Summarize at least 3 articles which explore play patterns, perseveration, and self injurious behaviors.

Play Patterns
Wolfberg (1995) defines play as an activity that is pleasurable, intrinsically motivated, flexible, non-literal, voluntary, and involves active engagement. In contrast, children with autism spectrum disorders often engage in inflexible, repetitive play patterns and may not exhibit symbolic or pretend behavior. Individuals with this disorder tend to view the world as concrete and literal; thereby displaying difficulty with abstract concepts and imaginative behavior. It is common for individuals with this disability to have restricted and unusual interests, so they may be resistant to explore play themes with others. The autistic child’s repetitive behaviors and lack of ability to understand a peer’s perspective may leave the peer not understanding how to effectively engage the ASD child in play and may result in the peer excluding a child with ASD.


Repetitive behaviors are characteristic of ASD but not exclusive to ASD as they are also seen in typically developing children and in children with other diagnoses. Repetitive behaviors are often present in typically developing children from infancy until approximately 4 years of age when there is a decline in these behaviors due to increased skills in the areas of emotional understanding and social communication. Children with ASD exhibit longer duration and more repetitive behaviors that tend to continue with age. There is evidence to support an association between repetitive behaviors and imagination in children with ASD. Studies reviewed by Honey et al (2006), have found that children with ASD demonstrate impairments in symbolic play and non symbolic play. It has also been reported that ASD children demonstrate less functional play and less elaborate functional play than their typically developing peers and peers with learning difficulties (Jarrold et al, 1996). Again, there are discrepancies in the research but the study conducted by Honey et al, found a correlation between repetitive behaviors and play in children with ASD between the ages of 2 and 8. This indicates that ASD children who exhibit fewer repetitive behaviors engaged in more play activities than ASD children who engaged in repetitive behaviors more frequently. It is interesting to note that typically developing children’s play abilities (2-4 years of age) were found to be predicted by expressive language but for the same age children with ASD, play was also predicted by repetitive behaviors. This information is in agreement with Wing and Gould (1979) indicating a three-way association between repetitive behavior, imagination and communication.

Honey, Emma, et al. "Repetitive Behaviour and Play in Typically Developing
Children and Children with Autism Spectrum DIsorders." Journal Of Autism
and Developmental Disorders 37 (2007): 1107-1115.

Perseveration
The study conducted by Watt et al (2008), examined repetitive stereotyped behaviors (RSB) in children between 18-24 months of age diagnosed with ASD and matched groups of children with developmental delays (DD) and typical development (TD). This study found that children with ASD demonstrated significantly higher frequency and longer duration of RSB with objects and RSB with body (moderate to large effect sizes) and sensory behaviors (small effects), compared to the DD and TD groups. A subset of RSB with objects was found to distinguish the ASD group – repetitively banging or tapping objects on a surface, rocking or flipping objects back and forth, swiping objects away repetitively, spinning, wobbling or rolling objects, moving or placing objects in a stereotyped manner or place and clutching objects for longer than expected. RSB with body that distinguished the ASD group included more repetitive banging of the table surface, rubbing the body and stiffening or posturing of the hands and fingers. This study did not find that sensory behaviors were related to repetitive behaviors with objects or body; however other studies have made this correlation (Gabriels et al).

This study also drew conclusions regarding a significant negative correlation between RSB with objects (but not body) with developmental level. Bishop et al. (2006) suggests that prolonged engagement in RSB over the developmental span of the 2nd and 3rd year of life may interfere with the ability to learn other skills impacting developmental outcomes/levels. This study also drew correlations between RSB with objects and social symptoms indicating that prolonged engagement in RSB with objects could impede social skill development over the 3rd year of life. In this larger study, early RSB was predictive of the severity of symptoms in ASD in the 3rd year of life and may be early red flags of autism in observational measures of children between 18-24 months. This study did not consider the potential functions of RSB but many other research studies have, with consideration given to stress reduction, sensory stimulation, reward, amelioration of an impoverished environment (Lewis and Bodfish, 1998), learned or operant behavior, cognitive impairment, weak “central coherence”, and executive dysfunction (Turner,1999).

Interesting video on youtube - with some good music! :) Just another perspective
http://www.youtube.com/watch?v=f15JexiQt4U


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.

Turner, Michelle. "Annotation: Repetitive Behaviour in Autism: A Review of
Psychological Research." Journal of Child Psychology and Psychiatry 40.6
(1999): 839-849.
Lewis, Mark, and James Bodfish. "Repetitive Behavior Disorders in Autism ."
Mental Retardation and Developmental Disabilities 4 (1998): 80-89.

Self-Injurious Behaviors
Self-injurious behavior often refers to any behavior that can cause tissue damage with two major theories providing possible functions of the behavior, physiological and social. Physiological reasons for self-injurious behavior may be biochemical. Some research suggests that the levels of certain neurotransmitters are associated with self-injurious behaviors. Beta endorphins produce an opiate like response and self-injury may increase the production or release of endorphins possibly increasing a euphoric-like feeling in the individual. Some studies have found drugs that block the binding at opiate receptor sites can successfully reduce self-injurious behaviors (Herman et al., 1989). Studies on laboratory animals have indicated that low levels of serotonin or high levels of dopamine are associated with self-injury as found by an increase in self-injurious and aggressive behaviors when medications were given to either reduce serotonin levels or increased dopamine levels (Mueller et al., 1982). Review of the literature indicates some research and anecdotal reports of decreased self-injurious behaviors after medical intervention including drugs to increase serotonin levels or decrease dopamine levels, as well as vitamin supplements (B6), calcium supplements, and changes to diet. A study conducted by Hollander et al (2003), found that the administration of oxytocin, decreased the severity and the number of different types of repetitive behaviors in autistic individuals confirming their hypothesis that deficits in oxytocin peptide processing plays a role in the severity of compulsive/repetitive and even self-injurious behaviors. Research also indicates the possibility of self-injurious behavior occurring as a result of seizures, genetic disorders, pain, frustration, arousal and sensory. The arousal theory suggests that self-injury may increase or decrease one’s arousal level. Self-injury to increase arousal level may be considered an extreme form of self-stimulation and self-injury to decrease arousal level may release tension/anxiety.

Possible social causes of self-injurious behavior may include poor communication skills leading to frustration. Social attention – Lovaas (1965), demonstrated self-injurious behaviors increasing when given positive attention or positive reinforcement whereas ignoring the behavior decreased the frequency of the self-injurious behaviors (extinction); extreme care needs to be given to consistency as the behavior will continue and even become more extreme if intermittently reinforced. Other individuals may engage in self-injurious behaviors as a way to obtain something they want such as an object or event (Durand, 1986). Another possible social cause is to avoid or escape an “aversive” social encounter. An individual may engage in self-injurious behavior prior to a social interaction in order to avoid the interaction or may engage in the self-injurious behavior to escape a social interaction that has already begun.

The concluding information from the Together For Autism website, reminds one that there are many possible reasons for an individual to engage in self-injurious behaviors. Edelson et al. (1983) observed three different forms of self-injury by the same individual. This individual banged his head against his knee and then received attention; pinched his stomach after the staff asked him to do something; and bit his wrist after he asked for something but did not receive it.

It is noted that when self-injurious behaviors occur, a functional analysis of the behavior should be conducted in order to obtain detailed information including a description of the behavior and the relationships between the behavior and physical and social environment. However, when self-injurious behavior is the result of a biochemical abnormality, there may be little or no relationship between the person’s physical/social environment and self-injury. The functional analysis would prove to be a valuable tool in trying to identify the cause of the self-injurious behavior to assist with implementing the correct intervention strategy as the various physiological and social possibilities as causes for self-injurious behaviors would have different interventions to address the underlying cause.

Edelson, Stephen. TogetherForAutism.org. 2009. 21 Mar. 2009
.

Hollander, Eric, et al. "Oxytocin Infusion Reduces Repetitive Behaviors in
Adults with Autistic and Asperger's Disorders." Neuropsychopharmacology 28
(2003): 193-198