Issues addressed in this chapter

5.2.1 Issues relating to imagination

The main focus of this chapter is to assess imagination in autistic adults in a more detailed way in order to examine their relationship with RRBs, with particular focus on different components of imagination (generativity, novelty and fluency). The penultimate section of Chapter One (page 50) discussed the potential relationship between imagination and RRBs, as well as the methodological difficulties that have impeded a definitive conclusion being drawn, which should be addressed before further examining this relationship.

Firstly, evidence for the relationship between imagination and RRBs has been drawn from a wide range of contexts: play behaviours, ideational and verbal fluency and thinking about the future. These represent very different areas of imagination, and although they are all compatible with my definition of imagination (the generation and flexible manipulation of existing concepts to form novel ideas, which may be rooted in past experience and may result in adaptive outputs [creativity]), it is not clear how these areas relate to one another and exactly what they are measuring. Few studies (N=13) have assessed different types of imagination in one sample of

individuals with ASD, and even fewer (N=5) have directly correlated the different types of imagination; overall significant associations have been found between different measures of imagination (Angus et al., 2015; Begeer et al., 2009; Lind & Bowler, 2010), although the relationship between generativity measures (e.g. UOT and design

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fluency) and the impossible person task has been shown to depend on planning (Low et al., 2009) or limited to TD children (Ten Eycke & Müller, 2016). As the literature comprises such a variety of measures, the nature of imagination in autistic adults is not yet clear (see discussion in Chapter One, page 29). Understanding imagination in autistic adults has a twofold purpose; in the context of this thesis, it is important to understand both imagination and RRB in order to draw conclusions regarding the relationship between them, and as I have noted (page 3), RRBs are currently better defined than imagination. In a broader context, it is important to improve our understanding of imagination in autistic adults as it provides useful information for diagnosis.

In order to address this first issue, I decided to include a variety of measures simultaneously, covering four domains of imagination: ideational fluency, design fluency, thinking about the future and retrospective reports of childhood pretend play. All of these domains have been previously explored in the context of understanding their relationship with RRBs, with the exception of drawing/design fluency, which forms a large part of the imagination literature in ASD. These aspects were chosen as they all fit my working definition of imagination, and they encompass a range of

imaginative activities (for a more detailed discussion, see Chapter Two). Ideational and design fluency are measured by three subscales from the TTCT. Thinking about the future is measured by the PFT, a fluency task that has not yet been tested in an autistic population. Performance on this task may be affected by anxiety and/or depression (see Chapter Two, pages 78-79), and therefore the Hospital Anxiety and Depression Scale (HADS) was included. Given that two of the imagination measures depend on verbal fluency, a verbal fluency measure was included to control for this in any significant associations. Finally, a short form of the DISCO (see page 143) was

administered which allows for the retrospective assessment of childhood pretend play. Measurement of several different aspects of imagination in a single sample may reveal how these different constructs relate to one another to form the single construct of imagination in autistic adults.

Related to this, there are several different dimensions of imagination that could be measured, relating to novelty, generativity and flexibility as shown in Figure 1 (page

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12). I have noted that ASD researchers often measure fluency while neglecting other dimensions of imagination such as originality or flexibility (e.g. page 26). Although fluency is an important part of imagination, it may be confounded with EF difficulties – such as a difficulty with generativity - and it is therefore important to consider other ways of measuring imagination. It is also important as RRBs may be differentially related to separate constructs; for example there may exist a negative relationship with fluency, but a positive one with originality (page 55). As discussed previously in Chapter One, Wallach and Kogan (1965) consider the most important aspect of imaginative ability to be originality, which is conceptually equivalent to novelty in my definition of imagination. This refers to thinking of ideas that are unusual or even unique to a participant. Originality is usually scored in terms of how many other participants responded in the same way; for example, an idea may be original if no more than 5% of the sample had the same idea. In addition to originality, flexibility may be an important reflection of imaginative ability. The inflexibility of thought may also be logically related to a person’s RRB, which can be characterised at least in part as inflexible behaviour. The TTCT allows for originality and flexibility to be scored in a standardised manner. This represents the first time the relationship between RRBs and originality and flexibility have been assessed in an exclusively ASD sample.

5.2.2 Issues relating to RRBs

The main measure of RRBs in this study for assessing the relationship with imagination was the RBQ-2A. As this study was carried out in a smaller sample, and it is therefore wise to reduce the number of analyses conducted, the total RBQ-2A score will not be used in this chapter to assess the relationship between imagination and RRBs. This is especially pertinent considering the findings from the pretend play data in Study Four and in previous research (Turner, 1997) that the relationship with RRB is specific to IS. Instead in terms of imagination analyses, the focus will be on IS only, using RMB and RSB as the control subscales25_.

An important issue with regards to RRBs has been the reliance on self-report thus far. This is also true for imagination, but will be addressed in this chapter by the use of standardised measures. As I have mentioned, a short form of the DISCO (page

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143) was administered as part of this study. Usually the DISCO is carried out with the parents of an individual, but in this case participants were interviewed directly, although they were offered to bring a parent with them. Therefore the DISCO still relies in part on self-report, however, it allows for the trained interviewer to interpret the participant’s answers and code items accordingly. The DISCO includes several items relating to RRBs. As mentioned in Chapter One, the DISCO’s RRB items have not yet been validated as a standalone measure of this phenomenon, so caution is needed when interpreting them; nevertheless these items may help to validate self-report findings from the RBQ-2A. Of particular interest here is the item limited pattern of self-chosen activities, which codes whether an individual has a wide range of activities and interests that they spontaneously engage in, or prefers to engage in repetitive tasks and routines, and is analogous to the RBQ-2A’s item 20 which was found in Study Four to be related to past pretend play.

One of the aims of this study was to assess aspects of the reliability and validity of the RBQ-2A that I have not yet tested. Firstly I aimed to assess the test-retest reliability of the RBQ-2A, by having participants complete the RBQ-2A at two time points and then assessing the correlations between their scores at each time points. Secondly, I aimed to assess the correlational validity of the RBQ-2A by comparing it with two measures, the RRB items from the DISCO and a recent questionnaire, the Adult Routines Inventory (ARI; Evans, Uljarević, Lusk, Loth & Frazier, 2017). The ARI is an adult version of the Childhood Routines Inventory (CRI; Evans et al., 1997) that I noted in Chapter One (page 58) as being unpublished at the time of carrying out the work from this thesis. Finally, I explained in Chapter Two (page 62) that construct validity is also demonstrated when a measure of a construct is associated with

measures of other constructs to which it is theoretically related. It has been suggested that RRBs both serve to alleviate anxiety, and are a consequence of feeling anxious (e.g. Lidstone, Uljarević, et al., 2014; Rodgers, Glod, Connolly, & McConachie, 2012). In line with this, there is evidence that anxiety and RRBs are positively associated with each other (e.g. Joosten, Bundy & Einfeld, 2009; Stratis & Lecavalier, 2013); although there is some evidence that this is specific to IS rather than RSMBs (e.g. Rodgers et al., 2012). Indeed IS as measured by the parent-report RBQ-2 is significantly associated

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with anxiety (Lidstone, Uljarević, et al., 2014). Therefore, if the RBQ-2A is associated with a measure of anxiety in accordance with previous research and theory, this would support the construct validity of the RBQ-2A.

5.3 Study Five: Assessing the relationship between self-reported RRBs