Context-related differences in RBs/problem behaviors between groups

Children in the music and robot groups demonstrated greater frequencies of self-injurious/negative behaviors compared to the academic group in the early session (see Figure 6-3C). Both intrinsic and extrinsic factors could contribute to RBs/problem behaviors in children with ASDs (Joosten, Bundy, & Einfeld, 2009). Intrinsic factors, such as the need to obtain more sensory input or to reduce excessive sensory input, as well as attempts to modulate arousal levels and reduce stress in challenging situations, could motivate children to engage in RBs (Cunningham & Schreibman, 2008; Gabriels et al., 2008; Joosten et al., 2009; Leekam et al., 2011; Lewis & Bodfish, 1998; Turner, 1999). Moreover, extrinsic motivators such escape from a challenging activity and increased attention from teachers and caregivers could also serve as triggers for RBs/problem behaviors. The music and robotic contexts involved the practice of gross and fine motor tasks requiring imitation, praxis, balance, and bilateral coordination skills. Given the pervasive motor difficulties in this population (Bhat et al., 2011; Downey & Rapport, 2012; Fournier et al., 2010), these activities might have been challenging, and hence may have led to considerable stress in the music and robot groups. Moreover, unlike academic and fine motor activities, gross movement-based activities are not typically included within the standard of care treatment of children with ASDs (Landa, 2007). Hence, the novelty of the contexts and the practiced activities might have further contributed to increased frustration, leading to RBs in children. Children with ASDs increased their stereotyped behaviors when the difficulty of the task that children engaged in was increased (Durand and Carr, 1987). In fact, children used stereotypies as a way to communicate with teachers and escape from the demanding situation, since most teachers used ‘time out’ as a strategy to decrease their problem behaviors (Durand & Carr, 1987). Anxiety is one of the strongest motivators of RBs and problem behaviors (Joosten et al., 2009; Leekam et al., 2011). Children with ASDs become

with novel and demanding situations (Joosten et al., 2009). When children engaged in high-demand activities such as math, there was an increase in stereotypy (Conroy, Asmus, Sellers, & Ladwig, 2005). The authors reasoned that children engaged in stereotypies to gain an optimal level of arousal and to reduce anxiety levels (Conroy et al., 2005). Along the same lines, the music and robot groups might have engaged in higher levels of negative behaviors as a way to reduce their anxiety, regulate their

stress/arousal levels, or as a mode of communication in an attempt to escape from the unfamiliar and novel context. In contrast, the academic group engaged in academic and fine motor table-top tasks, which were generally more familiar and predictable than the activities in the movement groups. Academic and cognitive skills are the main targets of traditional ABA interventions that are commonly provided to children with ASDs within school settings (Landa, 2007; Lovaas, 2003). Our observations of affective states of children while they engaged in training activities also suggest that the academic group showed maximum interested affect and compliance with activities compared to the movement groups. The familiarity of the context and training activities might have led to lower frequencies of self- injurious/negative behaviors in this group. Moreover, the structure of the environment was more constrained as a result of the nature of the table-top activities, which might have limited children’s opportunities to demonstrate non-compliant behaviors such as running away or physical tantrums. Overall, the novelty and unpredictability of the training activities and the unconstrained nature of the training environment might have led to greater negative behaviors in the music and robot groups.

The academic group demonstrated greater sensory behaviors compared to the music group in the early session and compared to both music and robot groups in the late session (see Figure 6-3A). Possible reasons for these findings could include the nature of our training activities, children’s preference for non- social object play, their difficulties with disengaging attention, and the limited nature of object play in children with ASDs. Our training aimed to promote triadic social interactions within a stationary setting in the academic group. For this purpose, children engaged in goal-oriented activities with their social partners, using supplies such as Play-Doh®, Duplo® blocks, Zoob (Infinitoy®), crayons, and glue. We

believe that the proximity of the supplies/objects in the academic context provided children with multiple opportunities to engage in non-social object-based play. Our findings are consistent with other studies in which children who later developed ASDs engaged in greater episodes of non-social exploration with objects instead of social interactions with caregivers and peers during infancy and early childhood (Maestro et al., 2002; Maestro et al., 2005; Maestro et al., 2006; Williams, Reddy, & Costall, 2001; Williams, 2003). Along the same lines, young children with ASDs preferred to look at objects for a longer duration in contrast to children with developmental delays and TD children, who attended more to people during a free play session with toys in the presence of caregivers (Swettenham et al., 1998). Further, difficulties with disengaging attention (Landry & Bryson, 2004) and shifting attention between objects and people (Lewy & Dawson, 1992; McArthur & Adamson, 1996; Swettenham et al., 1998) might also explain children’s restricted and repetitive actions with objects (Turner, 1999). Children with autism demonstrated greater frequencies of gaze shifts between two objects and fewer gaze shifts between people and objects or between two people compared to TD children (Swettenham et al., 1998). Given their preference for object play and the nature of the environmental setup for the training activities in the academic group, we believe that children engaged in greater object-related sensory behaviors in this group than in the other groups. In contrast, the movement groups did not provide children with easy access to objects during training, which might have led to lower frequencies of sensory behaviors in these groups. Our reasoning is also supported by our observation of the attention patterns of children within the training contexts. While children in the academic group looked most at objects, children in the movement groups, music and robotic, looked more at social partners during the training activities. Lastly, in terms of the nature of object-based play, we found that the academic group engaged in different forms of primitive sensorimotor exploration with objects, including odd visual exploration, tactile behaviors such as rubbing or tapping, and olfactory behaviors such as repetitive sniffing of objects. These findings are consistent with studies that found that when children with ASDs played with toys, the sensorimotor properties of objects were most salient for them leading to simple and repetitive forms of manipulations with toys

Messer, & Jordan, 1998). Moreover, both high-functioning and low-functioning children with ASDs used primitive forms of exploration employing vision, touch, taste, and smell while interacting with objects in restricted and inflexible ways (Freeman, Ritvo, & Schroth, 1984; Libby et al., 1998; Williams, 2003). A possible reason for children engaging in restricted and repetitive sensory manipulation of objects could be their difficulty in generating new types of behaviors (Turner, 1999). This lack of creativity might lead to less diverse and more restricted patterns of play (Hobson, Lee, & Hobson, 2009; Jarrold, Boucher, & Smith, 1996; Lewis & Boucher, 1995). Overall, both children’s predilection for objects and the nature of our training activities might have led to higher frequencies of sensory behaviors in the academic group compared to the movement groups.