Qualitative impairments in social interaction is one of the defining characteristics for the diagnosis of Autistic Disorder and for Asperger syndrome, according to the DSM-IV-TR (APA, 2000). Social impairments can include: lack of use of nonverbal behaviors such as eye gaze, gestures, body postures, and facial expressions; lack of social-emotional reciprocity; impairment in expression of pleasure in the happiness of others; and a lack of interaction with peers, including an absence of symbolic or imaginative play activities (APA, 2000). This core impairment has led some to identify social deficits as the “heart” of autism spectrum disorders (Gutstein, 2005).
Two of the factors that appear to be predictive of the diagnosis of ASD on the CHAT (Baron-Cohen, Allen, & Gillberg, 1992) screening tool for infants involve a social component: (1) lack of joint attention skills or lack of protodeclarative pointing, and (2) lack of eye gaze with a caregiver that is found in joint attention and social referencing. Research has revealed that children diagnosed with autism rarely pointed to external events, followed points, or alternated their gaze between objects and people during infancy (Wetherby & Prutting, 1984). They also were found to be impaired in their ability to direct or share attention with the experimenter compared with typical peers and those with mental retardation (Mundy, Sigman, Ungerer, & Sherman, 1986). Compared with children with Down syndrome and typical peers, children with autism displayed fewer orienting responses to stimuli, and this lack of responding was more severe for social stimuli (Dawson, Meltzoff, Osterling, Rinaldi, & Brown, 1998). Children with autism have been shown to display relatively few deictic gestures, or gestures used for social reasons such as in joint attention (Attwood, Firth, & Hermelin, 1988).
Some authors hypothesize that the basic problem for infants with ASD is one of attention (Bogdashina, 2005). Due to possible problems with overselectivity of stimuli (Schreibman & Lovaas, 1973) and an inability to select relevant stimuli, infants and young children with ASD may not attend to caregiver facial expression or consider eye gaze as important. Other researchers state that specific deficits in imitation skills may be fundamental (Rogers & Bennetto, 2000). The tendency of children with autism not to imitate others may be due to impairment with identifying with others (Carpenter, 2006). Both social-cognitive understanding and social motivations affect what infants will copy from a demonstration, and impairments in either aspect will explain a lack of imitation in children with ASD (Carpenter).
Others hypothesize that the basic problem in ASD is an inability to express and understand affect. An early study by Ricks (1979) indicated that parents of children could identify the vocal expressions made by their offspring as surprise, joy, frustration, and so on, but that these vocal sounds were idiosyncratic and could not be identified by parents unfamiliar with the child with autism, such as parents of typical children and parents of those with mental retardation.
Researchers have found that children with autism spectrum disorders display facial expressions for the same amount of time as their peers (McGee, Feldman, & Chernin, 1991; Mundy et al., 1986), but that the expressions may not match the context—for example, children with ASD may show a negative facial expression in a context that typically elicits a positive one (McGee et al.; Mundy et al.). Children with ASD may be insensitive to faces. Studies have found that children with autism showed a preference for matching photographs based on accessories rather than facial expression (Weeks & Hobson, 1987).
When researchers asked adults to interact with their children with ASD, it was found that the children with autism engaged in similar amounts of looking, vocalizing, and smiling compared with their peers; however, they tended not to show objects or point out events to caregivers (Sigman, Mundy, Sherman, & Ungerer, 1986). Another study showed that children with autism displayed the same amount of pride, or smiling, when they completed a puzzle, but were less likely to seek attention for the achievement by showing the finished puzzle to someone else (Kasari, Sigman, Baumgartner, & Stipek, 1993). Children with autism are also less likely to exhibit an empathy response to situations when others display fear or pain compared with typical peers and those with Down syndrome (Sigman & Ruskin, 1999). In general, students with autism spectrum disorders may need to learn to attend and respond appropriately to nonverbal social cues. Taking turns (Koegel, Koegel, & Carter, 1999), reading facial expressions of emotion (Taylor & McDonough, 1996), and accurately interpreting voice tone (Lamers & Hall, 2003) are some of the social skills that are likely weak or lacking for students with autism spectrum disorders.
The defining characteristics according to the DSM-IV-TR (APA, 2000) also include lack of varied, spontaneous make-believe play and a failure to develop peer relationships. It is rare for a child with autism to spontaneously produce pretend play such as object substitution (Lewis & Boucher, 1988). It is not uncommon for learners with ASD to be uninterested in any social interaction with peers and to avoid sharing toys or activities with peers. Even when individuals with ASD have specific social behaviors, they engage in social interaction less often (Lord & Magill, 1989).
Some individuals with autism spectrum disorders have good social skills and may even seek out interaction with adults but rarely initiate with peers (Fredeen & Koegel, 2006). Compared with their typical peers, children with ASD infrequently initiate bids to play with peers or initiate social interaction with siblings (Fredeen & Koegel). Lack of social initiation with peers results in a decrease of learning opportunities from peers.
The play behavior of children with ASD also differs from that of their peers. They are often content to play with toys alone and do not seek out adults in order to share toy play (Sigman & Mundy, 1989). In addition, the restricted patterns of interest may manifest as using toys in a repetitive manner for purposes other than using the toy as it was intended (Schuler & Wolfberg, 2000). For example, a child with autism spectrum disorder may line up cars in a row in the same order each time, or spend time spinning the wheels of the car in the air. Overall, children with autism spectrum disorders engage in fewer different functional play acts and produce less diverse functional play compared with peers of a similar maturational age (Sigman & Ungerer, 1984).
Individuals with ASD often have difficulty engaging in the complexities of a sustained conversation. An individual with ASD might dominate the topic of conversation with a repetitive pattern of interest, may lack the ability to initiate a topic, or may not respond to others consistent with a topic introduced by a conversation partner (Mesibov, Shea, & Schopler, 2004). Craig and Evans (1989) revealed that students with language impairments had difficulty obtaining a turn in a conversation by interrupting others compared with peers.
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Excerpt from Autism Spectrum Disorders: From Theory to Practice, by L.J. Hall, 2009 edition, p. 176-177.
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