Matthew D. Lerner

The Impact of Pretend Play on Children's Development: A Review of the Evidence

Pretend play has been claimed to be crucial to childrens healthy development. Here we examine evidence for this position versus 2 alternatives: Pretend play is 1 of many routes to positive developments (equifinality), and pretend play is an epiphenomenon of other factors that drive development. Evidence from several domains is considered. For language, narrative, and emotion regulation, the research conducted to date is consistent with all 3 positions but insufficient to draw conclusions. For executive function and social skills, existing research leans against the crucial causal position but is insufficient to differentiate the other 2. For reasoning, equifinality is definitely supported, ruling out a crucially causal position but still leaving open the possibility that pretend play is epiphenomenal. For problem solving, there is no compelling evidence that pretend play helps or is even a correlate. For creativity, intelligence, conservation, and theory of mind, inconsistent correlational results from sound studies and nonreplication with masked experimenters are problematic for a causal position, and some good studies favor an epiphenomenon position in which child, adult, and environment characteristics that go along with play are the true causal agents. We end by considering epiphenomenalism more deeply and discussing implications for preschool settings and further research in this domain. Our take-away message is that existing evidence does not support strong causal claims about the unique importance of pretend play for development and that much more and better research is essential for clarifying its possible role.

Parental influence on children with attention-deficit/hyperactivity disorder: II. Results of a pilot intervention training parents as friendship coaches for children.

We report findings from a pilot intervention that trained parents to be “friendship coaches” for their children with Attention-Deficit/Hyperactivity Disorder (ADHD). Parents of 62 children with ADHD (ages 6–10; 68% male) were randomly assigned to receive the parental friendship coaching (PFC) intervention, or to be in a no-treatment control group. Families of 62 children without ADHD were included as normative comparisons. PFC was administered in eight, 90-minute sessions to parents; there was no child treatment component. Parents were taught to arrange a social context in which their children were optimally likely to develop good peer relationships. Receipt of PFC predicted improvements in children’s social skills and friendship quality on playdates as reported by parents, and peer acceptance and rejection as reported by teachers unaware of treatment status. PFC also predicted increases in observed parental facilitation and corrective feedback, and reductions in criticism during the child’s peer interaction, which mediated the improvements in children’s peer relationships. However, no effects for PFC were found on the number of playdates hosted or on teacher report of child social skills. Findings lend initial support to a treatment model that targets parental behaviors to address children’s peer problems.

A Randomized Trial of a Classroom Intervention to Increase Peers' Social Inclusion of Children with Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE Interventions for peer problems among children with attention-deficit/hyperactivity disorder (ADHD) typically focus on improving these childrens behaviors. This study tested the proposition that an adjunctive component encouraging the peer group to be socially inclusive of children with ADHD would augment the efficacy of traditional interventions. METHOD Two interventions were compared: contingency management training (COMET), a traditional behavioral management treatment to improve socially competent behavior in children with ADHD, and Making Socially Accepting Inclusive Classrooms (MOSAIC), a novel treatment that supplemented behavioral management for children with ADHD with procedures training peers to be socially inclusive. Children ages 6.8-9.8 (24 with ADHD; 113 typically developing [TD]) attended a summer day program grouped into same-age, same-sex classrooms with previously unacquainted peers. Children with ADHD received both COMET and MOSAIC with a repeated measures crossover design. TD children provided sociometric information about the children with ADHD. RESULTS Whereas the level of behavior problems displayed by children with ADHD did not differ across treatment conditions, children with ADHD displayed improved sociometric preference and more reciprocated friendships, and received more positive messages from peers, when they were in MOSAIC relative to COMET. However, the beneficial effects of MOSAIC over COMET predominantly occurred for boys relative to girls. CONCLUSIONS Data support the concept that adjunctive procedures to increase the inclusiveness of the peer group may ameliorate peer problems among children with ADHD, and suggest the potential utility of modifying MOSAIC to be delivered in regular classroom settings.

Socio-Dramatic Affective-Relational Intervention for Adolescents with Asperger Syndrome & High Functioning Autism: Pilot Study

This study examined the effectiveness of a novel intervention called ‘socio-dramatic affective-relational intervention’ (SDARI), intended to improve social skills among adolescents with Asperger syndrome and high functioning autism diagnoses. SDARI adapts dramatic training activities to focus on in vivo practice of areas of social skill deficit among this population. SDARI was administered as a six-week summer program in a community human service agency. Nine SDARI participants and eight age- and diagnosis-group matched adolescents not receiving SDARI were compared on child- and parent-report of social functioning at three week intervals beginning six weeks prior to intervention and ending six weeks post-intervention. Hierarchical Linear Modeling (HLM) was used to estimate growth trends between groups to assess treatment outcomes and post-treatment maintenance. Results indicated significant improvement and post-treatment maintenance among SDARI participants on several measures of child social functioning. Implications for practice and research are discussed.

Understanding Parent–Child Social Informant Discrepancy in Youth with High Functioning Autism Spectrum Disorders

We investigated discrepancies between parent- and self-reported social functioning among youth with autism spectrum disorders (ASD). Three distinct samples showed discrepancies indicating that parents viewed their children as performing one standard deviation below a standardization mean, while youth viewed themselves as comparably-skilled relative to peers. Discrepancies predicted lower parental self-efficacy, and lower youth-reported hostile attributions to peers, marginally-lower depression, and decreased post-treatment social anxiety. Discrepancies predicted outcomes better than parent- or youth-report alone. Informant discrepancies may provide valuable additional information regarding child psychopathology, parental perceptions of parenting stress, and youth treatment response. Findings support a model where abnormal self-perceptions in ASD stem from inflated imputation of subjective experiences to others, and provide direction for improving interventions for youth and parents.

Anxiety in youth with and without autism spectrum disorder: Examination of factorial equivalence

Although anxiety is frequently reported among children and adolescents with autism spectrum disorder (ASD), it has not been established that the manifest symptoms of anxiety in the context of ASD are the same as those seen in youth without ASD. This study sought to examine the metric and latent factor equivalence of anxiety as measured by the Multidimensional Anxiety Scale for Children, parent-report (MASC-P) and child-report (MASC-C), in youth with anxiety disorders and ASD with intact verbal ability (n=109, M(age)=11.67 years, 99 male) and a gender-matched comparison group of typically developing (TD) children and adolescents with anxiety disorders but without ASD (n=342, M(age)=11.25 years, 246 male). Multigroup factorial invariance (MFI) using structural equation modeling indicated equivalent latent factors in youth with and without ASD on the MASC-C (metric invariance). However, the item means and covariances along with the relations among the factor scores were different for the youth with ASD (i.e., lack of evidence for scalar or structural invariance). The MASC-P data did not fit the measures established structure for either the ASD or TD group, and post-hoc exploratory factor analysis revealed a different factor structure in the ASD group. Findings suggest that the MASC-C may not measure identical constructs in anxious youth with and without ASD. Further research on the structure of the MASC in clinical samples is warranted.

Multimodal emotion processing in autism spectrum disorders: An event-related potential study

This study sought to describe heterogeneity in emotion processing in autism spectrum disorders (ASD) via electrophysiological markers of perceptual and cognitive processes that underpin emotion recognition across perceptual modalities. Behavioral and neural indicators of emotion processing were collected, as event-related potentials (ERPs) were recorded while youth with ASD completed a standardized facial and vocal emotion identification task. Children with ASD exhibited impaired emotion recognition performance for adult faces and child voices, with a subgroup displaying intact recognition. Latencies of early perceptual ERP components, marking social information processing speed, and amplitudes of subsequent components reflecting emotion evaluation, each correlated across modalities. Social information processing speed correlated with emotion recognition performance, and predicted membership in a subgroup with intact adult vocal emotion recognition. Results indicate that the essential multimodality of emotion recognition in individuals with ASDs may derive from early social information processing speed, despite heterogeneous behavioral performance; this process represents a novel social-emotional intervention target for ASD.

A Preliminary Randomized Controlled Trial of Two Social Skills Interventions for Youth With High-Functioning Autism Spectrum Disorders

This study examined the effects of two social skills interventions, Sociodramatic Affective Relational Intervention (SDARI) and Skillstreaming, to compare their treatment mechanisms, social performance- and knowledge-training. A total of 13 youth with autism spectrum disorders were randomly assigned to 4 weeks of 1-day/week SDARI or Skillstreaming. Groups were matched on parent and child demographics, and intervention staff training. Participants were assessed on social behavior during treatment sessions, peer sociometrics, staff-reported social skills, and parent-reported social skill generalization. Results indicated that both groups increased in reciprocated friendship nominations and staff-reported social skills. Relative to Skillstreaming participants, SDARI participants liked and interacted more with each other after a single session. However, Skillstreaming participants increased in peer liking and interaction over the course of the intervention; SDARI participants decreased slightly. Parents reported no change in social functioning at home. Implications for research and practice are discussed.

Group-based social skills interventions for adolescents with higher-functioning autism spectrum disorder: a review and looking to the future

In this paper, we synthesize the current literature on group-based social skills interventions (GSSIs) for adolescents (ages 10–20 years) with higher-functioning autism spectrum disorder and identify key concepts that should be addressed in future research on GSSIs. We consider the research participants, the intervention, the assessment of the intervention, and the research methodology and results to be integral and interconnected components of the GSSI literature, and we review each of these components respectively. Participant characteristics (eg, age, IQ, sex) and intervention characteristics (eg, targeted social skills, teaching strategies, duration and intensity) vary considerably across GSSIs; future research should evaluate whether participant and intervention characteristics mediate/moderate intervention efficacy. Multiple assessments (eg, parent-report, child-report, social cognitive assessments) are used to evaluate the efficacy of GSSIs; future research should be aware of the limitations of current measurement approaches and employ more accurate, sensitive, and comprehensive measurement approaches. Results of GSSIs are largely inconclusive, with few consistent findings across studies (eg, high parent and child satisfaction with the intervention); future research should employ more rigorous methodological standards for evaluating efficacy. A better understanding of these components in the current GSSI literature and a more sophisticated and rigorous analysis of these components in future research will lend clarity to key questions regarding the efficacy of GSSIs for individuals with autism spectrum disorder.

Considering ERP difference scores as individual difference measures: Issues with subtraction and alternative approaches

There is growing interest in psychophysiological and neural correlates of psychopathology, personality, and other individual differences. Many studies correlate a criterion individual difference variable (e.g., anxiety) with a psychophysiological measurement derived by subtracting scores taken from two within-subject conditions. These subtraction-based difference scores are intended to increase specificity by isolating variability of interest. Using data on the error-related negativity (ERN) and correct response negativity (CRN) in relation to generalized anxiety disorder (GAD), we highlight several conceptual and practical issues with subtraction-based difference scores and propose alternative approaches based on regression. We show that ERN and CRN are highly correlated, and that the ΔERN (i.e., ERN - CRN) is correlated in opposite directions both with ERN and CRN. Bivariate analyses indicate that GAD is related to ΔERN and ERN, but not CRN. We first show that, by using residualized scores, GAD relates both to a larger ERN and smaller CRN. Moreover, by probing the interaction of ERN and CRN, we show that the relationship between GAD and ERN varies by CRN. These latter findings are not evident when using traditional subtraction-based difference scores. We then completed follow-up analyses that suggested that an increased P300 in anxious individuals gave rise to the apparent anxiety/CRN relationship observed. These findings have important conceptual implications for facilitating the interpretability of results from individual difference studies of psychophysiology.