How do skills/abilities and cognition impact perseverative play/repetitive play? How do play patterns/self-injurious behaviors impact daily function?

There are conflicting findings in the literature that examines the relationship between repetitive and stereotyped behaviors (RSB) and developmental levels in children with autism. Some studies, as reviewed by Watt et al. (2008) indicate a lack of association between RSBs and developmental levels (language stages and mental ages). However, other studies have found that RSBs and developmental levels were significantly related. Variabilities in age and the measures used to assess language stages and mental ages may have accounted for the discrepancies in the various studies.

One study by Bishop et al. (2006), examined 830 children with ASD and found that as the children got older there was a strong correlation between developmental levels and RSBs (lower developmental levels and increased RSBs – specifically resistance to change, compulsions/rituals, repetitive use of objects, unusual attachments, stereotyped speech and self-injury). With increased RSBs in terms of type and frequency, the obvious impact on play and daily function would be a decrease in functional abilities and/or acquisition of new skills. It has been found that early RSBs have a significant impact on the acquisition of a number of skills during interventions (Boppe et al. 2005). This study showed that preschool children with fewer RSBs at the onset of intervention showed more progress in social skill development over 2 years. It was also found that children who showed a decrease in RSBs within 6 months to 1 year of intervention demonstrated greater gains in language, ADLs and IQ scores over 2 years. Both findings demonstrate the significant need to work on decreasing the number and frequency of RSBs during the preschool years. It could be hypothesized that prolonged RSBs across the crucial developmental period of the 2nd and 3rd years of life may interfere with learning opportunities and may have a cumulative impact on developmental outcomes over time.

A point to ponder, review of the literature also indicates that the perseverative nature of ASD individuals, while most often viewed as a weakness, can be regarded as a possible strength. It could be considered that if a child prefers repetition, this type of task may produce more focused and sustained attention than tasks requiring flexibility and dynamic problem solving. On the negative side, of course, perseverative behavior can be regarded as mental “downtime” during which no new stimulation is being received. Byrna Siegel reminds us as interventionists, that the perseverative tendencies may be utilized to influence motivation in a child who may otherwise be non motivated. She challenges us to be creative and utilize the goal directed motivation (which can be seen when a “stim” or “stimming toy” is present) to achieve new learning.

Please view this PDF on play – http://www.thehelpgroup.org/pdf/Handout13.pdf

Watt, Nola, et al. "Repetitive and Stereotyped Behaviors in Children with Autism Spectrum Disorders in the Second Year of Life." Journal of Child Psychology and Psychiatry 49.8 (2008): 826–837.
Siegel, Byrna. Helping CHildren with Autism Learn: Treatment Approaches for Parents and Professionals. N.p.: Oxford University Press, 2003.