2016 Gatlinburg Conference Poster
PS-76
Title: Examining Genetic Subtype Differences in Pretend Play among Children with Prader-Willi Syndrome
Authors: Anastasia Dimitropoulos, Olena Zyga, Sandra Russ, Nathan Danker, Elizabeth Roof, Elizabeth Dykens
Introduction: The processes involved in pretend play are associated with the positive development of cognitive, emotional, and
social skills (Russ, 2004). Deficits in play have been identified in children with various developmental disorders, including autism
spectrum disorder (ASD). Play deficits in ASD are related to delayed social, language, affective, and creativity development.
Specifically, children with ASD can express high rates of repetitive behaviors and rigid/stereotyped play. Although research
suggests individuals with Prader-Willi syndrome (PWS) have social deficits and repetitive behaviors similar to that of ASD with a
greater risk associated with the maternal uniparental disomy (mUPD) subtype, play patterns have not been well studied. While
hallmark characteristics of PWS include hyperphagia, obsessive-compulsive symptoms, and cognitive delays, understanding
social-cognitive risk factors for individuals with the disorder is important for planning intervention and increasing quality of life.
Recently, Zyga et al. (2015) found pretend play in children with PWS to be similar to children with ASD with reduced socialcognitive processing. In addition, children with PWS did not differ from those with ASD in individual and joint play. The addition
of a play partner increased social-cognitive scores in both groups. However, the effects of genetic subtype could not be
examined in that small sample. The purpose of the current research is to extend this examination of pretend play in a larger
sample of children to identify if early social-cognitive processes in play differ by genetic subtype in children with PWS.
Methods: 60 Children with PWS (DEL=29, mean age=9.97; mUPD=31, mean age=9.95) underwent the Autism Diagnostic
Observation Schedule (ADOS) as part of larger studies examining the social phenotype of PWS at either CWRU (n=14) or
Vanderbilt University (n=46). The ADOS sessions were video recorded and secondary analyses of play abilities were assessed by
scoring the "Make-Believe Play" activity using a modified Affect in Play Scale (APS; Russ, 2004). The modified APS scored
participants on scaled measures of comfort, imagination in play, organization of storyline, affective expression in play, frequency
of symbolic versus functional play versus no play acts, and number of repetitive actions. In addition, the "Make-Believe Play"
activity included both individual and joint play periods, where the child played with the experimenter.
Results and Discussion: Preliminary analyses indicate that during both the individual and joint play periods, genetic subtype
groups did not differ in play ability and showed a similar pattern of deficits across all original measures within the APS
(Imagination, Organization, Comfort, Frequency/Categories of Affect expressed) and spent the majority of time in No Play
activities (DEL = 72%; mUPD = 73%). These findings add to previous findings (Zyga et al., 2015) and suggest that children with
PWS do indeed have deficits within their play abilities that are not mediated by genetic subtype. Additional results indicate both
groups showed gains in most measures with the addition of a play partner. However, only the DEL subtype showed a significant
increase (t=-4.34, p<.001) in time spent in symbolic play from individual (3%) to joint play (18%). Overall, these results suggest
that play facilitation allowed for similar increases in social-cognitive processes in play in both groups, however, DEL subtype may
be more malleable in terms of symbolic increases in play. Intervention tailored to target deficits in both groups could be
beneficial in increasing play skills and more global processes related to pretend play development.
References/Citations:
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Russ (2004). Play in child development and psychotherapy: Toward empirically supported practice. Mahwah, NJ:
Lawrence Erlbaum.
Zyga, Russ, Ievers-Landis, & Dimitropoulos. (2015). Assessment of Pretend Play in Prader-Willi Syndrome: A Direct
Comparison to Autism Spectrum Disorder. Journal of autism and developmental disorders, 45(4), 975-987.