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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
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Parents experiences of
introducing everyday object
use to their children with
autism
E MMA WI L L I A MS University of Surrey, UK
L I NDA K E ND E L L - S C OT T King Alfreds University
College,Winchester, UK
A L A N C OS TA L L University of Portsmouth, UK
A B S T R AC T A semi-structured interview study, investigating the
acquisition of everyday object use in children with autism and develop-
mentally matched controls, is presented. Parents were asked to describe
how their child currently used various everyday objects during
mealtime and washing routines, the process by which this came about,
and any problems encountered in attempting to introduce appropriate
object use. Following transcription, the interviews were treated using
a method combining phenomenological and content analysis. The
statements generated were condensed, using progressive categoriz-
ation, into three tables of summary statements. These represented the
different sources of inuence on the childrens object use and the
problems parents experienced in attempting to guide their childs
actions. Relative to comparison groups, parents of children with autism
reported that they experienced more problems and used more inten-
sive teaching methods, and that their children were less actively
involved. The ndings are discussed in relation to the inuence of other
people in shaping object use and implications for intervention
programmes.
ADDRE S S Correspondence should be addressed to: DR E MMA WI L L I AMS , Depart-
ment of Psychology, School of Human Sciences,The University of Surrey, Guildford, Surrey
GU2 7XH, UK. e-mail: e.i.williams@surrey.ac.uk
Introduction
It is very probable that children with autism, who have extensive problems
in relating to other people, will experience corresponding difculties in
acquiring the social conventions surrounding everyday object use. Little
published evidence exists, however, concerning the problems, if any,
autism 2005
SAGE Publications
and The National
Autistic Society
Vol 9(5) 495514; 057869
1362-3613(200512)9:5
www.sagepublications.com
DOI: 10.1177/1362361305057869
K E Y WOR D S
autism;
everyday
object use;
parent
interviews;
qualitative
analysis;
social
inuence
04 WILLIAMS 057869 (bc-t) 26/10/05 8:43 am Page 495
experienced by parents of such children in shaping their childs use of
various 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 as
bathing and feeding provide highly predictable social contexts in which
children and adults coordinate their attention to each other and an object
of mutual interest. It may also help clinicians devise educational programmes
to help parents teach their children to use various everyday objects, such
as items of cutlery skills that are essential to becoming an independently
functioning member of society.
The acquisition of everyday object use by typical infants
According to Valsiner (1987), a number of factors shape the way that
infants come to use everyday objects: direct and indirect guidance by care-
givers, the childs own eagerness to participate in the activities of the adults
around them, and the nature of the object itself. Valsiner carried out a small
number of longitudinal case studies in which mothers and their infants
(followed from 7/8 months to 2 years) were videotaped interacting during
mealtimes. Mothers were observed using a number of different techniques
to guide their childs attention and skill in using the implements they were
given in culturally appropriate ways. These included structuring the wider
setting so as to promote desired actions, whilst discouraging undesirable
ones, and placing their hands over those of the child physically to guide
his 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 and
their willingness to copy them ensure that their actions will, eventually, be
shaped in conventional ways even without direct intervention.
Autism and the use of everyday objects
Our review of the literature identied only one study relating to everyday
object use in children with autism. Ungerer and Sigman (1981) assessed
the ability of 16 children with autism (MA = 24.8 months; CA = 51.7
months), who were inpatients at a neuropsychiatric institute, to use the
objects they encountered in their daily environment appropriately. Primary
nursing staff were given a checklist comprising 62 objects commonly found
in the home and residential hospital setting. For each object, the staff
recorded whether the children could use it spontaneously, whether they
AUT I S M 9(5)
496
could use it if verbally prompted, or whether, even with verbal prompting,
they were unable to use the object according to its designated function. Of
the 62 objects surveyed, the children were able to use, on average, just
under 60 percent of them appropriately either on their own or with verbal
prompting. Twenty-ve percent of objects were reported as never having
been used properly, even with a verbal cue. The childrens ability to use the
remainder could not be assessed, either because they were unavailable to
the child or because the primary caregiver was unable to give any infor-
mation regarding them. In addition it was not clear to what extent each
child required verbal prompting to use an object appropriately, and no data
were collected from a comparison group of typical children or children
with learning difculties.
Case study reports present a less positive picture of the acquisition of
everyday object use by children with autism than suggested by Ungerer
and Sigman (1981). Asperger (1944, p. 39) notes the difculties parents
experienced in getting their children to eat normally at the meal table. Park
(1983) also describes the problems of her daughter with autism in using
spoons and cups. Her ability to use these things was much delayed and she
needed intensive training in order to use them properly. The use of objects
such as spoons, taps and light switches had to be extensively trained, using
the hand-over-hand method, and periods of retraining were required when
her 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 assess
everyday 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 with
autism have in trying to get their children to use everyday objects appro-
priately; and insufcient research on the introduction and maintenance of
everyday object use by parents of typical children. The current study aims
to address these by: (1) asking parents of children with autism about their
experiences of trying to introduce their child to, and maintain, the appro-
priate use of various everyday objects routinely used during mealtime and
washing activities, and (2) comparing these with the experiences of
parents of children with Downs syndrome and typical children matched
for developmental age.
WI L L I A MS E T A L . : E V E RY DAY OB J E C T US E
497
Method
Participants
Thirty parents, all primary caregivers, were interviewed. Ten parents had
one child with autism, 10 had a child with Downs syndrome and 10 had
typical children. The childrens ages ranged from 15 months to 7 years 5
months. The primary caregivers were all mothers, except in the case of two
boys with Downs syndrome whose father was the main carer. The parents
of the typical children were recruited through local nurseries. The parents
of the children with autism and those of children with Downs syndrome
were selected by approaching local nurseries and schools for moderate and
severe learning disabilities. Each child with autism included in the study
had received a primary diagnosis of autism, based on the administration
of the revised version of the Autism Diagnostic Interview (ADIR: Lord
et al., 1994) and according to the criteria given in either the International
Classication of Diseases 10th edition (ICD-10: World Health Organization, 1990)
or the Diagnostic and Statistical Manual of Mental Disorders, 4th Edn (DSM-IV: American
Psychiatric 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 Downs
syndrome and one typical child. Eight autismDowns and eight autism
typical pairs were matched to within 1 month of each other. The remain-
ing pairs were matched within 2 months. A one-way ANOVA revealed no
signicant between-group differences on this measure (F(2, 24) = 0.20,
p = 0.98). The Downs syndrome and autism groups were also matched as
closely as possible for sex and chronological age (t = 1.0, p = 0.33; see
Table 1), as both factors might inuence the childrens experience with the
everyday objects. In addition, each childs gross and ne motor skills were
assessed using the motor subdomain of the Vineland Adaptive Behaviour
Scales (VABS: Sparrow et al., 1984), so that the level of these skills recorded
for each group could be taken into account in the interpretation of any
ndings. A one-way ANOVA revealed no between-group differences in ne
motor skills (F(2, 20) = 1.36, p = 0.28), but the children with autism were
found 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 interview
The rst two authors each conducted ve interviews with each group of
parents. The interview schedule was semi-structured, enabling the inter-
viewers to focus on specic topics of interest whilst allowing information
AUT I S M 9(5)
498
not previously thought of to arise from the parents themselves. Two pilot
interviews were conducted by each interviewer and discussed in detail in
order to minimize differences between the interviewers with regard to the
way they interacted with the parents, to assess the quality of the infor-
mation elicited by the interview schedule, and to ensure that the interview
was not so long as to over-tax either the parent or the interviewer.
The selection of interview questions nally included in the schedule
was informed by the published research literature on the topic (Valsiner,
1987) and by information gathered by the rst author in the course of
discussions with parents of young children with autism. The resulting
interview schedule (see appendix) was divided into three sections. Ques-
tions in sections A and B focused on childrens competence in using
everyday objects during mealtime and washing activities, respectively, and
on the parents experiences in introducing their children to the appropri-
ate use of these objects. These activities were chosen as being situations in
which certain objects, such as items of cutlery and toothbrushes, are
routinely used and introduced to infants. Each parent was asked to give an
open-ended account of the most recent mealtime or washing routine,
including details of any objects used by their child. This was followed by
more specic questions which included: asking the parent to describe what
the child did the last time they used the object (and if this behaviour were
499
Table 1 Participant characteristics
Downs Autism Typical
N 10 10 10
Male:female 9:1 9:1 7:3
Chronological age (months):
mean 54 62.2 23.9
SD 16.9 19.9 8.3
range 3675 4389 1638
Bayley developmental age (months):
mean 22.7 23.2 23.1
SD 8 8.3 9.01
range 1638 1538 1539
VABS gross motor subdomain (months):
mean 21.9 38.1 23.6
SD 5.2 16.3 8.0
range 1629 2271 1435
VABS ne motor subdomain (months):
mean 30.6 30.6 24.7
SD 8.2 9.1 6.9
range 1639 2044 1634
VABS: Vineland Adaptive Behaviour Scale.
typical); whether they would like to see any changes in the childs use of
the object; and how they thought the child came to use the object in this
way. If the parents referred to their own role in introducing their child to
the appropriate use of an object, they were prompted to give more details
regarding any strategies mentioned or problems encountered. The third
section of the interview (section C) asked parents whether they had used
any other strategies, not previously mentioned, to introduce an object to
their child. They were then taken through a list of strategies known from
research literature to be commonly used by parents, omitting those they
had already mentioned, and asked whether they had used them and, if so,
whether they had proved successful. Parents were asked to give a specic
example for each strategy they reported.
Procedure
Each parent was visited in the home, with no visit lasting longer than 2
hours. The interview was tape-recorded and lasted approximately 30
minutes. One investigator conducted the interview, the other administered
the Bayley test and the motor subdomain of the Vineland Adaptive Behav-
iour Scales.
Data analysis
Examination of the interview transcripts followed the guidelines outlined
by Giorgi (1985), which combine phenomenological and content analysis.
In this approach, although some presuppositions of the investigators may
serve to structure the ndings, the participants own descriptions of their
experiences form the primary basis for understanding the particular
phenomenon under investigation (see Htu et al., 1988 and Yardley et al.,
1992 for further applications of this methodology). Although parents
views are likely to be coloured by their knowledge of their childs age and
diagnosis, we considered that their reports would provide us with a
valuable starting point in exploring the neglected area of everyday object
use. The process of analysis consisted of the following three stages.
Stage 1 The rst author isolated all statements referring to the following
themes: problems experienced by parents in introducing their child to, and
maintaining, the appropriate use of an object; specic parental strategies
designed to introduce proper object use; and any means by which parents
thought their child had come to use a particular object conventionally. State-
ments were then broken down into the smallest unit that allowed for the
sense of the statement to remain intact (Yardley et al., 1992). The origin of
the interview data (group and childparent pair) was recorded by each
statement, using a letter and number system. The context was noted in
AUT I S M 9(5)
500
square brackets where this was essential to making sense of a statement. This
process yielded approximately 1500 relevant statements. Reliability in terms
of isolating statements from the transcripts was checked by having the
second author code 30 percent of the transcripts (three per group), yielding
a mean percentage agreement of 85 percent (range 7790 percent).
Stage 2 Progressive categorization was undertaken to structure the data
and a series of inter-rater comparisons was employed to ensure that the
category denitions arrived at reected the nature of the statements assigned
to them as closely as possible. Based on the themes identied by the list of
statements isolated from the transcripts, a rst classication scheme was
arrived at through the consultation of both interviewers. Two of the main
categories (adult strategies and problems in introducing objects) were pre-
selected as the interview schedule had been designed to elicit information
relating to these topics. The third, child role, as well as all the subcategories,
emerged directly from the statements made by the parents. Following
Yardley et al. (1992), ow charts were compiled which outlined the rules
used to classify each particular statement into its appropriate subcategory
(details from rst author). Reliability was established by getting a third
investigator, who had no previous involvement with the study, to code 20
percent of the statements, with an equal selection of statements being taken
from each group of parents. The resulting percentage agreement was 76
percent. Any problems identied by investigator 3 were resolved by joint
consultation and the categorization scheme was amended accordingly. A
fourth, independent, investigator carried out a nal reliability check (on 30
percent of the statements) which resulted in an 87 percent agreement.
Stage 3 The statements within each subcategory were then represented
by summary statements (designed to capture the essential content of each
subcategory) to which investigator 3 coded the original statements with
greater than 90 percent accuracy.
Results
Analysis of the interview statements
Three overall themes emerged from the progressive categorization of the
parental statements: problems reported in introducing and maintaining
appropriate object use, adult inuences (both parents and teachers at
school/nursery) in shaping object use, and the childs role in this process.
Tables 24 present the lists of summary statements relating to these three
themes respectively and the numbers of parents from each group reporting
501
each statement. Only summary statements based on the accounts of at least
four parents from any group, or 10 parents overall (i.e. a third of the total
sample), were included in these tables. Data for individual participants are
available from the rst author on request.
Problems in introducing and/or maintaining appropriate object use
Table 2 clearly shows that those parents who had a child with autism
experienced many more problems than parents who had children in either
of the two comparison groups.
AUT I S M 9(5)
502
Table 2 Problems reported by parents in introducing their children to the
appropriate use of everyday objects
Summary statements Number of parents reporting behaviour
Autism Downs Typical
Problems relating to the use of objects
Interest in unusual aspect of object persistently 7 0 1
disrupts appropriate use
Uses object in an odd/unusual way 7 0 0
Not interested in using, or refuses to use, a 4 4 0
particular object
Difculty 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 9
Motor problems prevent proper use of object 2 4 1
Dislike of touching objects, or feeling them in 4 1 0
the mouth
Ability to use an object appropriately has 4 0 0
disappeared
Problems relating to other people
Fails to copy other peoples actions with objects 5 0 0
Not interested in what other people are doing 6 0 0
with objects
Refuses to eat with other people at the table 5 0 0
Fails to respond to parents verbal prompting 6 0 0
Repeated verbal prompting/demonstration by 5 0 0
parent required before child learns to use
an object appropriately
Problems relating to activity
Not interested in food that requires the use of 5 2 0
cutlery
Not interested in food/washing/doing teeth 7 4 1
Gets fed up with eating/drinking and then plays 0 4 4
around with cutlery/cup
Problems relating to the use of objects Seven parents in the autism
group remarked that their childs own particular interests/obsessions
obstructed their efforts to get the child to use an object appropriately. For
example, in the following statement the childs interest in pouring led the
child to use the object incorrectly:
He was easy to change from a teat to a spout. Not quite so hot going from a
cup with a lid to a cup with a lid off because he had this thing in those days
about pouring . . . so it was always very tempting for him to want to pour.
(child 8, autism)
A further problem identied from the statements of parents in this group
was an unusual use of objects, particularly items of cutlery:
When he rst used his spoon he always used it upside down for some strange
reason. He would always put the stuff on upside down and . . . somehow
when he got to his mouth . . . he would scoop it up the right way, then he
would 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 was
such a short lived thing (child 4, autism). Half of the parents in this group
also noted their childs difculty in generalizing the appropriate use of an
object, either from one context to another, or across different objects of the
same 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 cup
its just pushed over. Home is beaker, school is cup (child 5, autism).
An equal number described their childs insistence on using the same
object to perform a particular activity, refusing to use other objects of the
same type even if they would have afforded the same function.
Problems relating to the inuence of other people All parents who
had a child with autism reported problems relating to their childs failure
to be inuenced by other people in their object use. Half of these stated
that their child currently, or at some time in the recent past, had refused
to eat with other people at the table: He wouldnt eat his yoghurt if anyone
was in the room. I had to show him the bowl outside the room, put the
bowl in here . . . and then the whole family would have to stay out of the
room until he had nished (child 5, autism). Six parents recounted that
their 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 be
tucking into lovely food. She will not be motivated by any of them. She
will do her own thing (child 10, autism). Half of the parents in this group
503
remarked on their childs failure spontaneously to copy the actions of other
people with objects, sometimes in striking contrast to their non-autistic
sibling: L. [sibling] does things by example. She would just look at what
you are doing, and copy it because thats the way it should be done . . . but
with B. [child with autism], you have to teach him how to do something
(child 9, autism).
Problems relating to the activities themselves According to several
parents of children with autism (n = 7) or Downs syndrome (n = 4), their
childs lack of interest in the activities of eating, washing, or doing their
teeth prevented them introducing those objects traditionally used for these
activities. Three parents of children with Downs syndrome attributed this
to laziness, saying that their child was unwilling to carry out a particular
activity independently. Five parents of children with autism, and two who
had a child with Downs syndrome specically stated that their child was
not 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 adopted
to shape, or maintain, their childrens use of everyday objects. Almost
without exception, parents in the autism and Downs groups described
using physical guidance by placing their hands over those of the child.
Only three parents of typical children identied this as a strategy. A number
of parents in each group reported physically correcting their childs use of
an object: Sometimes I can get him to move his hand further down [the
spoon]. I would move [his hand] down (child 5, Downs).
Strategies involving joint activity The majority of parents reported
using some kind of joint activity to help shape their childs use of particu-
lar objects, although the specic form this took differed between groups.
Over half of the parents in the autism (n = 6) and typical (n = 8) groups
said that they sometimes performed part of the action, leaving the child to
do the rest.
For example: Ill put the food on the fork and leave it and hell pick it
up (child 3, autism). Six parents of children with autism and ve with
children with Downs syndrome described breaking the task up to make it
easier for the child: We would leave little amounts of water for him in cups
around the house, and then you know he could drink them as appropriate
(child 8, autism). In addition, six parents of typical children described a
strategy involving turn-taking, which was less commonly reported by
parents of children with Downs syndrome (n = 3), and not mentioned by
AUT I S M 9(5)
504
505
Table 3 Adult strategies used to shape childrens appropriate use of everyday
objects: parental strategies and the role of school/nursery teachers
Physical strategies
Parent puts their hands over the childs and 9 10 3
performs the action on object with child
Parent 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 strategies
Parent verbally prompts correct object use 1 6 6
Parent demonstrates appropriate use of an object 1 7 6
Parent praises/encourages correct use of an object 1 3 4
Parent either repeatedly verbally reinforces, e.g. 5 0 0
use of fork, stab and lift, stab and lift, or
demonstrates several times
Joint activity
Parent 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 6
action with the object
Parent breaks up a task into smaller parts in order 6 5 3
to make it easier to use an object, e.g. putting
only small amounts of liquid in a cup, or cutting
up food
Setting the context
Parent gives child the object to play with prior to 1 2 4
introducing its proper use
Parent 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/nursery
School/nursery introduces a particular object to 4 4 N/A
a
the child rather than the parent
School/nursery helps in training child to use a 5 1 N/A
particular object appropriately
School 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 attending
a nursery or school.
any parent of a child with autism. This took two different forms: either
both 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 turns
in using each one.
Verbal and modelling strategies All parents in the typical and Downs
groups reported making use of the less interventionist strategies of verbal
prompting and/or modelling to initiate and maintain proper object use.
Verbal prompting involved the parent either verbally correcting their childs
use of an object, or simply prompting them to use it in situations where
it was appropriate to do so. Modelling refers to cases where the parent
physically demonstrated the correct use of an object to the child. Neither
verbal prompting nor modelling of this kind were identied from the
interview statements as strategies commonly used by parents of children
with autism (n = 2). However, half the parents did report using either
repeated verbal reinforcement or repeated demonstration in their attempts to
either establish or maintain appropriate object use: I encourage [the use
of the fork] all the time, stab and lift, stab and lift (child 9, autism); just
showing him things over and over again (child 6, autism).
Comparing their child with autism with a typical sibling, several parents
in the autism group remarked on the greater conscious effort that was
required to shape their childs object use. For example: I dont remember
having to teach [older brother] particularly, there must have been a little bit
there, 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 children
commented on the ease with which their child picked up the conventional
use 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 reported
setting the context for object use in some way. Four parents with typical
children said that they had given their child an object to play with before
introducing its conventional use. The same number in the Downs
syndrome group described their attempts to make the use of an object fun,
in order to motivate their child: I normally sing and dance through the
Barney video [a video about cleaning teeth] while he cleans his teeth. We
try to make it a sort of fun thing, so that it is not a chore (child 4, Downs).
AUT I S M 9(5)
506
The role of the school/nursery in promoting conventional object
use
Table 3 presents the summary statements relating to the inuence of the
school or nursery on a childs object use. Parents of both children with
autism and Downs syndrome described the school/nursery as sometimes
taking the initiative in introducing certain objects: It wasnt until they said
at 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 helped
train their child in using certain objects, as part of their programme to
encourage 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 fork
H., stab and lift (child 6, autism). Some parents (n = 4) in this group said
that the school got more out of their children than they could, either because
the environment was more structured or because the teachers were trained.
The childs role in the acquisition of appropriate object use
Table 4 lists the summary statements relating to how active the children
themselves were in entering into the appropriate use of various everyday
objects. A striking difference was revealed between the autism and
comparison groups. Whilst all parents of typical children, and all but one
of the parents in the Downs syndrome group, said that their child actively
participated in learning to use the objects, only two parents of children
with autism mentioned this.
507
Table 4 The childs role in entering into the appropriate use of everyday objects
Interest in other peoples use of objects
Watches what other people (parents, siblings) are 1 5 9
doing with objects
Imitates other peoples (parents, siblings, peers) 0 8 10
actions on objects
Child shows a desire to use an object when they 0 7 7
see other people (parents, siblings, peers) using it
Independence
Takes object from parent and uses it independently 1 5 6
Refuses help from parent because wants to use 0 3 5
object on their own
Child themselves initiates the use of an object by 0 5 9
indicating (verbally or non-verbally) that they
want to use it
Interest in what other people are doing with objects Parents in both
comparison groups remarked on the interest shown by their child in what
other people, particularly parents and older siblings, were doing with
objects. This interest was expressed in three main ways. First, the children
were reported to study how, and when, other family members used certain
objects, particularly at the table: all of my children will be round the table,
and she watches them . . . she is studying them, she watches everything
they are doing (child 2, Downs). Second, the parents recounted that such
observations sometimes led their child to ask for a specic object that they
saw a parent or sibling using, not necessarily because they wanted to use
that object themselves, but simply in order to identify with other family
members: 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 his
older sister (child 4, typical). Third, parents reported that their children
sometimes observed the actions of other people on objects and then, to the
best of their ability, tried to copy those actions. For example: quite often
he would reach from his highchair for a coaster and bring the coaster onto
his highchair, and put his cup on the coaster to show that he was copying
us (child 6, typical). Only one parent of a child with autism reported that
her child showed an interest in what other people were doing with objects,
by observing their actions, and this developed only after participation in
an intensive behaviour modication programme.
Expressions of independence Another way in which the children in the
Downs and typical groups were said to take the initiative in using everyday
objects was by showing a desire to use these objects independently. This
was demonstrated by the child grabbing an object from the parent (who
was trying to help them with it) because they wanted to use it on their
own, by the child atly refusing any help with a particular object, or by
them initiating the introduction of an object by declaring that they wanted
to use it. Only one parent of a child with autism reported that he had
shown independence by taking an object in order to use it on his own.
Discussion
Summary of main ndings
1 Parents of children with autism reported experiencing more problems
in introducing the appropriate use of everyday objects, relative to
parents of the other children. In particular, they recounted two kinds
of difculty rarely mentioned by other parents: their childs unusual
AUT I S M 9(5)
508
dealings with the objects themselves, which disrupted appropriate use;
and failure to use other people as a model, or source of inspiration, for
their own actions on objects.
2 All parents of children in the Downs and typical groups commented
on their childs active participation in learning to use everyday objects.
This included a desire to use objects independently; interest in, and
emulation 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 children
to appropriate everyday object use: physical intervention, verbal
prompting/demonstration of a desired action, joint activity, and
context setting. The strategy most frequently mentioned by parents of
children with autism was direct physical shaping of their childs
actions. They also recalled using the less direct strategies of verbal
prompting or demonstration but, unlike parents in the two compari-
son groups, reported that these had to be successively repeated before
their child responded.
4 Parents in the autism and Downs groups described the school as
playing an important role in introducing particular objects, or in
training their child to use them.
The role of other people in shaping everyday object use
These ndings support Valsiners (1987) contention that direct instruction
by caregivers is not the only means by which young children acquire the
conventions surrounding everyday object use. Almost without exception,
the parents in the typical and Downs groups spontaneously reported that
their childs object use was shaped, not only through conscious instruction
by them, but also indirectly through the childs exposure to other peoples
use of everyday objects.
In contrast, parents in the autism group described their children as
lacking interest in what other people are doing with objects and in repro-
ducing these actions. Moreover, the refusal of some children with autism
to eat at the table with other family members meant that, even if the child
were motivated to copy other peoples use of eating utensils, the oppor-
tunity was simply not there. Only one parent in the autism group indicated
that her child watched what other people did with objects, and this was
only after an intensive behaviour modication programme. No parents
mentioned that their child was motivated to use an object by seeing
someone else do so.
The predominant use of physical methods of instruction by parents of
children with autism, their need successively to repeat verbal prompts and
509
demonstrations, as well as the importance they give to structured interven-
tion by the school, may also reect the failure of children with autism to
learn through watching and imitating other people. Although parents of
children with Downs syndrome also reported using predominantly
physical strategies, these were used in conjunction with demonstration and
verbal prompting, as well as indirect means of social inuence.
The role of the object in shaping how it is used
According to Valsiner (1987), the form of an object itself helps to shape
the childs actions in socially acceptable ways. However, this study suggests
that, in the case of the children with autism, their often idiosyncratic
relationship with the objects themselves obstructs conventional object use.
Only the parents of children with autism mentioned that their childs odd
use of certain objects, their interest in isolated, non-functional, aspects of
particular objects, or their co-option of an object to perform a favourite
preoccupation (such as pouring) persistently disrupted appropriate use.
Implications for intervention
The present ndings also have implications for interventions with children
with autism. It is important that parents and teachers are made aware of
why skills, which in typical children seem to be acquired spontaneously,
are much more difcult for children who lack access to the more indirect
socially mediated routes to learning. The ndings also suggest that when a
child 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 of
more 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 this
when using a cup. In light of this, it is important that programmes are indi-
vidually tailored, as these interests need to be identied and appropriately
targeted for each child.
Limitations of present study and future research
The information gained from the project provides an insight into the
problems parents experience in introducing the conventional use of
everyday objects to their children. However, there is a need to be tentative
in drawing conclusions on the basis of interview information alone,
because of parents subjectivity. For example, parents knowledge of their
childs specic diagnosis may affect the expectations they have of their child
and the way in which they interpret their own particular experiences. In
AUT I S M 9(5)
510
511
addition, the age of the child could inuence the parents views of what
that child ought to be able to do in terms of object use. They may expect
more of older children regardless of the specic diagnosis the child has
been given. This is particularly relevant in light of the fact that the typical
children in the current study were signicantly younger than the children
in 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 inform
intervention programmes. The impact of chronological age and mental age
on the childrens use of objects and seeing other people use them also
needs to be assessed.
Conclusion
The ndings from this study indicate that conventional object use may be
both delayed and, in some respects, qualitatively different from that of
children with Downs syndrome and typical children in real-world
contexts, as well as in the context of play. The parents who had children
with autism reported more problems in introducing conventional object
use, less active involvement on the part of their child in this process, and
the need for intensive methods of training, both at home and at school.
Acknowledgements
The 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 and
Andrew Gemmell for their help in establishing the reliability of the coding
scheme and two anonymous reviewers for their helpful comments on an
earlier version of this article.
Appendix: interview schedule
1
Section A
Information for parents
Were particularly interested in young childrens use of common, everyday household objects, rather than in
objects used for play. As this is a relatively new research area we consider you the expert and we are therefore
not anticipating any particular type of answer. Our research will greatly benet 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 a
sandwich from the plate on the oor), ask for a description of an alternative, more
structured 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 the
following:
(a) What did your child do when you last gave them this object?
(b) Can you remember when they rst started doing this?
Note to interviewer: if the parent has difculty answering this question, prompt by
asking them to compare with a sibling (if applicable) or with friends children of the
same age, or to focus on specic 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 B
Washing 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 C
Strategies 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 talked
about?
AUT I S M 9(5)
512
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 rst 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 physically
guides their childs actions with an object, for example putting their hand
over the childs hand while they are brushing their teeth, and moving the
childs hand so they are making the appropriate brushing movements.
(ii) Verbal prompting: this is where a parent/caregiver/sibling reminds their
child about what to do with an object verbally, for example reminding
their child to brush up and down with the toothbrush.
(iii) Demonstration: this is where a parent/caregiver/sibling shows a child
how to use an object by using it themselves, for example brushing their
own 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 you
do 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?
Note
1 The interview schedule contains a number of closed questions, in addition to
more open ones, as we originally planned to conduct a comparative quantitative
analysis of the childrens competence in using those everyday objects most
frequently mentioned by parents, in addition to the qualitative analysis presented
here. However, it was decided that the information obtained from the information
schedule was not specic enough to lend itself to such an analysis.
513
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