolic transformation (Feitel-son, 1977; Feitelson & Ross, 1973). In addi-tion, the play of Western children who areseverely socioeconomically deprived is markedby continued sensorimotor practice play quali-ties (Murphy, 1972). Western preschoolersfrom rural settings also demonstrate a paucityof symbolic play transformations compared totheir middle class suburban peers (Feitelson &Ross, 1973). Thus, symbolic play is to some ex-tent a cultural phenomenon, supported by adultprovision of play materials and play space, aswell as by adult psychological support throughactive participation and modeling of pretendplay and encouragement and respect for chil-dren’s pretend play activities.

While adults often think of children’s pre-tend play as involving fantastic images anddeeply imaginative and creative activities,the reality of early pretend play is that it in-volves a replaying of daily life events (andagain reflects the fuzzy boundaries betweendefferred imitation and early pretend play).Young children play out their lives: bedtimeroutines; mealtime routines; family dramas;and trips to the doctor, zoo, vet, and MacDon-ald’s; using real objects, miniatures, and neu-tral objects, as well as verbal scripts associatedwith these activities. The learning mechanismappears to involve deferred imitation or sociallearning. And this leads to the final hypothesisconcerning the nature of pretend play deficits

in autism—the impairment of social learningmechanisms in autism.

Earlier, this chapter reviewed what is cur-rently known about problems of imitation inautism. Given the early reliance of pretendplay on deferred imitation, you would expectthat these two skills are related, both in typi-cal development and in autism. To our knowl-edge, there are currently no published data onthe relationships between deferred imitationand symbolic play.

Second, reenacting life events requires thatchildren attend to social events and be ori-ented to others, their actions on objects, andtheir interactions. As Sigman and Ungerer sug-gested in 1984, lack of typical pretend playearly in life in autism may reflect the lack ofsocial learning on the part of the young childwith autism or lack of pleasure in the socialroutines of life. Note that lack of social learn-ing would affect functional play, which alsoinvolves the expression of socially conven-tional ways of acting on objects, as well assymbolic play. Relationships between playskills and social engagement have been de-scribed by Sigman and Ruskin (1999) in alarge longitudinal study in which preschoolfunctional and symbolic play skills predictedadolescent peer engagement, but not languagedevelopment, in a large group of children withautism. The sociocultural aspects of pretendplay have been eloquently summarized byTomasello et al. (1999): “. . . the process ofsymbolic play development, as other culturalskills such as language development, may beseen as a delicate interplay between children’semerging skills to interact with the world inculturally conventional ways, and their emerg-ing skills to use these cultural conventions inindividually creative ways” (p. 583).

Finally, this kind of “acculturation” theoryis congruent with the already described rela-tionships between language and symbolic play,since both rely heavily on acculturation, or so-cial learning and imitation, in the toddler pe-riod. Given the autism-specific effects on earlysocial orienting documented by Osterling andDawson (1994); Baranek (1999); Werner, Daw-son, Osterling, and Dinno (2000); and others ininfant video studies, there is every reason to be-lieve that this would result in a diminished be-

volk_c14.qxd 2/28/05 9:51 AM Page 398


havioral repertoire early enough to affect bothfunctional and symbolic play (see Loveland,2001, for a compelling description of this eco-logical model of autism). Whether the lack ofsocial modeling, social learning, and experien-tial differences can fully account for the diffi-culties in spontaneous production of functionaland symbolic play is unclear (Harris, 2000).

While we currently have no studies thatdescribe relationships among symbolic playand social interest, social orientation, and imi-tation in early autism, the intervention evi-dence is useful here. A number of studies havedocumented improvements in children withautism’s pretend play through a variety of fo-cused treatment interventions, both behavioraland relational. These studies have demon-strated increases in frequency and complexityof symbolic play after treatment and corollaryincreases in social and communicative interac-tions with others. This treatment literatureprovides some indirect support for the hypoth-esis that there is an experiential aspect to thesymbolic play difficulties seen in autism andthat interventions focused on increasing chil-dren’s experience and motivation for such playhas effects on play complexity, play frequency,and increased social engagement.

The social hypothesis may present us withan independent explanation for the symbolicplay difficulties in autism, or it may be inter-twined with the generativity hypothesis, in thatwhen social engagement and social learning arenot providing new play content and ideas, chil-dren are left to the mercy of their own imma-ture and meager repertoire of sensory motoracts to create play schemas.

Methodological Issues

A variety of methodological problems pervadethe studies of pretend play in autism and havebeen well discussed by Baron-Cohen (1987)and Jarrold et al. (1993). While the more re-cent studies demonstrate improved methods,both researchers and readers of research mustbe sensitive to the design challenges involved.Selection of comparison groups is an ongoingchallenge in autism studies. The questionof autism-specific differences requires an age-matched clinical comparison group, rather

than a typical group matched for developmen-tal level (although the typical group is a veryuseful third group in these studies, since itprovides a point of comparison for the datafrom the clinical comparison group). Becausesymbolic play has been found to have relation-ships with language abilities in some studies, itis crucial that groups are matched for expres-sive language skill rather than nonverbal oroverall IQ or MA. Some researchers have ar-gued that this needs to include a measure ofexpressive language complexity, rather than ameasure of picture naming vocabulary only,since picture naming may overestimate thelanguage skills of children with autism.

In terms of tasks, a pervasive problem hasbeen in the inconsistent definition of pretendplay. Acts to self, acts to dolls, and use ofminiatures have been classified as symbolicacts in some studies and as functional play actsin others. Baron-Cohen (1987) has suggested aclear definition of symbolic play, and Libbyet al. (1998) have provided an excellent classi-fication system for discriminating sensorimo-tor play from functional play, as well as cleardefinitions of symbolic play in line withBaron-Cohen’s. While both of these systemsclassify doll play as functional (even when thedoll is exhibiting agency), the unique and spe-cific problems that children with autism havewith doll play may illustrate that doll play in-volves symbolic rather than functional playand should be empirically examined.

Moving to the issue of task administration,the state of the science in this area requires thatexperimenters examine children’s competenceseparate from their performance of pretendplay. Having adults model pretend play acts andthen scoring the child’s productions as symbolicacts confounds imitation with symbolic produc-tion and impedes interpretation of findings, asnicely discussed by Libby, Powell, Messer, andJordan (1997). Data have been most typicallycoded as frequency counts from videotape.There are some tools in the literature that pro-vide developmental play age equivalents (e.g.,Fewell, 1992), which can be useful in examiningdevelopmental correlates. However, if such toolsare used, it is critical that the definitions ofpretend play in those tests be examined tomake sure that symbolic play is being classified

volk_c14.qxd 2/28/05 9:51 AM Page 399


according to the principles described earlier. Fi-nally, what frequency variables are gatheredand analyzed has significant effect on the inter-pretation of group differences. As the studiesfrom Sigman’s lab have illustrated, examiningtotal number of play acts in a category can givequite a different picture than examining numberof novel play acts or maturity of play acts. Qual-itative differences may be missed when morefine-grained aspects of the play are not consid-ered. Finally, both ceiling and floor effects havearisen in some of the symbolic play studies.Making sure that all the groups in a study areappropriately challenged by the task is crucialfor identifying autism-specific differences orlack of differences.

Summary of Play

The work in symbolic play in autism seemspoised at the edge of new developments. Theincreasing evidence that typically developingchildren are not actually using symbols as suchuntil ages 3 to 4 requires us to view these earlypretend play schemas as something other thansymbolism per se. Metarepresentational theoryis not a persuasive explanation for thesedeficits due to the timing of the deficits, thelack of symbolic ability of typically developingchildren in the early stages of pretend play, andthe parallel impairments between pretend playand simpler types of play. Executive dysfunc-tion theories capture several aspects of theplay problems in autism: the predominance ofrepetitive, simple play behavior, both in senso-rimotor schemes and in symbolic schemes; theability to demonstrate understanding and pro-duction of symbolic transformations under var-ious conditions; and the lack of f luency inspontaneously generating schemas. Yet, we donot currently have convincing data of early ex-ecutive function differences in autism, nor dowe have data that clearly links play difficultieswith other executive function variables. Theecological, or social learning theory, is attrac-tive, but it needs to be developed and tested.

Symbolic play research would benefit fromrefinement of our methods. We need straightfor-ward procedures that are consistently usedacross studies so that data can be comparedmore easily. In each new study, we need to ex-amine relations with other developmental skills,

with neuropsychological correlates, and withsocial and environmental variables. The ques-tion of brain-behavior relations has only begunto be mentioned. Finally, we need to explore thetheorized relations among immediate imitation,deferred imitation, pantomime, and symbolicplay. Such efforts will most likely have a greatpayoff, for studying the primary symptoms ofautism comparatively and at multiple levels ofanalysis have taken us far in understandingautism and have broadened considerably our un-derstanding of normal development.

CONCLUSION

The research literature in imitation and sym-bolic play clearly demonstrates the severitywith which autism affects these skills. Theearly appearance of these two skills in normaldevelopment and their seeming importance inhuman social, communicative, and cognitivedevelopment indicate that their impairment inautism may have powerful roles in determiningoutcomes in autism. From the work that hasbeen done in imitation, it appears that there isa fundamental difficulty with imitation ofother people’s actions in autism that permeatesmany different kinds of tasks and performanceacross both highly scaffolded and natural set-tings. In contrast, performance of functionaland symbolic play varies according to setting,with normalized levels of play demonstratedin certain types of scaffolded situations andthe most impaired performance demonstratedin spontaneous or free play situations. Thiscompetence-performance distinction in sym-bolic play appears to indicate that mediatingvariables are at work, and the area of executivedysfunctions, particularly generativity deficits,is a prime candidate. Thus, the current litera-ture leads us to consider that imitation may bethe more primary of the autism deficits, withplay abnormalities reflecting effects of intel-lectual impairment, executive dysfunction,possible experiential deficits, and imitationdecrements. Developmental theory links imi-tation and symbolic play, a hypothesis that hasnot yet been tested. If this is indeed the case,these two areas of difficulty may in fact repre-sent one core impairment in autism. We awaitstudies that examine performance in these twoskill areas to other levels of analysis, in autism

volk_c14.qxd 2/28/05 9:51 AM Page 400


and in other developmental groups, while at thesame time examining the role of experience andenvironment, to understand the meaning ofthese skill deficits in the development of thebehavioral phenotype in autism.

Cross-References

Developmental aspects of autism are addressedin Chapters 8 to 10, social development inautism is reviewed in Chapter 11 and com-municative development in Chapter 12, affec-tive aspects of autism are reviewed in Chapter15, and theoretical perspectives are reviewedin Chapters 21 through 26.

REFERENCES

Adams, L. (1998). Oral-motor and motor-speechcharacteristics of children with autism. Focuson Autism and Other Developmental Disabili-ties, 13, 108–112.

Aldridge, M. A., Stone, K. R., Sweeney, M. H., &Bower, T. G. (2000). Preverbal children withautism understand intentions of others. Devel-opmental Science, 3, 294–301.

Asendorpf, J. B., & Baudonniere, P. (1993). Self-awareness and other-awareness: Mirror self-recognition and synchronic imitation amongunfamiliar peers. Developmental Psychology,29, 88–95.

Avikainen, S., Kulomaki, T., & Hari, R. (1999).Normal movement reading in Asperger sub-jects. Neuroreport, 10, 3467–3470.

Ayres, A. J. (2000). Developmental dyspraxia andadult onset apraxia. Torrance, CA: Sensory In-tegration International.

Baldwin, J. M. (1906). Social and ethical interpre-tations in mental development. New York:Macmillan.

Baranek, G. (1999). Autism during infancy: A ret-rospective video analysis of sensory-motorand social behaviors at 9–12 months of age.Journal of Autism and Developmental Disor-ders, 29, 213–224.

Baron-Cohen, S. (1987). Autism and symbolicplay. British Journal of Developmental Psy-chology, 5, 139–148.

Bennetto, L. (1999). A componential approach toimitation and movement deficits in autism.Dissertation Abstracts International, 60(2-B),819.

Bennetto, L., Pennington, B. F., & Rogers, S. J.(1996). Intact and impaired memory functionsin autism. Child Development, 67, 1816–1835.

Blanc, R., Tourrette, C., Delatang, N., Roux, S.,Barthelemy, C., & Adrien, J. L. (2000). Regu-lation of symbolic activity and development ofcommunication in children with autistic disor-der. European Review of Applied Psychology,50, 369–381.

Bruner, J. S. (1972). Nature and uses of immatu-rity. American Psychologist, 27, 687–708.

Byrne, R. W., & Russon, A. E. (1998). Learning byimitation: A hierarchical approach. Behavioraland Brain Sciences, 21, 667–721.

Carpenter, M., Pennington, B. F., & Rogers, S. J.(2001). Understanding of others’ intentions inchildren with autism. Journal of Autism and De-velopmental Disorders, 31, 589–599.

Carpenter, M., Pennington, B. F., & Rogers, S. J.(2002). Interrelations among social-cognitiveskills in young children with autism. Journalof Autism and Developmental Disorders, 32,91–106.

Charman, T. (2003). Why is joint attention a pivotalskill in autism? Philosophical Transactions ofthe Royal Society, 358, 315–324.

Charman, T., & Baron-Cohen, S. (1994). Anotherlook at imitation in autism. Development andPsychopathology, 6, 403–413.

Charman, T., & Baron-Cohen, S. (1997). Brief re-port: Prompted pretend play in autism. Journalof Autism and Developmental Disorders, 27,321–328.

Charman, T., Swettenham, J., Baron-Cohen, S.,Cox, A., Baird, G., & Drew, A. (1997). Infantswith autism: An investigation of empathy, pre-tend play, joint attention, and imitation. Devel-opmental Psychology, 33, 781–789.

Curcio, F. (1978). Sensorimotor functioning andcommunication in mute autistic children. Jour-nal of Autism and Childhood Schizophrenia, 8,281–292.

Damasio, A. R., & Maurer, R. G. (1978). A neuro-logical model for childhood autism. Archivesof Neurology, 35, 777–786.

Dawson, G., & Adams, A. (1984). Imitation and so-cial responsiveness in autistic children. Journalof Abnormal Child Psychology, 12, 209–226.

Dawson, G., & Galpert, L. (1990). Mothers’ use ofimitative play for facilitating social responsive-ness and toy play in young autistic children. De-velopment and Psychopathology, 2, 151–162.

Dawson, G., Meltzoff, A., Osterling, J., & Rinaldi,J. (1998). Neuropsychological correlates ofearly symptoms of autism. Child Development,69, 1276–1285.

Dawson, G., Munson, J., Estes, A., Osterling, J., Mc-Partland, J., Toth, K., et al. (2002). Neurocog-nitive function and joint attention ability inyoung children with autism spectrum disorder

volk_c14.qxd 2/28/05 9:51 AM Page 401


versus developmental delay. Child Develop-ment, 73, 345–358.

DeLoache, J. S. (1995). Early symbol understand-ing and use. In D. Medin (Ed.), The psychologyof learning and motivation (pp. 65–114). NewYork: Academic Press.

DeMyer, M. K., Alpern, G. D., Barton, S., DeMyer,W. E., Churchill, D. W., Hingtgen, J. N., et al.(1972). Imitation in autistic, early schizo-phrenic, and nonpsychotic subnormal children.Journal of Autism and Childhood Schizophre-nia, 2, 264–287.

DeMyer, M. K., Hingtgen, J. N., & Jackson, R. K.(1981). Infantile autism reviewed: A decade ofresearch. Schizophrenia Bulletin, 7, 388–451.

Feitelson, D. (1977). Cross-cultural studies of rep-resentational play. In B. Tizard & D. Harvey(Eds.), Biology at play (pp. 6–14). Philadel-phia: Lippincott.

Feitelson, D., & Ross, G. S. (1973). The ne-glected factor—play. Human Development, 11,291–296.

Fewell, R. R. (1992). Play Assessment Scale (5threv.). (Available from University of Miami,Mailman Center for Child Development, P.O.Box 014621, Miami FL 33101)

Forman, D. R., & Kochanska, G. (2001). Viewingimitation as child responsiveness: A link be-tween teaching and discipline domains of so-cialization. Developmental Psychology, 37,198–206.

Fraiberg, S. (1977). Insights from the blind: Com-parative studies of blind and sighted infants.New York: New American Library.

Goldstein, H., Wickstrom, S., Hoyson, M.,Jamieson, B., & Odom, S. L. (1988). Effects ofsociodramatic play training on social and com-municative interaction. Education and Treat-ment of Children, 11, 97–117.

Gopnik, A., & Meltzoff, A. N. (1994). Minds, bod-ies, and persons: Young children’s understand-ing of the self and others as ref lected inimitation and theory of mind research. In S. T.Parker, R. W. Mitchell, & M. L. Bocchia(Eds.), Self-awareness in animals and human(pp. 166–186). New York: Cambridge Univer-sity Press.

Griffith, E. M., Pennington, B. F., Wehner, E. A.,& Rogers, S. J. (1999). Executive functions inyoung children with autism. Child Develop-ment, 70, 817–832.

Hammes, J. G. W., & Langdell, T. (1981). Precur-sors of symbol formation and childhood autism.Journal of Autism and Developmental Disorders,11, 331–346.

Harris, P. (1993). Pretending and planning. In S.Baron-Cohen, H. Tager-Flusberg, & D. Cohen

(Eds.), Understanding other minds: Perspectivesfrom autism (pp. 182–202). Oxford, England:Oxford University Press.

Harris, P., & Leevers, H. J. (2000). Pretending,imagery, and self-awareness in autism. InS. Baron-Cohen, H. Tager-Flusberg, & D. J.Cohen (Eds.), Understanding other minds: Per-spectives from developmental cognitive neuro-science (2nd ed., pp. 182–202). Oxford,England: Oxford University Press.

Hatfield, E., Cacioppo, J. T., & Rapson, R. L.(1994). Emotional contagion. New York: Cam-bridge University Press.

Hauck, J. A., & Dewey, D. (2001). Hand preferenceand motor functioning in children with autism.Journal of Autism and Developmental Disor-ders, 31, 265–278.

Heimann, M. (1998). Imitation in neonates, in olderinfants and in children with autism: Feedbackto theory. In S. Braten (Ed.), Intersubjectivecommunication and emotion in early ontogeny(de la Maison des Science de l’homme ed.,pp. 89–104). Cambridge, NY: Cambridge Uni-versity Press.

Heimann, M., & Ullstadius, E. (1999). Neonatalimitation and imitation among children withautism and Down’s syndrome. In J. Nadel &G. Butterworth (Eds.), Imitation in infancy(pp. 235–253). Cambridge, England: Cam-bridge University Press.

Hermelin, B., & O’Connor, N. (1970). Psychologi-cal experiments with autistic children. NewYork: Pergamon Press.

Heyes, C. M., & Galef, B. G. (Eds.). (1996). Sociallearning in animals: The roots of culture. SanDiego, CA: Academic Press.

Hill, D. A., & Leary, M. R. (1993). Movement distur-bance: A clue to hidden competencies in personsdiagnosed with autism and other developmentaldisabilities. Madison, WI: DRI Press.

Hobson, R. P. (1989). Beyond cognition: A theory ofautism. In G. Dawson (Ed.), Autism: Nature, di-agnosis and treatment (pp. 22–48). New York:Guilford Press.

Hobson, R. P., & Lee, A. (1999). Imitation andidentification in autism. Journal of Child Psy-chology and Psychiatry, 40, 649–660.

Hobson, R. P., Lee, A., & Brown, R. (1999). Autismand congenital blindness. Journal of Autismand Developmental Disorders, 29, 45–56.

Hobson, R. P., Ouston, J., & Lee, A. (1989). Nam-ing emotion in faces and voices: Abilities anddisabilities in autism and mental retardation.British Journal of Developmental Psychology,7, 237–250.

Huang, C. T., Heyes, C., & Charman, T. (2002).Infants’ behavioral reenactment of “Failed

volk_c14.qxd 2/28/05 9:51 AM Page 402


Attempts”: Exploring the roles of emulationlearning, stimulus enhancement, and under-standing of intentions. Developmental Psychol-ogy, 38, 840–855.

Hughes, C. (1996). Planning problems in autism atthe level of motor control. Journal of Autismand Developmental Disorders, 26, 99–109.

Iacoboni, M., Woods, R. P., Brass, M., Bekkering,H., Mazziotta, J. C., & Rizzolatti, G. (1999).Cortical mechanisms of human imitation. Sci-ence, 286, 2526–2528.

Jarrold, C. (1997). Pretend play in autism: Execu-tive explanations. In J. Russell (Ed.), Autismas an executive disorder (pp. 101–133). Ox-ford, England: Oxford University Press.

Jarrold, C., Boucher, J., & Smith, P. (1993). Sym-bolic play in autism: A review. Journal of Autismand Developmental Disorders, 23, 281–307.

Jarrold, C., Boucher, J., & Smith, P. K. (1996).Generativity deficits in pretend play inautism. British Journal of Developmental Psy-chology, 14, 275–300.

Jarrold, C., Smith, P. K., Boucher, J., & Harris, P.(1994). Comprehension of pretense in childrenwith autism. Journal of Autism and Develop-mental Disorders, 24, 433–455.

Jones, V., & Prior, M. (1985). Motor imitation abil-ities and neurological signs in autistic chil-dren. Journal of Autism and DevelopmentalDisorders, 15, 37–46.

Kavanaugh, R. D., & Harris, P. L. (1994). Imagin-ing the outcome of pretend transformations:Assessing the competence of normal childrenand children with autism. Developmental Psy-chology, 30, 847–854.

Kimberg, D. Y., & Farah, M. J. (1993). A unified ac-count of cognitive impairments followingfrontal lobe damage: The role of working mem-ory in complex, organized behavior. Journal ofExperimental Psychology, 122, 411–428.

Kohen-Raz, R., Volkmar, F. R., & Cohen, D. J.(1992). Postural control in children withautism. Journal of Autism and DevelopmentalDisorders, 22, 419–432.

Kugiumutzakis, G. (1999). Genesis and develop-ment of early infant mimesis to facial andvocal models. In J. Nadel & G. Butterworth(Eds.), Imitation in infancy (pp. 36–59).Cambridge, England: Cambridge UniversityPress.

Leslie, A. (1987). Pretense and representation: Theorigins of “Theory of Mind.” PsychologicalReview, 94, 412–426.

Lewis, V., & Boucher, J. (1988). Spontaneous, in-structed and elicited play in relatively ableautistic children. British Journal of Develop-mental Psychology, 6, 325–339.

Lewis, V., & Boucher, J. (1995). Generativity in theplay of young people with autism. Journalof Autism and Developmental Disorders, 25,105–122.

Libby, S., Powell, S., Messer, D., & Jordan, R.(1997). Imitation of pretend play acts by chil-dren with autism and Down syndrome. Journalof Autism and Developmental Disorders, 27,365–383.

Libby, S., Powell, S., Messer, D., & Jordan, R.(1998). Spontaneous play in children withautism: A reappraisal. Journal of Autism andDevelopmental Disorders, 28, 487–497.

Lord, C., & Pickles, A. (1996). Language level andnonverbal social-communicative behaviors inautistic and language-delayed children. Jour-nal of the Academy of Child and AdolescentPsychiatry, 35, 1542–1550.

Loveland, K. A. (2001). Toward an ecological the-ory of autism. In J. A. Burack, T. Charman, N.Yirmiya, & P. R. Zelazo (Eds.), The develop-ment of autism: Perspective from theory andresearch (pp. 17–37). Mahwah, NJ: Erlbaum.

Loveland, K. A., Tunali-Kotoski, B., Pearson, D. A.,& Brelsford, K. A. (1994). Imitation and ex-pression of facial affect in autism. Developmentand Psychopathology, 6, 433–444.

Manjiviona, J., & Prior, M. (1995). Comparison ofAsperger syndrome and high-functioning autis-tic children on a test of motor impairment.Journal of Autism and Developmental Disor-ders, 25, 23–40.

McCune-Nicholich, L. (1977). Beyond sensorimotorintelligence: Assessment of symbolic maturitythrough analysis of pretend play. Merrill-Palmer Quarterly, 23, 89–99.

McCune-Nicholich, L. (1981). Toward symbolicfunctioning: Structure of early pretend gamesand potential parallels with language. ChildDevelopment, 52, 785–797.

McDonough, L., Stahmer, A., Schreibman, L., &Thompson, S. J. (1997). Deficits, delays, anddistractions: An evaluation of symbolic playand memory in children with autism. Develop-ment and Psychopathology, 9, 17–41.

Meltzoff, A., & Gopnik, A. (1993). The role of im-itation in understanding persons and develop-ing a theory of mind. In S. Baron-Cohen,H. Tager-Flusberg, & D. J. Cohen (Eds.), Un-derstanding other minds: Perspectives fromautism (pp. 335–366). Oxford, England: Ox-ford University Press.

Meltzoff, A., & Moore, M. K. (1977). Imitation offacial and manual gestures by human neonates.Science, 198, 75–78.

Minshew, N. J., Goldstein, G., & Siegel, D. J.(1997). Neuropsychologic functioning in

volk_c14.qxd 2/28/05 9:51 AM Page 403


autism: Profile of a complex information pro-cessing disorder. Journal of the InternationalNeuropsychological Society, 3, 303–316.

Morgan, S. B., Cutrer, P. S., Coplin, J. W., & Ro-drigue, J. R. (1989). Do autistic children differfrom retarded and normal children in Piagetiansensorimotor functioning? Journal of ChildPsychology and Psychiatry, 30, 857–864.

Mundy, P., Sigman, M., Ungerer, J., & Sherman, T.(1986). Defining the social deficits of autism:The contribution of non-verbal communicationmeasures. Journal of Child Psychology andPsychiatry, 27, 657–669.

Murphy, L. B. (1972). Infants’ play and cognitivedevelopment. In M. W. Piers (Ed.), Play anddevelopment (pp. 119–126). New York: Norton.

Nadel, J., & Peze, A. (1993). What makes immediateimitation communicative in toddlers and autis-tic children. In J. Nadel & L. Camaioni (Eds.),New perspectives in early communication devel-opment (pp. 139–156). London: Routledge.

Nakamura, K., Kawashima, R., Ito, K., Sugiura,M., Kato, T., Nakamura, A., et al. (1999). Ac-tivation of the right inferior frontal cortexduring assessment of facial emotion. Journalof Neurophysiology, 82, 1610–1614.

Ohta, M. (1987). Cognitive disorders of infantileautism: A study employing the WISC, spatialrelationships, conceptualization, and gesturalimitation. Journal of Autism and Developmen-tal Disorders, 17, 45–62.

Osterling, J., & Dawson, G. (1994). Early recogni-tion of children with autism: A study of firstbirthday home videotapes. Journal of Autismand Developmental Disorders, 24, 247–257.

Osterling, J., Dawson, G., & Munson, J. (2002).Early recognition of one-year old infants withautism spectrum disorder versus mental retar-dation. Development and Psychopathology, 14,239–251.

Ozonoff, S., & McEvoy, R. E. (1994). A longitudi-nal study of executive function and theory ofmind development in autism. Development andPsychopathology, 6, 415–431.

Ozonoff, S., Pennington, B. F., & Rogers, S. J.(1991). Executive function deficits in high-functioning autistic children: Relationship totheory of mind. Journal of Child Psychologyand Psychiatry, 32, 1081–1105.

Page, J., & Boucher, J. (1998). Motor impairmentsin children with autistic disorder. Child Lan-guage Teaching and Therapy, 14, 233–259.

Pennington, B. F., & Ozonoff, S. (1991). A neurosci-entific perspective on continuity and disconti-nuity in developmental psychopathology. InD. Cicchetti & S. L. Toth (Eds.), Rochestersymposium on developmental psychopathology:

Vol. 3. Models and integrations (pp. 117–159).Rochester, NY: University of Rochester Press.

Perner, J. (1991). Understanding the representa-tional mind. Cambridge, MA: MIT Press.

Piaget, J. (1962). Play, dreams, and imitation inchildhood. New York: Norton.

Prior, M., & Hoffman, W. (1990). Brief report:Neuropsychological testing of autistic childrenthrough an exploration with frontal lobe tests.Journal of Autism and Developmental Disor-ders, 20, 581–590.

Rapin, I. (1996). Preschool children with inadequatecommunication: Developmental language disor-der. London: Mac Keith Press.

Ricks, D. M., & Wing, L. (1975). Language, com-munication, and the use of symbols in normaland autistic children. Journal of Autism andChildhood Schizophrenia, 5, 191–221.

Riguet, C. B., Taylor, N. D., Benaroya, S., & Klein,L. S. (1981). Symbolic play in autistic, Down’s,and normal children of equivalent mental age.Journal of Autism and Developmental Disorders,11, 439–448.

Rizzolatti, G., & Arbib, M. A. (1998). Languagewithin our grasp. Trends in Neuroscience, 21,188–194.

Rizzolatti, G., Fadiga, L., Fogassi, L., & Gallese, V.(2003). From mirror neurons to imitation:Facts and speculations. In A. Meltzoff & W.Prinz (Eds.), The imitative mind: Development,evolution, and brain bases (pp. 247–266). Cam-bridge, England: Cambridge University Press.

Rodier, P. M. (2000). The early origins of autism.Scientific American, 282, 56–63.

Roeyers, H., Van Oost, P., & Bothuyne, S. (1998).Immediate imitation and joint attention inyoung children with autism. Development andPsychopathology, 10, 441–450.

Rogers, S. J. (1999). An examination of the imitationdeficit in autism. In J. Nadel & G. Butterworth(Eds.), Imitation in infancy (pp. 254–283).Cambridge, England: Cambridge UniversityPress.

Rogers, S. J., Bennetto, L., McEvoy, R. E., & Pen-nington, B. F. (1996). Imitation and pantomimein high functioning adolescents with autismspectrum disorders. Child Development, 67,2060–2073.

Rogers, S. J., & Lewis, H. (1989). An effective daytreatment model for young children with per-vasive developmental disorders. Journal of theAmerican Academy of Child and AdolescentPsychiatry, 28, 207–214.

Rogers, S. J., & Pennington, B. F. (1991). A theo-retical approach to the deficits in infantileautism. Development and Psychopathology, 3,137–162.

volk_c14.qxd 2/28/05 9:51 AM Page 404


Rogers, S. J., & Puchalski, C. (1984). Developmentof symbolic play in visually impaired infants.Topics in Early Childhood Special Education, 3,57–64.

Rogers, S. J., Stackhouse, T., Hepburn, S. L., &Wehner, E. A. (2003). Imitation performancein toddlers with autism and those with otherdevelopmental disorders. Journal of Child Psy-chology and Psychiatry and Allied Disciplines.

Rogoff, B., Mistry, J., Goncu, A., & Mosier, C.(1993). Guided participation in cultural activ-ity by toddlers and caregivers. Monographs ofthe Society for Research in Child Development,58, 1–161.

Rumsey, J., & Hamburger, S. D. (1988). Neuropsy-chological findings in high-functioning menwith infantile autism, residual state. Journal ofClinical and Experimental Neuropsychology,10, 201–221.

Russell, J. (1997). Executive functioning in autism.Oxford, England: Oxford University Press.

Rutherford, M. D., & Rogers, S. J. (in press). Thecognitive underpinnings of pretend play. Jour-nal of Autism and Developmental Disorders.

Sigman, M., & Ruskin, E. (1999). Continuity andchange in the social competence of childrenwith autism, Down syndrome, and develop-mental delays. Monographs of the Society forResearch inn Child Development, 64, 1–114.

Sigman, M., & Ungerer, J. (1984). Cognitive andlanguage skills in autistic, mentally retarded,and normal children. Developmental Psychol-ogy, 20, 293–302.

Smith, I. M., & Bryson, S. E. (1998). Gesture imi-tation in autism: I. Nonsymbolic postures andsequences. Cognitive Neuropsychology, 15,747–770.

Stern, D. N. (1985). The interpersonal world of thehuman infant. New York: Basic Books.

Stone, W. L., Ousley, O. Y., & Littleford, C. D.(1997). Motor imitation in young childrenwith autism: What’s the object? Journal of Ab-normal Child Psychology, 25, 475–485.

Stone, W. L., & Yoder, P. J. (2001). Predicting spo-ken language level in children with autismspectrum disorders. Autism, 5, 341–361.

Teitelbaum, P., Teitelbaum, O., Ney, J., Fryman, J.,& Maurer, R. G. (1998). Movement analysis ininfancy may be useful for early diagnosis ofautism. Proceedings of the National Academyof Sciences, USA, 95, 13982–13987.

Thorp, D. M., Stahmer, A. C., & Schreibman, L.(1995). Effects of sociodramatic play trainingon children with autism. Journal of Autism andDevelopmental Disorders, 25, 265–282.

Tilton, J. R., & Ottinger, D. R. (1964). Comparisonof the toy play behavior of autistic, retarded,and normal children. Psychological Reports,967–975.

Tomasello, M. (1998). Intending that others jointlyattend. Pragmatics and Cognition, 6, 1998,229–243.

Tomasello, M., Kruger, A. C., & Ratner, H. H.(1993). Cultural learning. Behavioral and BrainSciences, 16, 495–552.

Tomasello, M., Striano, T., & Rochat, P. (1999). Doyoung children use objects as symbols? BritishJournal of Developmental Psychology, 17,563–584.

Trevarthen, C., Kokkinaki, T., & Fiamenghi, G. A.(1999). What infant’s imitations communicate.In J. Nadel & G. Butterworth (Eds.), Imitationin infancy (pp. 127–185). Cambridge, England:Cambridge University Press.

Ungerer, J., & Sigman, M. (1981). Symbolic playand language comprehension in autistic chil-dren. Journal of the American Academy of ChildPsychiatry, 20, 318–337.

Uzgiris, I. C. (1981). Two functions of imitationduring infancy. International Journal of Be-havioral Development, 4, 1–12.

Uzgiris, I. C. (1999). Imitation as activity: Its devel-opmental aspects. In J. Nadel & G. Butterworth(Eds.), Imitation in infancy (pp. 186–206).Cambridge, England: Cambridge UniversityPress.

Want, S. C., & Harris, P. L. (2002). Social learning:Compounding some problems and dissolvingothers. Developmental Science, 5, 39–41.

Werner, E., Dawson, G., Osterling, J., & Dinno, N.(2000). Brief report: Recognition of autismspectrum disorder before one year of age: Aretrospective study based on home videotapes.Journal of Autism and Developmental Disorders,30, 157–162.

Williams, E., Reddy, V., & Costall, A. (2001). Tak-ing a closer look at functional play in childrenwith autism. Journal of Autism and Develop-mental Disorders, 31, 67–77.

Williams, J. H., Whiten, A., Suddendorf, T., & Per-rett , D. I. (2001). Imitation, mirror neuronsand autism. Neuroscience and BiobehavioralReview, 25, 287–295.

Wing, L., Gould, J., Yeates, S., & Brierley, L.(1977). Symbolic play in severely mentally re-tarded and in autistic children. Journal of ChildPsychology and Psychiatry, 18, 167–178.

volk_c14.qxd 2/28/05 9:51 AM Page 405

Imitation and Play in Autism - Wiley: Home

Documents

Transcript of Imitation and Play in Autism - Wiley: Home