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http://aut.sagepub.com Autism DOI: 10.1177/1362361305057869 2005; 9; 495 Autism Emma Williams, Linda Kendell-Scott and Alan Costall autism Parents' experiences of introducing everyday object use to their children with http://aut.sagepub.com/cgi/content/abstract/9/5/495 The online version of this article can be found at: Published by: http://www.sagepublications.com On behalf of: The National Autistic Society can be found at: Autism Additional services and information for http://aut.sagepub.com/cgi/alerts Email Alerts: http://aut.sagepub.com/subscriptions Subscriptions: http://www.sagepub.com/journalsReprints.nav Reprints: http://www.sagepub.co.uk/journalsPermissions.nav Permissions: http://aut.sagepub.com/cgi/content/refs/9/5/495 Citations by georgela taranu on April 17, 2009 http://aut.sagepub.com Downloaded from

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    Autism

    DOI: 10.1177/1362361305057869 2005; 9; 495 Autism

    Emma Williams, Linda Kendell-Scott and Alan Costall autism

    Parents' experiences of introducing everyday object use to their children with

    http://aut.sagepub.com/cgi/content/abstract/9/5/495 The online version of this article can be found at:

    Published by:

    http://www.sagepublications.com

    On behalf of:

    The National Autistic Society

    can be found at:Autism Additional services and information for

    http://aut.sagepub.com/cgi/alerts Email Alerts:

    http://aut.sagepub.com/subscriptions Subscriptions:

    http://www.sagepub.com/journalsReprints.navReprints:

    http://www.sagepub.co.uk/journalsPermissions.navPermissions:

    http://aut.sagepub.com/cgi/content/refs/9/5/495 Citations

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  • 495

    Parents experiences ofintroducing everyday objectuse to their children withautism

    E M M A W I L L I A M S University of Surrey, UK

    L I N D A K E N D E L L - S C O T T King Alfreds UniversityCollege,Winchester, UK

    A L A N C O S T A L L University of Portsmouth, UK

    A B S T R A C T A semi-structured interview study, investigating theacquisition of everyday object use in children with autism and develop-mentally matched controls, is presented. Parents were asked to describehow their child currently used various everyday objects duringmealtime and washing routines, the process by which this came about,and any problems encountered in attempting to introduce appropriateobject use. Following transcription, the interviews were treated usinga method combining phenomenological and content analysis. Thestatements generated were condensed, using progressive categoriz-ation, into three tables of summary statements. These represented thedifferent sources of influence on the childrens object use and theproblems parents experienced in attempting to guide their childsactions. Relative to comparison groups, parents of children with autismreported that they experienced more problems and used more inten-sive teaching methods, and that their children were less activelyinvolved. The findings are discussed in relation to the influence of otherpeople in shaping object use and implications for interventionprogrammes.

    A D D R E S S Correspondence should be addressed to: D R E M M A W I L L I A M S , Depart-ment of Psychology, School of Human Sciences,The University of Surrey, Guildford, SurreyGU2 7XH, UK. e-mail: [email protected]

    Introduction

    It is very probable that children with autism, who have extensive problemsin relating to other people, will experience corresponding difficulties inacquiring the social conventions surrounding everyday object use. Littlepublished evidence exists, however, concerning the problems, if any,

    autism 2005SAGE Publicationsand The National

    Autistic SocietyVol 9(5) 495514; 057869

    1362-3613(200512)9:5

    www.sagepublications.comDOI: 10.1177/1362361305057869

    K E Y W O R D S

    autism;everyday

    object use;parent

    interviews;qualitative

    analysis;social

    influence

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  • experienced by parents of such children in shaping their childs use ofvarious everyday objects. Such information might usefully inform interven-tions designed to promote joint attention and communication skills since,as Carpenter and Tomasello (2000) have noted, daily activities such asbathing and feeding provide highly predictable social contexts in whichchildren and adults coordinate their attention to each other and an objectof mutual interest. It may also help clinicians devise educational programmesto help parents teach their children to use various everyday objects, suchas items of cutlery skills that are essential to becoming an independentlyfunctioning member of society.

    The acquisition of everyday object use by typical infants

    According to Valsiner (1987), a number of factors shape the way thatinfants come to use everyday objects: direct and indirect guidance by care-givers, the childs own eagerness to participate in the activities of the adultsaround them, and the nature of the object itself. Valsiner carried out a smallnumber of longitudinal case studies in which mothers and their infants(followed from 7/8 months to 2 years) were videotaped interacting duringmealtimes. Mothers were observed using a number of different techniquesto guide their childs attention and skill in using the implements they weregiven in culturally appropriate ways. These included structuring the widersetting so as to promote desired actions, whilst discouraging undesirableones, and placing their hands over those of the child physically to guidehis or her action. As the children became more adept at using the cutlery,mothers were more likely to prompt them verbally, or use verbal encour-agement when they were using an object correctly. Valsiner (1987)proposed that only short, episodic, periods of intensive parental instruc-tion may be needed, as the childrens interest in other peoples actions andtheir willingness to copy them ensure that their actions will, eventually, beshaped in conventional ways even without direct intervention.

    Autism and the use of everyday objects

    Our review of the literature identified only one study relating to everydayobject use in children with autism. Ungerer and Sigman (1981) assessedthe ability of 16 children with autism (MA = 24.8 months; CA = 51.7months), who were inpatients at a neuropsychiatric institute, to use theobjects they encountered in their daily environment appropriately. Primarynursing staff were given a checklist comprising 62 objects commonly foundin the home and residential hospital setting. For each object, the staffrecorded whether the children could use it spontaneously, whether they

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  • could use it if verbally prompted, or whether, even with verbal prompting,they were unable to use the object according to its designated function. Ofthe 62 objects surveyed, the children were able to use, on average, justunder 60 percent of them appropriately either on their own or with verbalprompting. Twenty-five percent of objects were reported as never havingbeen used properly, even with a verbal cue. The childrens ability to use theremainder could not be assessed, either because they were unavailable tothe child or because the primary caregiver was unable to give any infor-mation regarding them. In addition it was not clear to what extent eachchild required verbal prompting to use an object appropriately, and no datawere collected from a comparison group of typical children or childrenwith learning difficulties.

    Case study reports present a less positive picture of the acquisition ofeveryday object use by children with autism than suggested by Ungererand Sigman (1981). Asperger (1944, p. 39) notes the difficulties parentsexperienced in getting their children to eat normally at the meal table. Park(1983) also describes the problems of her daughter with autism in usingspoons and cups. Her ability to use these things was much delayed and sheneeded intensive training in order to use them properly. The use of objectssuch as spoons, taps and light switches had to be extensively trained, usingthe hand-over-hand method, and periods of retraining were required whenher daughter encountered an unfamiliar version of the same object.

    Rationale for current study

    There are a number of problems facing the researcher in trying to assesseveryday object use in autism: an absence of systematic research evidence,using appropriate control groups; a lack of evidence, other than from indi-vidual case studies, regarding the experiences that parents of children withautism have in trying to get their children to use everyday objects appro-priately; and insufficient research on the introduction and maintenance ofeveryday object use by parents of typical children. The current study aimsto address these by: (1) asking parents of children with autism about theirexperiences of trying to introduce their child to, and maintain, the appro-priate use of various everyday objects routinely used during mealtime andwashing activities, and (2) comparing these with the experiences ofparents of children with Downs syndrome and typical children matchedfor developmental age.

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  • Method

    ParticipantsThirty parents, all primary caregivers, were interviewed. Ten parents hadone child with autism, 10 had a child with Downs syndrome and 10 hadtypical children. The childrens ages ranged from 15 months to 7 years 5months. The primary caregivers were all mothers, except in the case of twoboys with Downs syndrome whose father was the main carer. The parentsof the typical children were recruited through local nurseries. The parentsof the children with autism and those of children with Downs syndromewere selected by approaching local nurseries and schools for moderate andsevere learning disabilities. Each child with autism included in the studyhad received a primary diagnosis of autism, based on the administrationof the revised version of the Autism Diagnostic Interview (ADIR: Lordet al., 1994) and according to the criteria given in either the InternationalClassification of Diseases 10th edition (ICD-10: World Health Organization, 1990)or the Diagnostic and Statistical Manual of Mental Disorders,4th Edn (DSM-IV: AmericanPsychiatric Association, 1994).

    The groups of children were individually matched for general develop-mental age on the Bayley Scales of Infant Development (BSIDII: Bayley,1993). Each child with autism was matched to one child with Downssyndrome and one typical child. Eight autismDowns and eight autismtypical pairs were matched to within 1 month of each other. The remain-ing pairs were matched within 2 months. A one-way ANOVA revealed nosignificant between-group differences on this measure (F(2, 24) = 0.20,p = 0.98). The Downs syndrome and autism groups were also matched asclosely as possible for sex and chronological age (t = 1.0, p = 0.33; seeTable 1), as both factors might influence the childrens experience with theeveryday objects. In addition, each childs gross and fine motor skills wereassessed using the motor subdomain of the Vineland Adaptive BehaviourScales (VABS: Sparrow et al., 1984), so that the level of these skills recordedfor each group could be taken into account in the interpretation of anyfindings. A one-way ANOVA revealed no between-group differences in finemotor skills (F(2, 20) = 1.36, p = 0.28), but the children with autism werefound to be functioning at a higher level of gross motor development than either the typical (U = 13.5, p = 0.05) or Downs groups (U = 4.5,p < 0.01).

    The interviewThe first two authors each conducted five interviews with each group ofparents. The interview schedule was semi-structured, enabling the inter-viewers to focus on specific topics of interest whilst allowing information

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  • not previously thought of to arise from the parents themselves. Two pilotinterviews were conducted by each interviewer and discussed in detail inorder to minimize differences between the interviewers with regard to theway they interacted with the parents, to assess the quality of the infor-mation elicited by the interview schedule, and to ensure that the interviewwas not so long as to over-tax either the parent or the interviewer.

    The selection of interview questions finally included in the schedulewas informed by the published research literature on the topic (Valsiner,1987) and by information gathered by the first author in the course ofdiscussions with parents of young children with autism. The resultinginterview schedule (see appendix) was divided into three sections. Ques-tions in sections A and B focused on childrens competence in usingeveryday objects during mealtime and washing activities, respectively, andon the parents experiences in introducing their children to the appropri-ate use of these objects. These activities were chosen as being situations inwhich certain objects, such as items of cutlery and toothbrushes, areroutinely used and introduced to infants. Each parent was asked to give anopen-ended account of the most recent mealtime or washing routine,including details of any objects used by their child. This was followed bymore specific questions which included: asking the parent to describe whatthe child did the last time they used the object (and if this behaviour were

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    Table 1 Participant characteristics

    Downs Autism Typical

    N 10 10 10Male:female 9:1 9:1 7:3Chronological age (months):

    mean 54 62.2 23.9SD 16.9 19.9 8.3range 3675 4389 1638

    Bayley developmental age (months):mean 22.7 23.2 23.1SD 8 8.3 9.01range 1638 1538 1539

    VABS gross motor subdomain (months):mean 21.9 38.1 23.6SD 5.2 16.3 8.0range 1629 2271 1435

    VABS fine motor subdomain (months):mean 30.6 30.6 24.7SD 8.2 9.1 6.9range 1639 2044 1634

    VABS: Vineland Adaptive Behaviour Scale.

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  • typical); whether they would like to see any changes in the childs use ofthe object; and how they thought the child came to use the object in thisway. If the parents referred to their own role in introducing their child tothe appropriate use of an object, they were prompted to give more detailsregarding any strategies mentioned or problems encountered. The thirdsection of the interview (section C) asked parents whether they had usedany other strategies, not previously mentioned, to introduce an object totheir child. They were then taken through a list of strategies known fromresearch literature to be commonly used by parents, omitting those theyhad already mentioned, and asked whether they had used them and, if so,whether they had proved successful. Parents were asked to give a specificexample for each strategy they reported.

    ProcedureEach parent was visited in the home, with no visit lasting longer than 2hours. The interview was tape-recorded and lasted approximately 30minutes. One investigator conducted the interview, the other administeredthe Bayley test and the motor subdomain of the Vineland Adaptive Behav-iour Scales.

    Data analysisExamination of the interview transcripts followed the guidelines outlinedby Giorgi (1985), which combine phenomenological and content analysis.In this approach, although some presuppositions of the investigators mayserve to structure the findings, the participants own descriptions of theirexperiences form the primary basis for understanding the particularphenomenon under investigation (see Htu et al., 1988 and Yardley et al.,1992 for further applications of this methodology). Although parentsviews are likely to be coloured by their knowledge of their childs age anddiagnosis, we considered that their reports would provide us with avaluable starting point in exploring the neglected area of everyday objectuse. The process of analysis consisted of the following three stages.

    Stage 1 The first author isolated all statements referring to the followingthemes: problems experienced by parents in introducing their child to, andmaintaining, the appropriate use of an object; specific parental strategiesdesigned to introduce proper object use; and any means by which parentsthought their child had come to use a particular object conventionally. State-ments were then broken down into the smallest unit that allowed for thesense of the statement to remain intact (Yardley et al., 1992). The origin ofthe interview data (group and childparent pair) was recorded by eachstatement, using a letter and number system. The context was noted in

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  • square brackets where this was essential to making sense of a statement. Thisprocess yielded approximately 1500 relevant statements. Reliability in termsof isolating statements from the transcripts was checked by having thesecond author code 30 percent of the transcripts (three per group), yieldinga mean percentage agreement of 85 percent (range 7790 percent).

    Stage 2 Progressive categorization was undertaken to structure the dataand a series of inter-rater comparisons was employed to ensure that thecategory definitions arrived at reflected the nature of the statements assignedto them as closely as possible. Based on the themes identified by the list ofstatements isolated from the transcripts, a first classification scheme wasarrived at through the consultation of both interviewers. Two of the maincategories (adult strategies and problems in introducing objects) were pre-selected as the interview schedule had been designed to elicit informationrelating to these topics. The third, child role, as well as all the subcategories,emerged directly from the statements made by the parents. FollowingYardley et al. (1992), flow charts were compiled which outlined the rulesused to classify each particular statement into its appropriate subcategory(details from first author). Reliability was established by getting a thirdinvestigator, who had no previous involvement with the study, to code 20percent of the statements, with an equal selection of statements being takenfrom each group of parents. The resulting percentage agreement was 76percent. Any problems identified by investigator 3 were resolved by jointconsultation and the categorization scheme was amended accordingly. Afourth, independent, investigator carried out a final reliability check (on 30percent of the statements) which resulted in an 87 percent agreement.

    Stage 3 The statements within each subcategory were then representedby summary statements (designed to capture the essential content of eachsubcategory) to which investigator 3 coded the original statements withgreater than 90 percent accuracy.

    Results

    Analysis of the interview statementsThree overall themes emerged from the progressive categorization of theparental statements: problems reported in introducing and maintainingappropriate object use, adult influences (both parents and teachers atschool/nursery) in shaping object use, and the childs role in this process.Tables 24 present the lists of summary statements relating to these threethemes respectively and the numbers of parents from each group reporting

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  • each statement. Only summary statements based on the accounts of at leastfour parents from any group, or 10 parents overall (i.e. a third of the totalsample), were included in these tables. Data for individual participants areavailable from the first author on request.

    Problems in introducing and/or maintaining appropriate object useTable 2 clearly shows that those parents who had a child with autismexperienced many more problems than parents who had children in eitherof the two comparison groups.

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    Table 2 Problems reported by parents in introducing their children to theappropriate use of everyday objects

    Summary statements Number of parents reporting behaviour

    Autism Downs Typical

    Problems relating to the use of objectsInterest in unusual aspect of object persistently 7 0 1

    disrupts appropriate use Uses object in an odd/unusual way 7 0 0Not interested in using, or refuses to use, a 4 4 0

    particular object Difficulty in generalizing object use: either insists 5 0 0

    on using the same object or uses object in one context but not another

    Uses object inexpertly, e.g. spills/makes a mess 4 9 9Motor problems prevent proper use of object 2 4 1Dislike of touching objects, or feeling them in 4 1 0

    the mouthAbility to use an object appropriately has 4 0 0

    disappeared

    Problems relating to other peopleFails to copy other peoples actions with objects 5 0 0Not interested in what other people are doing 6 0 0

    with objectsRefuses to eat with other people at the table 5 0 0Fails to respond to parents verbal prompting 6 0 0Repeated verbal prompting/demonstration by 5 0 0

    parent required before child learns to use an object appropriately

    Problems relating to activityNot interested in food that requires the use of 5 2 0

    cutleryNot interested in food/washing/doing teeth 7 4 1Gets fed up with eating/drinking and then plays 0 4 4

    around with cutlery/cup

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  • Problems relating to the use of objects Seven parents in the autismgroup remarked that their childs own particular interests/obsessionsobstructed their efforts to get the child to use an object appropriately. Forexample, in the following statement the childs interest in pouring led thechild to use the object incorrectly:

    He was easy to change from a teat to a spout. Not quite so hot going from acup with a lid to a cup with a lid off because he had this thing in those daysabout pouring . . . so it was always very tempting for him to want to pour.(child 8, autism)

    A further problem identified from the statements of parents in this groupwas an unusual use of objects, particularly items of cutlery:

    When he first used his spoon he always used it upside down for some strangereason. He would always put the stuff on upside down and . . . somehowwhen he got to his mouth . . . he would scoop it up the right way, then hewould turn it, so that he would always be using it upside down. (child 3,autism)

    Only parents of children with autism reported the disappearance of a previ-ously acquired skill: He picked up the fork and ate the pasta . . . but it wassuch a short lived thing (child 4, autism). Half of the parents in this groupalso noted their childs difficulty in generalizing the appropriate use of anobject, either from one context to another, or across different objects of thesame type. Three parents said that their child would use an object at school,but not at home: At school hell have a normal cup . . . there isnt a beaker,so he accepts that at school he has to. But at home if you offer him a cupits just pushed over. Home is beaker, school is cup (child 5, autism).

    An equal number described their childs insistence on using the sameobject to perform a particular activity, refusing to use other objects of thesame type even if they would have afforded the same function.

    Problems relating to the influence of other people All parents whohad a child with autism reported problems relating to their childs failureto be influenced by other people in their object use. Half of these statedthat their child currently, or at some time in the recent past, had refusedto eat with other people at the table: He wouldnt eat his yoghurt if anyonewas in the room. I had to show him the bowl outside the room, put thebowl in here . . . and then the whole family would have to stay out of theroom until he had finished (child 5, autism). Six parents recounted thattheir children were not interested in what other people did with objects:There can be a whole load of children around the table, and they will betucking into lovely food. She will not be motivated by any of them. Shewill do her own thing (child 10, autism). Half of the parents in this group

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  • remarked on their childs failure spontaneously to copy the actions of otherpeople with objects, sometimes in striking contrast to their non-autisticsibling: L. [sibling] does things by example. She would just look at whatyou are doing, and copy it because thats the way it should be done . . . butwith B. [child with autism], you have to teach him how to do something(child 9, autism).

    Problems relating to the activities themselves According to severalparents of children with autism (n = 7) or Downs syndrome (n = 4), theirchilds lack of interest in the activities of eating, washing, or doing theirteeth prevented them introducing those objects traditionally used for theseactivities. Three parents of children with Downs syndrome attributed thisto laziness, saying that their child was unwilling to carry out a particularactivity independently. Five parents of children with autism, and two whohad a child with Downs syndrome specifically stated that their child wasnot interested in eating any foods requiring the use of cutlery.

    Adult strategies used to introduce/maintain appropriate object use

    Physical strategies Table 3 lists the different strategies parents adoptedto shape, or maintain, their childrens use of everyday objects. Almostwithout exception, parents in the autism and Downs groups describedusing physical guidance by placing their hands over those of the child.Only three parents of typical children identified this as a strategy. A numberof parents in each group reported physically correcting their childs use ofan object: Sometimes I can get him to move his hand further down [thespoon]. I would move [his hand] down (child 5, Downs).

    Strategies involving joint activity The majority of parents reportedusing some kind of joint activity to help shape their childs use of particu-lar objects, although the specific form this took differed between groups.Over half of the parents in the autism (n = 6) and typical (n = 8) groupssaid that they sometimes performed part of the action, leaving the child todo the rest.

    For example: Ill put the food on the fork and leave it and hell pick itup (child 3, autism). Six parents of children with autism and five withchildren with Downs syndrome described breaking the task up to make iteasier for the child: We would leave little amounts of water for him in cupsaround the house, and then you know he could drink them as appropriate(child 8, autism). In addition, six parents of typical children described astrategy involving turn-taking, which was less commonly reported byparents of children with Downs syndrome (n = 3), and not mentioned by

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    Table 3 Adult strategies used to shape childrens appropriate use of everydayobjects: parental strategies and the role of school/nursery teachers

    Summary statements Number of parents reporting behaviour

    Autism Downs Typical

    Physical strategiesParent puts their hands over the childs and 9 10 3

    performs the action on object with childParent physically corrects the childs use of an 5 6 4

    object, e.g. adjusts handgrip on spoon, tips up the bottom of a cup

    Verbal and modelling strategiesParent verbally prompts correct object use 1 6 6Parent demonstrates appropriate use of an object 1 7 6Parent praises/encourages correct use of an object 1 3 4Parent either repeatedly verbally reinforces, e.g. 5 0 0

    use of fork,stab and lift, stab and lift, or demonstrates several times

    Joint activityParent performs subpart of action with object, e.g. 6 3 8

    stabs an item of food and then hands the child the fork

    Child and parent take turns in carrying out the 0 3 6action with the object

    Parent breaks up a task into smaller parts in order 6 5 3to make it easier to use an object, e.g. putting only small amounts of liquid in a cup, or cutting up food

    Setting the contextParent gives child the object to play with prior to 1 2 4

    introducing its proper useParent makes the use of the object fun, e.g. singing 1 4 2

    whilst using the object, buying a novelty object

    The role of the school/nurserySchool/nursery introduces a particular object to 4 4 N/Aa

    the child rather than the parentSchool/nursery helps in training child to use a 5 1 N/A

    particular object appropriatelySchool has more success than parent in teaching 4 0 N/A

    child to use objects

    a This is not applicable in the case of the typically developing children who were not regularly attendinga nursery or school.

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  • any parent of a child with autism. This took two different forms: eitherboth parent and child had the same type of object and used it alternately;or they had two different, but related, objects between them and took turnsin using each one.

    Verbal and modelling strategies All parents in the typical and Downsgroups reported making use of the less interventionist strategies of verbalprompting and/or modelling to initiate and maintain proper object use.Verbal prompting involved the parent either verbally correcting their childsuse of an object, or simply prompting them to use it in situations whereit was appropriate to do so. Modelling refers to cases where the parentphysically demonstrated the correct use of an object to the child. Neitherverbal prompting nor modelling of this kind were identified from theinterview statements as strategies commonly used by parents of childrenwith autism (n = 2). However, half the parents did report using eitherrepeated verbal reinforcement or repeated demonstration in their attempts toeither establish or maintain appropriate object use: I encourage [the useof the fork] all the time, stab and lift, stab and lift (child 9, autism); justshowing him things over and over again (child 6, autism).

    Comparing their child with autism with a typical sibling, several parentsin the autism group remarked on the greater conscious effort that wasrequired to shape their childs object use. For example: I dont rememberhaving to teach [older brother] particularly, there must have been a little bitthere, but not that I remember [but] everything with J. had to be taught,and reminded to go carefully . . . it was literally saying over and over again(child 4, autism). In contrast, a number of parents of typical childrencommented on the ease with which their child picked up the conventionaluse of everyday objects, referring to the progress as a natural or spon-taneous one: I dont think [getting the child to use an object appropriately]is a strategy. I think it is something that comes naturally (child 8, typical).

    Setting the context Several parents in the comparison groups reportedsetting the context for object use in some way. Four parents with typicalchildren said that they had given their child an object to play with beforeintroducing its conventional use. The same number in the Downssyndrome group described their attempts to make the use of an object fun,in order to motivate their child: I normally sing and dance through theBarney video [a video about cleaning teeth] while he cleans his teeth. Wetry to make it a sort of fun thing, so that it is not a chore (child 4, Downs).

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  • The role of the school/nursery in promoting conventional objectuseTable 3 presents the summary statements relating to the influence of theschool or nursery on a childs object use. Parents of both children withautism and Downs syndrome described the school/nursery as sometimestaking the initiative in introducing certain objects: It wasnt until they saidat school that he was using [a fork] that I started to offer him one (child 2,autism). Five parents in the autism group also stated that the school helpedtrain their child in using certain objects, as part of their programme toencourage self-help skills: He gets support at school to help him with that[using a fork] as well. He has somebody sat there going heres your forkH., stab and lift (child 6, autism). Some parents (n = 4) in this group saidthat the school got more out of their children than they could, either becausethe environment was more structured or because the teachers were trained.

    The childs role in the acquisition of appropriate object useTable 4 lists the summary statements relating to how active the childrenthemselves were in entering into the appropriate use of various everydayobjects. A striking difference was revealed between the autism andcomparison groups. Whilst all parents of typical children, and all but oneof the parents in the Downs syndrome group, said that their child activelyparticipated in learning to use the objects, only two parents of childrenwith autism mentioned this.

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    Table 4 The childs role in entering into the appropriate use of everyday objects

    Summary statements Number of parents reporting behaviour

    Autism Downs Typical

    Interest in other peoples use of objectsWatches what other people (parents, siblings) are 1 5 9

    doing with objectsImitates other peoples (parents, siblings, peers) 0 8 10

    actions on objectsChild shows a desire to use an object when they 0 7 7

    see other people (parents, siblings, peers) using it

    IndependenceTakes object from parent and uses it independently 1 5 6Refuses help from parent because wants to use 0 3 5

    object on their ownChild themselves initiates the use of an object by 0 5 9

    indicating (verbally or non-verbally) that they want to use it

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  • Interest in what other people are doing with objects Parents in bothcomparison groups remarked on the interest shown by their child in whatother people, particularly parents and older siblings, were doing withobjects. This interest was expressed in three main ways. First, the childrenwere reported to study how, and when, other family members used certainobjects, particularly at the table: all of my children will be round the table,and she watches them . . . she is studying them, she watches everythingthey are doing (child 2, Downs). Second, the parents recounted that suchobservations sometimes led their child to ask for a specific object that theysaw a parent or sibling using, not necessarily because they wanted to usethat object themselves, but simply in order to identify with other familymembers: He had the preverbal little childrens knife, spoon and fork . . .he didnt really use them himself, but you know we used to put them out. . . umm again his own indication that he wanted a knife because of hisolder sister (child 4, typical). Third, parents reported that their childrensometimes observed the actions of other people on objects and then, to thebest of their ability, tried to copy those actions. For example: quite oftenhe would reach from his highchair for a coaster and bring the coaster ontohis highchair, and put his cup on the coaster to show that he was copyingus (child 6, typical). Only one parent of a child with autism reported thather child showed an interest in what other people were doing with objects,by observing their actions, and this developed only after participation inan intensive behaviour modification programme.

    Expressions of independence Another way in which the children in theDowns and typical groups were said to take the initiative in using everydayobjects was by showing a desire to use these objects independently. Thiswas demonstrated by the child grabbing an object from the parent (whowas trying to help them with it) because they wanted to use it on theirown, by the child flatly refusing any help with a particular object, or bythem initiating the introduction of an object by declaring that they wantedto use it. Only one parent of a child with autism reported that he hadshown independence by taking an object in order to use it on his own.

    Discussion

    Summary of main findings

    1 Parents of children with autism reported experiencing more problemsin introducing the appropriate use of everyday objects, relative toparents of the other children. In particular, they recounted two kindsof difficulty rarely mentioned by other parents: their childs unusual

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  • dealings with the objects themselves, which disrupted appropriate use;and failure to use other people as a model, or source of inspiration, fortheir own actions on objects.

    2 All parents of children in the Downs and typical groups commentedon their childs active participation in learning to use everyday objects.This included a desire to use objects independently; interest in, andemulation of, what other people were doing with them; and an eager-ness to use a particular object when they saw another person using it.Parents of children with autism rarely mentioned these behaviours.

    3 Parents described using four main strategies to introduce their childrento appropriate everyday object use: physical intervention, verbalprompting/demonstration of a desired action, joint activity, andcontext setting. The strategy most frequently mentioned by parents ofchildren with autism was direct physical shaping of their childsactions. They also recalled using the less direct strategies of verbalprompting or demonstration but, unlike parents in the two compari-son groups, reported that these had to be successively repeated beforetheir child responded.

    4 Parents in the autism and Downs groups described the school asplaying an important role in introducing particular objects, or intraining their child to use them.

    The role of other people in shaping everyday object useThese findings support Valsiners (1987) contention that direct instructionby caregivers is not the only means by which young children acquire theconventions surrounding everyday object use. Almost without exception,the parents in the typical and Downs groups spontaneously reported thattheir childs object use was shaped, not only through conscious instructionby them, but also indirectly through the childs exposure to other peoplesuse of everyday objects.

    In contrast, parents in the autism group described their children aslacking interest in what other people are doing with objects and in repro-ducing these actions. Moreover, the refusal of some children with autismto eat at the table with other family members meant that, even if the childwere motivated to copy other peoples use of eating utensils, the oppor-tunity was simply not there. Only one parent in the autism group indicatedthat her child watched what other people did with objects, and this wasonly after an intensive behaviour modification programme. No parentsmentioned that their child was motivated to use an object by seeingsomeone else do so.

    The predominant use of physical methods of instruction by parents ofchildren with autism, their need successively to repeat verbal prompts and

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  • demonstrations, as well as the importance they give to structured interven-tion by the school, may also reflect the failure of children with autism tolearn through watching and imitating other people. Although parents ofchildren with Downs syndrome also reported using predominantlyphysical strategies, these were used in conjunction with demonstration andverbal prompting, as well as indirect means of social influence.

    The role of the object in shaping how it is usedAccording to Valsiner (1987), the form of an object itself helps to shapethe childs actions in socially acceptable ways. However, this study suggeststhat, in the case of the children with autism, their often idiosyncraticrelationship with the objects themselves obstructs conventional object use.Only the parents of children with autism mentioned that their childs odduse of certain objects, their interest in isolated, non-functional, aspects ofparticular objects, or their co-option of an object to perform a favouritepreoccupation (such as pouring) persistently disrupted appropriate use.

    Implications for interventionThe present findings also have implications for interventions with childrenwith autism. It is important that parents and teachers are made aware ofwhy skills, which in typical children seem to be acquired spontaneously,are much more difficult for children who lack access to the more indirectsocially mediated routes to learning. The findings also suggest that when achild uses an object in an odd way, or there is a substantial delay in acquir-ing its conventional use, teaching programmes should focus on the use ofmore direct physical strategies to achieve success, such as hand-over-hand,physical correction or joint action. Stereotyped interests may also nega-tively affect childrens ability to use an object in a socially acceptable way.For example, a child who is interested in pouring will tend to focus on thiswhen using a cup. In light of this, it is important that programmes are indi-vidually tailored, as these interests need to be identified and appropriatelytargeted for each child.

    Limitations of present study and future researchThe information gained from the project provides an insight into theproblems parents experience in introducing the conventional use ofeveryday objects to their children. However, there is a need to be tentativein drawing conclusions on the basis of interview information alone,because of parents subjectivity. For example, parents knowledge of theirchilds specific diagnosis may affect the expectations they have of their childand the way in which they interpret their own particular experiences. In

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    addition, the age of the child could influence the parents views of whatthat child ought to be able to do in terms of object use. They may expectmore of older children regardless of the specific diagnosis the child hasbeen given. This is particularly relevant in light of the fact that the typicalchildren in the current study were significantly younger than the childrenin the Downs and autism groups. There is a need for longitudinal, obser-vational, studies to provide a detailed picture of the developmental trajec-tory of everyday object use in children with autism and to informintervention programmes. The impact of chronological age and mental ageon the childrens use of objects and seeing other people use them alsoneeds to be assessed.

    Conclusion

    The findings from this study indicate that conventional object use may beboth delayed and, in some respects, qualitatively different from that ofchildren with Downs syndrome and typical children in real-worldcontexts, as well as in the context of play. The parents who had childrenwith autism reported more problems in introducing conventional objectuse, less active involvement on the part of their child in this process, andthe need for intensive methods of training, both at home and at school.

    AcknowledgementsThe authors are grateful to Natalie Stark for helping with the data collec-tion for this study. They would also like to thank Merc Prat-Sala andAndrew Gemmell for their help in establishing the reliability of the codingscheme and two anonymous reviewers for their helpful comments on anearlier version of this article.

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  • Appendix: interview schedule1

    Section AInformation for parents

    Were particularly interested in young childrens use of common, everyday household objects, rather than inobjects used for play. As this is a relatively new research area we consider you the expert and we are thereforenot anticipating any particular type of answer. Our research will greatly benefit from your personal experi-ence and we would therefore like you to feel able to say anything you think is relevant to the question.

    Were going to ask about two particular situations: mealtimes and washing routines.

    Mealtimes

    1 Can you describe the most recent mealtime in your home in which your child was included?

    Note to interviewer: if the meal described is an informal one (e.g. child eats asandwich from the plate on the floor), ask for a description of an alternative, morestructured mealtime.

    2 Did your child use any objects during this mealtime? If so, can you tell me what they were?

    Note to interviewer: take three of the objects mentioned by the parent and ask thefollowing:

    (a) What did your child do when you last gave them this object?(b) Can you remember when they first started doing this?

    Note to interviewer: if the parent has difficulty answering this question, prompt byasking them to compare with a sibling (if applicable) or with friends children of thesame age, or to focus on specific times of the year, e.g. birthdays or Christmas.

    (c) Is this what they usually do with it?(d) Are there any changes you would like to see? (compare with sibling, if appropriate)(e) Thinking back to when your child started using the object in the way you described, how do you think

    it came about?

    Section BWashing routines

    3 Can you describe what happened last night or this morning in the bathroom in terms of washing?4 Did your child use any objects whilst washing/being washed? If so, can you tell me what they were?

    Questions then as (a)(e) in section A.

    Section CStrategies to encourage correct object use

    If the parent has already mentioned certain strategies they use to introduce an object,recap on these and then ask:

    5 Can you think of any other methods you have used, with other objects that you have not already talkedabout?

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  • Prompt if the following are not volunteered as each method is mentioned by parent/caregiver:

    (a) How often is this method used?(b) In what particular situations would this method be used?(c) How successful is this method?(d) Do you use it when the child first starts to use an object, or later?

    Prompt for the following methods if not already mentioned, by giving an example.Ensure that questions (a) to (d) above are asked.

    (i) Physical structuring: this is where a parent/caregiver/sibling physicallyguides their childs actions with an object, for example putting their handover the childs hand while they are brushing their teeth, and moving thechilds hand so they are making the appropriate brushing movements.

    (ii) Verbal prompting: this is where a parent/caregiver/sibling reminds theirchild about what to do with an object verbally, for example remindingtheir child to brush up and down with the toothbrush.

    (iii) Demonstration: this is where a parent/caregiver/sibling shows a childhow to use an object by using it themselves, for example brushing theirown teeth with a toothbrush in front of their child.

    OR

    If the parent has not mentioned any strategies used to introduce objects to their child,ask the following:

    6 Do you introduce, or have you ever introduced, your child to an object, or structured their current use?

    Then ask questions (a)(d) above.

    Problems experienced

    If the parent has already mentioned any problems in introducing objects to their child,recap on these and then ask:

    7 Are there any other problems you have experienced that you have not mentioned so far? If so, what do youdo about this?

    OR

    If the parent has not yet mentioned any problems in introducing objects to their child,ask the following:

    8 Do you experience any problems in teaching your child to use things in a way that is acceptable to you?If so, what do you do about this?

    Note1 The interview schedule contains a number of closed questions, in addition to

    more open ones, as we originally planned to conduct a comparative quantitativeanalysis of the childrens competence in using those everyday objects mostfrequently mentioned by parents, in addition to the qualitative analysis presentedhere. However, it was decided that the information obtained from the informationschedule was not specific enough to lend itself to such an analysis.

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