||The Relationships among Theory of Mind, Pretend Play, and Playfulness in Children with Autism Spectrum Disorder
||Department of Occupational Therapy
autism spectrum disorder
theory of mind
自閉症類群障礙(autism spectrum disorder, ASD)是終其一生的神經發展障礙，ASD孩童受損的心智理論能力(theory of mind)可能會造成他們社交互動上的困難，與其假扮遊戲(pretend play)的缺損及較差的玩性(playfulness)有關。然而，過去相關研究指出心智理論能力與假扮遊戲相關性的研究結果不一致，也沒有研究直接探討心智理論能力與玩性間的關係。因此，本研究目的為廣泛且全面地探討ASD孩童的心智理論能力與假扮遊戲和玩性間的關係，並且與發展遲緩(developmental delay, DD)孩童和正常發展(typically developing, TD)孩童比較，描述ASD孩童在心智理論能力、假扮遊戲及玩性的特徵。
本研究納入年齡介於3歲到7歲11個月的20位ASD孩童、20位DD孩童及20位TD孩童，並配對三組孩童的語言能力。孩童接受華語理解與表達詞彙測驗第二版(Receptive and Expressive Vocabulary Test-Second Edition)與心智理論測驗(Theory of Mind Test)的評估，並進入一個自由遊戲情境和一個假扮遊戲情境，分別用來評估玩性測驗(Test of Playfulness)與兒童自發性假扮遊戲評估(Child-Initiated Pretend Play Assessment)。孩童的照顧者則接受自閉症兒童行為檢核表(Childhood Autism Rating Scale)的訪談。資料分析包含敘述性統計、單因子變異數分析(one-way analysis of variance)及皮爾森相關係數(Pearson’s correlation coefficient)。
研究結果顯示ASD孩童相較於DD和TD孩童有心智理論能力與假扮遊戲的缺損以及較差的玩性。相關性分析結果則證實心智理論能力與假扮遊戲中的模仿行為 (r = -.481, p < .05)以及假扮遊戲中的物品取代行為有關(r = .479, p < .05)，但心智理論能力與玩性無顯著相關。
Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder. Children with ASD are found to have impaired theory of mind (ToM), which might cause their poor socialization and be associated with pretend play deficit and lower playfulness. However, previous findings on the relationship between ToM and pretend play have been inconsistent, and no studies have directly examined the relationship between ToM and playfulness. Therefore, the main purpose of this study was to comprehensively examine the relationships among ToM, pretend play, and playfulness in children with ASD. Furthermore, one more purpose was to characterize ToM, pretend play, and playfulness in children with ASD as compared to children with developmental delay (DD) and typically developing (TD) children.
Twenty children with ASD, 20 children with DD, and 20 TD children aged between 3 and 7.11 were recruited for this study. The three groups of children were matched for verbal ability. Children were measured with the Receptive and Expressive Vocabulary Test-Second Edition and the Theory of Mind Test, and they entered a free play condition and a pretend play condition for the Test of Playfulness and the Child-Initiated Pretend Play Assessment, respectively. The children’s caregivers were interviewed with the Childhood Autism Rating Scale. Descriptive analysis, one-way analysis of variance, and Pearson’s correlation coefficient were used for the data analysis.
The results showed that children with ASD had deficits in ToM and pretend play, and felt less playful as compared to children with DD and TD children. The results of the correlational analysis confirmed that ToM was associated with imitated actions (r = -.481, p < .05) and the behaviors of object substitution (r = .479, p < .05) in pretend play. However, the results failed to show a significant relationship between ToM and playfulness.
The present study provides a complete understanding of the relationships among ToM, pretend play, and playfulness in children with ASD. The findings support the idea that children with ASD who have better ToM may be able to develop more spontaneous pretend play behaviors and the behaviors of object substitution. However, the limitations of this study include the small sample size, the underestimated ToM due to that considerately good verbal ability and long assessment time were required for the ToM test, and the inability to generalize the results to children with lower-functioning and non-verbal ASD. Further studies are warranted to include more participants, apply a measurement of ToM that is less time-consuming and less verbally-demanding, and recruit lower-functioning and non-verbal children with ASD to illustrate the relationships among ToM, pretend play, and playfulness.
TABLE OF CONTENTS VII
LIST OF TABLES X
LIST OF FIGURES XI
LIST OF APPENDICES XII
CHAPTER 1 INTRODUCTION 1
CHAPTER 2 LITERATURE REVIEW 5
2.1 Autism spectrum disorder 5
2.1.1 Diagnosis 5
2.1.2 Prevalence 6
2.1.3 Prognosis 6
2.2 Play 7
2.2.1 Definition and importance 7
2.2.2 Model of play 8
2.3 Pretend play 9
2.3.1 Definition, development, and importance 9
2.3.2 Pretend play in children with autism spectrum disorder 10
2.4 Playfulness 11
2.4.1 Definition and importance 11
2.4.2 Playfulness in children with autism spectrum disorder 12
2.5 Theory of mind 13
2.5.1 Definition, development, and importance 13
2.5.2 Theory of mind in children with autism spectrum disorder 15
2.6 The relationship between theory of mind and pretend play in children with autism spectrum disorder 16
2.7 The relationship between theory of mind and playfulness in children with autism spectrum disorder 17
2.8 Summary of the literature review 18
CHAPTER 3 METHODS 20
3.1 Purposes and hypotheses 20
3.2 Participants 20
3.3 Measurements 22
3.3.1 Child-Initiated Pretend Play Assessment (ChIPPA) 22
3.3.2 Test of Playfulness (ToP) 24
3.3.3 Theory of Mind Test (ToM test) 25
3.3.4 Childhood Autism Rating Scale (CARS) 26
3.3.5 Receptive and Expressive Vocabulary Test-Second Edition (REVT2) 27
3.4 Procedures 28
3.4.1 Measurement preparations 28
3.4.2 Pilot study 29
3.4.3 Study procedures 30
3.5 Data analysis 31
3.5.1 Descriptive statistics 31
3.5.2 Inferential statistics 31
CHAPTER 4 RESULTS 32
4.1 Demographic characteristics of the participants 32
4.2 Theory of mind in children with autism spectrum disorder 33
4.3 Pretend play in children with autism spectrum disorder 33
4.4 Playfulness in children with autism spectrum disorder 34
4.5 The relationships among theory of mind, pretend play, and playfulness in children with autism spectrum disorder 34
CHAPTER 5 DISCUSSION 36
5.1 Theory of mind in children with autism spectrum disorder 36
5.2 Pretend play in children with autism spectrum disorder 37
5.3 Playfulness in children with autism spectrum disorder 39
5.4 he relationships among theory of mind, pretend play, and playfulness in children with autism spectrum disorder 40
5.5 Limitations 41
5.6 Conclusions and clinical applications 41
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