Question 2.

How do skill/abilities and cognition impact perseverative play/repetitive play?

 Ducks in a row
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In a study conducted by D.K. Wong, (Wong, 2001) three major cognitive theories were proposed to account for the behavioral symptoms of autism: 

• Theory of Mind  
• Central Coherence Theory
• Executive Dysfunction

These three theories have had varying degrees of success in accounting for the repetitive behaviors, language impairments, and communicative difficulties which are symptomatic of autism. However the study concluded that deficits in Executive Functioning showed the strongest correlation with perseveration and repetitive behaviors.

Executive function is the ability to initiate an idea, make a plan, draw from memory, and carry out that plan. A child with an ASD who has poor executive function will be impacted by an inability to play constructively. The skills inherent in executive function require that the child build a fund of knowledge about his environment and the objects in it. This fund of knowledge is built and developed through play and interaction with their environment.

Without these cognitive functions the child will lack the ability to generate an idea, think imaginatively, create a mental picture or plan, or retrieve information from memory and carry out that plan.

As a result of these deficits children with an ASD will:

• Do less exploration and play with fewer toys.
• Tend not to engage in pretend or imaginative play.
• Tend not to use toys in novel ways.
• Display a lack of imagination that limits exploration and play with toys.
• Become preoccupied with certain aspects or sensory features of a particular toy like the spinning wheels of a car.
• Engage in perseverative restrictive repetitive play patterns. 

How do play patterns and self-injurious behaviors impact learning and daily function?

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The lack of constructive play patterns reduces learning opportunities. Restrictive repetitive play means that the child misses out on exploration of the uses of toys and their actions, cause/effect, and affordances. While engaging in repetitious play and self-injurious behaviors a child misses out on social and learning opportunities. It can impact their ability to attend, learn and develop imagination and pretend play.

Repetitious play and self-injurious behaviors can draw negative attention to the child causing further social isolation. A preoccupation with repetitious play and self-injurious behaviors has also been shown to impact language development and as a result communication and social skills.

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References:

Honey, E., Leekam, S., & Turner, M. (2006, 10 27). Repetitive Behaviour and Play in Typically Developing Children. Journal of Autism and Developmental Disorders, pp. 1107-1115.

Miller Kuhaneck, H., & Watling, R. (Eds.). (2010). Autism: a Comprehensive Occupational Therapy Approach (3rd ed.). Bethesda, MD, USA: AOTA Press.

Turner, M. (1999). Annotation: Repetitive Behaviour in Autism: A Review. Journal of Child Psychology and Psychiatry, 839-849.

Wong, D. (2001). Executive functioning and repetitive behaviours in autism. Australian Society for the Study of Brain Impairment. Magnetic Island, Queensland: University of Western Australia.