“Strange” Play As a Marker for Autism in Infants?
November 7, 2008 by Kristina Chew, PhD
Filed under Health
Unusual use of toys in infancy a clue to later autism, according to a stuy published in the October issue of Autism, the journal of the National Autistic Society. M.I.N.D. Institute researcher Sally Ozonoff is the lead author. “Strange play” is said to include spinning, rotating and visual exploring objects in “unusual” ways; 66 infants were involved in the study and nine were later diagnosed with autism; seven out of those nine were noted to spin, etc., toys.
Ozonoff is quoted as saying that “‘About a third of parents notice signs before a child’s first birthday.’” Researchers hope to be able to identify autism earlier. Indeed, it’s the sort of study likely to lead parents of young children to scrutinize, and over-scrutinize, their baby’s play. (”Oh no, junior is lining up those stacking cups by size along the floorboards again.”) It’s also the sort of study that leads me, inevitably, to glance at Charlie’s baby pictures and say, yeah, at 2 months and before, he was always looking slantwise out of the corners of his eyes and to remember how he could focus for minutes and minutes on certain pictures in his chunky little board books. There was one called Baby’s Colors with two-page layouts of babies surrounded by objects of each color; Charlie’s favorite was “Miss Brown” (as Jim said), an Asian girl surrounded by a host of teddy bears, many bigger than her. Charlie would turn back endlessly to see the photo and tape the red bowtie of one bear with exquisite attention; with finesse. And over, and over, again. Nothing wrong with this, we thought, just a boy looking at his books—-or not.
Will any hint “strange” or “not normal” play in a young child now set a parent (already worrying about vaccines and seeking certainty) on edge?
I think the Scottish Play is quite strange, maybe it should not be viewed by pregnant women, for fear that it causes autism in the unborn child, never mind it might lead to it’s being from it’s mothers womb, untimely ripped.
I don’t know that we know that much about so called normal play, never mind how that develops in communities isolated from our current cultural paradigms, to say what is abnormal or not, and this reductio ad absurdam could lead to banning the television, chopping down the pylons and running out in the rain for fear of the dreaded contagion.
Well best leave prediction to the mediums and astrologer eh
Ha ha!! Or, should we also point out choices of “toys”. Wasn’t it cute when Casey was sitting on the woodfloor at around 12 months letting a plastic drink coaster drop over and over and over to watch it spin? This would go on for long periods, but he would laugh, and at the time do these cute little movements (stimming,duh) and we just thought he was having fun!..well, he was but…..
I remember my son lining up his dominoes or those chunky crayola markers (standing up by their caps). But he never had the eye contact avoidance, the sensory issues or lack of communication. He also played normally with other toy and enjoyed a variety of books – but he did have his strong attachement there too…to chunky board book on Hanukkah (and we’re Catholics LOL) In regards to the latter, his was more an issue of the signal getting distorted going in and out…difficulty with nuances and abstract concepts.
Absolutely agree!!
I remember SO WELL, and am still angry about the montessori lady telling me that my child had to SORT the colored pieces of plastic by color BEFORE holding them up to his eyes to see the world through “colored glasses.”
Tom also LOVED to draw. We actually put pieces of paper around the walls of our living rooms so that he could scribble on them in all different colors.
If these are “strange” forms of play, I say more power to Tom. IMHO, they were the most creative, interesting types of play I’ve seen… and I still can’t wrap my brain around the idea that he really SHOULD have been playing house!
Lisa (autism.about.com)
I think what you say is somewhat true, about parents maybe being on heightened alert for any sign of “not normal” play. My daughter is four and has autism. My two year old son the other day (with a minor speech delay and some social shyness) was walking on his toes the other day and I immediately had that thought….autism. But I took a few minutes to really think about where he was developmentally, how he liked to fly planes around the living room making jet noises, how he points out every single thing he sees that is interesting, how he seems so concerned when his sister is upset, etc. He is developing very typically in the areas of social, emotional and communication (even with the delay and shyness).
Maybe it’s just something parents have to ask themselves…do I KNOW something isn’t typical behavior here or am I just being paranoid? I really do believe our intuition tells us the answer to that. If we really believe something isn’t developing typically, an evaluation can’t hurt. If we can answer that we’re paranoid and to wait another few weeks to see if this or that thing is a phase (reading the same book over and over, lining up toys, etc), likely we’ll get a more reliable answer for ourselves. I KNEW my daughter wasn’t developing typically from a very young age. She wasn’t bonding to us the way a baby does, she seemed to act as if she was all alone in the world and had needs, but couldn’t meet them herself and had no sense that we were there to help her. We used to say that she acted like an abused child from a foreign orphanage – on edge, not attached, distant. No one saw what we saw for three years. At three, she was finally diagnosed with autism by the school psychologist (and a very good private psychologist was lined up ready to do the same after his eval of her) and last Friday, she was diagnosed with Mitochondrial Disease by a team of genetics doctors. I KNEW with her. No one could sway me. I knew. With my son…I’m having a harder time being terribly concerned with his slower development – maybe because he is so attached to us and plays so well. A phase here and there of “hmmm, that’s not typical behavior” usually amounts to a whole lot of nothing when we find out it was just a phase.
Hopefully, parents will continue to really watch and follow their children’s development and be honest with themselves so they aren’t living in denial…or fear.
I have to say that I don’t really believe that Mommy Instinct (or intuition) is as reliable as all that. At least, not when it comes to diagnosing autism in a toddler.
In fact, I think Mommy Instinct is often overplayed across the board.
While moms do know their children very well, they DON’T generally have a background in child development (which would provide them with a basis for comparison). They haven’t seen other children respond in a classroom setting. They may be overprotective (assuming their child needs extra support) – or they may have a personal need to see their child treated as “normal” even when that child clearly has issues.
In short, while I’d like to think that just being honest with oneself is enough, it just…isn’t.
Lisa (about.com guide to autism)
Tom loved spinning things and did a lot of spinning himself–although that faded away a year or so ago. He was on the late-side walking and never really learned to crawl. Pointing: nope. Eye contact: unreliable. I thought he was just shy.
I remember his 18 month check up and the doctor asking if I had any concerns. Well, he does like to run around with his eyes closed, I reported. Really? said the doctor. Oh, you’ve heard of that? I asked. No, said he, but don’[t worry. He’s just experiencing the world in his own way.
Yes, indeed.
First-time moms like me are probably not the best with the mommy meter: on the other hand, the experts see so much and know so much they can (and do) jump to conclusions. But once a dx is made, then it’s crucial I think to do a LOT of research and reading, ask lots of questions of the experts and other parents in similar situations, be aware of the things Lisa points out–nd then go with your gut. Nobody knows your kid like you do.
My mommy instinct has been right on target so far for pretty much everything, but then again, I’m a developmental biologist, so maybe it’s not just instinct.
That said, our youngest was speech delayed, has severe social anxiety, won’t make eye contact with most people, toe walks on occasion, and has motor issues out the wazoo. Yet, I still don’t think he’s necessarily autistic (thanks, mommy instinct!), although I firmly believe that had we not gotten him into some interventions a year ago, he’d be having a very different time of it right now, and so would we. He may be quirky or on the spectrum or whatever–it doesn’t matter to me, honestly. But the one thing I’ve noticed about him, the thing that is wildly different from his oldest brother, who unequivocally IS autistic, is that our youngest PLAYS in ways that most people think children play. He gets little people and has them do little people things, like ride in cars or get on a boat. He makes car sounds.
And strangely enough, that’s where my mommy instinct really kicks in. Yes, he does these things, BUT his play is very stereotyped and repetitive, and he says the same things over and over as he does it, rather than producing de novo ideas. Now, what kind of an expert to you have to be to observe “typical” play and still find it to be atypical in a way that raises a red flag?
But our oldest was simply more interesting in his play. Would I call it “strange”? No. Just interesting. And he didn’t just line up toys, although her certainly did that. He also didn’t just spin things, although he certainly did that, as well, obsessively. It was the kinds of “toys” that he chose that really stood out–and that still stands out. He collected nuts–acorns or walnuts–and lined THOSE up, making patterns with them all across the carpet. He slept with a boiled egg and wanted to carry one around with him wherever he went. Now that’s something people would consider “strange,” but we just thought it was kind of interesting. Red flag? Sure, as we look back. We had no idea at the time, and I’m not sure we would have cared that much.
If parents are looking for signs, in my opinion, if the signs are there, they won’t have to look very hard as long as they know what they’re looking for and can parse these confusing messages. They’re the parents. It’s their responsibility to do exactly that, whether they’re child development specialists or not. If they think they’ve found something, they can ask a professional. And time will undoubtedly tell, regardless.
As a mother, I KNEW something wasn’t right about the way my child played even as an infant. She wasn’t interested in as many or the same toys as other people’s kids – it was the same toys over and over, the same books over and over. I had Sandra Boynton’s “Barnyard Dance” literally memorized from reading it to her so often. I’d take her to playgroups and she didn’t even really seem aware the other kids were there.
She did other things too, like refusing to be held, even as an infant. She’d scream till she literally threw up if we put in her crib before she was asleep. The only way she’d go asleep was if we put her in her bouncy chair in front of a Baby Einstein video. She’d pass out in seconds, and then we had to hold our breaths to move her, asleep, into her crib, and hope she didn’t wake up and start screaming.
Letting my baby fall asleep in front of a video was absolutely NOT the way I intended to raise my child. But I learned quickly that it was the only thing that worked. I know now that she needed stimulation (and still does) to fall asleep.
Despite what I thought of initially as just her quirks, she was developing normally in other ways at that point – eating, crawling, etc. But she never started talking and she never seemed attached to us, never would accept comfort.
As crushing as it was to hear the word “autism”, it was a relief in some ways too to get an explanation for the differences that I had been seeing literally since she was only a few weeks old.
Moms observe a million and one little things about their children. They may not have the diagnostic vocabulary to explain to a therapist or doctor WHY they think something is wrong (I didn’t until I started learning about autism) but they often do get a gut feeling from just that accumulation of things they observe but can’t explain.
I think, if you visited “typical” parenting websites, you would find plenty of parents frustrated by their children’s preference for the same things, over and over again.
MOST kids like sameness. MOST kids like repetition. The same good night rituals. The same favorite books and videos.
In fact, most adults like repetition and ritual too. Monday night football rituals. Girls night out rituals. The same turkey and cranberry recipes. The same beers. The same TV shows.
The question, then, is “when does preference for sameness and repetition become an issue?”
Seems to me that the answer is NOT self evident. It depends on the age of the person, the situation (an anxious adult is more likely to prefer rituals than a relaxed and confident adult), the household/culture in which they’re raised, and so forth.
Is a desire to hear the same good night song every night a sign of a problem? Probably not. Is a desire to watch the same video over and over again a sign of a problem? Could be… or not.
How about stacking blocks? Laying out train tracks? Playing with tops and yo yos? When is a preference pathological or problemmatic? Seems to me that it’s very tough indeed to draw the line!
Lisa (about.com guide to autism)
I wasn’t trying to say that a mother’s instinct or intuition is good grounds for a diagnosis, but I’m also tired of being easily dismissed and patronized because I’m “just” a parent. Some concerns parents have end up being something, sometimes, not so much. In the end, as long as the child gets any needed services and assistance for areas where they might have trouble functioning, what does it matter that the concerns are brought to the doctor and the doctor actually takes thoughtful time to observe, listen and understand? This “oh, no. Here we go with all the paranoid parents that have no idea what they’re talking about” completely undermines parenting in general. Am I really just here to feed and clothe my child? The “professionals” will take of the real parts of raising a child once the child hits K-12 and I should just sit back and wait around for them to tell me when they’ve decided to be concerned??
The point at which the repetition and need for sameness (or an other ASD trait interrupts a person’s ability to function – to sleep, eat, play, interact with those around them, keep a job, a relationship, etc. at that point, the repetition or need for sameness might need to be addressed. Maybe it’s because of the degree to which some of these symptoms extremely limited my daughter’s ability to function, but it did not at all seem like a blurry line to draw.
Lisa, I have to say, I find your comments about parent’s instincts amazingly condescending for somone who writes to a (largely) target audience of…parents.
I don’t happen to have a medical degree and yet during my son’s 209 day NICU stay, and pretty much since then too, I always *sensed* that there was something wrong with my son at least a week or more before the doctors would finally listen, investigate, and my son would head off for yet another life-saving surgery.
I also “knew” before the so-called specialists confirmed it that there was something “not right” with my son’s development. I may not have had the vocabulary to pinpoint it or the list of extra initials after my name to lend “credibility” (intentional quotes) to my observations but I was proven right each time. Had I *not* trusted my instincts my child might not be alive or might be significantly worse off.
Granted not *all* parents’ instincts are right *all* the time, but there does exist an incredible symbiosis between parent and child —especially mother and child. Many people have finely tuned instincts and intuition which should not be discounted.
Nik’s mom – I’m sorry you find me condescending; it certainly wasn’t intended.
I do think that parents can see changes or issues in their children that others don’t – but not because of some special, undefined instinct or intuition. In my opinion, when parents (moms and dads alike)have a “gut” sense that something’s wrong, it’s because they’ve made observations, consciously or unconsciously, that concern them. Of course, parents have more of a vested interest in their child’s welfare than practitioners do, and so they are willing to go the extra mile to be sure that issues are dealt with (or at least investigated).
I certainly ran into an issue with our beloved pediatrician, who spent a minute or two with Tom when I raised concerns and said “he’s fine.” He did recommend a developmental pediatrician when I asked for a name, but overall he was very little help. But I can’t claim intuitive or instinctive knowledge of anything except our preschool director’s insistance that there were “red flags.”
I’m very uncomfortable with Jenny M.’s representation of mothers as having a sort of supernatural knowledge of their children’s needs. I think it’s this kind of thinking that leads moms to feel that they should “know” which treatments will work, which doctors and therapists are trustworthy, etc. And I think it’s scary when moms are led to feel that they can and should – simply because they are moms – “recover” their autistic children.
Lisa (autism.about.com)
Lisa, what you’re discussing at the end of the above comment is the issue in reverse. It’s one thing to “sense” that someone needs to take a look at your child. That sense can be grounded in the million little things you know intimately about your own child and can compare with other children. And it’s different from the “intuition” of mothers who “sense” that some professional is wrong or that some “treatment” is exactly what the child needs. That “sense” is, often, grounded in a lack of information about the “treatment” in question or a lack of overall expertise and a tendency to hope that one’s own situation will prove different from that of everyone else’s, that one’s own child is that unique individual who “needs” that treatment.
In the first case, the intuitive conclusion springs from real, genuine, experiential knowledge of the child and is defensible as such. In the second case, the “intuition” springs from ignorance and often a complete lack of information, experience, or expertise against a backdrop of desperation or narcissism or “mom will save the day,” and it’s usually not defensible or supportable. I view the two kinds of “intuition” as very different.
That said, I had two pediatricians who told me my son was “fine” when I queried them about his obsessive spinning, his echolalia, and some other issues. Their rationale was that he looked at them in the eye, ergo he was “typical.” And I didn’t buy what they were saying, but my own knowledge–real, scientific knowledge, not intuition–told me that they likely were off the mark in using that as the sole criterion. Even so, we took a watch-and-wait attitude for some period following these opinions until a developmental pediatrician diagnosed him.
Emily – I agree with you completely. Seeing unusual behaviors, questioning them, keeping a careful eye out – all seems very reasonable and logical.
But you’re not saying that somehow, as a mother, you just knew your son was autistic. You knew something was up, and you did everything you could to find out what it was – and to act on it.
You’re saying – and I agree – that scientific knowledge, coupled with parental concern, led you to press forward with your concerns.
I guess I did the same thing relatively to my pediatrician… though I was not at all sure what we’d find. I just knew that there was SOMEthing to find, since there were so many ways in which Tom was not like his peers. Again, not intuition, but observation.
Back to the topic of this blog, I’m concerned that there will be a lot of parents overthinking their child’s individual idiosyncracies, and “intuiting” that every odd glance or unusual use of a plaything is a sign of an autism spectrum disorder. I’d never suggest, though, that a truly concerned parent should ignore red flags!
Lisa
I have distinct memory of, when about six months, having a rattle which had bars which trapped a ball inside, and I thought the purpose was to get the ball out, and I was trying to figure out how to get the ball out.
When I was about ages 5-8, I would engage in some typical play in groups, like when some other kids would come over to our house, and we would play house or something, or if my sister’s were there. Mostly my “typical” play was quite atypical in manifestation, and I would spend the time spinning car wheels or something.
Maybe — just maybe — if we stopped pathologizing sensory play (which is what most of this “strange” play is, after all) and fearing the worst, we’d be better equipped to focus on how best to help our kids develop to be the best they can be, even with a potentially different set of strengths and weaknesses.
Back in 1993 when Jeremy was 2, he was not acquiring speech, and he began to become completely engaged in simple, repetitive sensory play. At the time we knew nothing about autism, and we feared the worst — that it was degenerative (it isn’t), that there was no hope (that’s wrong too), and that he was inevitably destined to end up in an institution (also wrong).
Our school district did the right thing and funded his placement in what turned out to be an excellent preschool placement for him. It advertised itself as ABA-based, but was willing to work with us on an agenda we set. We were much more concerned with helping along his cognitive development than with normalizing his behavior. So there were no goals of “look at me” or “quiet hands” or “good sitting”. Instead, we leveraged the sensory and pattern-seeking things that Jeremy enjoyed, to focus on helping him absorb, in his own way, the pre-academics and cognitive calisthenics that his nonautistic peers were getting by osmosis in typical preschool environments (which he wasn’t).
It didn’t make him less autistic. It did help support his acquisition of reasoning skills, preliteracy, and eventually expressive speech.
Behavior? The important thing was to get him to start reasoning about behavior, his and others’: antecedents, and consequences. Supporting his efforts to do so, and trusting him to do so, once he really understood the consequences of a situation, particularly dangerous consequences, was critical.
Children, whether nonautistic or autistic, live up — or down — to the expectations we have of them. Pathologizing sensory and pattern-seeking play is not a winning strategy in that regard. Nor is forcing social play on a child not yet ready for it simply because Penelope Leach or whomever says it should be developing by a given chronological age.
The right thing to do is always to leverage what the child has as far as strengths and interests — never to discard, or suppress, or “extinguish” anything that isn’t causing harm to self or others or violating boundaries.
This is true regardless of how “high-functioning” or “low-functioning” you’ve been told your child is (or might become).