Acceso a derechos de la población en su condición de desplazada

2.5.2.1 Retrospective reports of pretend play

Pretend play was included as this is a very important area of research in ASD. However, this is obviously more difficult to study in adults who likely no longer engage in pretend play – although two of the participants that I consulted raised the point that some autistic adults do engage in a form of pretend play such as pretending to be

76

another person “in their head” or by taking part in live action role play. I have already discussed the issues surrounding the retrospective recall of pretend play, such as the effect of memory and self-perception (page 73).

The relationship between childhood pretend play and RRBs was assessed in two studies. The first, Study Four (Chapter Four, page 119), was carried out on data from an online survey of adults with self-reported clinical diagnoses of ASD. The second, Study Five (Chapter Five, page 139), was carried out in a group of adults with ASD with diagnoses of ASD confirmed by clinical reports and/or the DISCO as

administered by myself. Since Study Four was designed as an online survey study I developed pretend play questions based on the DISCO (see Chapter Four, page 120). These were piloted with seven autistic individuals (see Chapter Three, page 82) who were able to answer them satisfactorily and did not report any specific problems with the questions. These questions were taken from the DISCO as this interview is based on the early work of Wing and Gould (1979), and assesses imaginative abilities in more detail than other diagnostic tools such as the ADOS. For Study Five, I administered the abbreviated form of the DISCO (see page 143), which includes the items on which I based Study Four’s pretend play questions as part of its schedule. One disadvantage of this approach is the fact this makes it more difficult to compare the findings from Study Four (questionnaire items) with the findings from Study Five (interview).

However, this disadvantage is balanced by the fact that administering these questions in interview format removes some of the issues surrounding the use of questionnaires as the interviewer is able to respond to participants’ queries directly, provide further explanation and examples for specialised terms, and elicit more information from participants.

2.5.2.2 The AQ imagination subscale

As Studies One and Three were conducted online and there are no diagnostic tools for ASD that can be administered entirely online and anonymously, I included the AQ (see page 85 for more details) in order to check that participants identifying as autistic met the clinical cut-off for ASD, and to ensure that participants in Study One did not meet this cut-off. The AQ is not a screening or diagnostic tool, but it is useful as a measure of autistic traits. The AQ is divided into five subscales, including one that

77

represents imagination. Therefore, although I did not initially intend to measure imagination in this way, I used the AQ data as an additional assessment of imagination.

However, the subscales of the AQ, in particular imagination, have certain weaknesses. In their original paper, Baron-Cohen et al. (2001) did not use factor analysis to determine the subscales; these were instead determined conceptually. Several factor analyses have failed to find support for the proposed subscales (e.g. Austin, 2005; Hoekstra, Bartels, Cath & Boomsma, 2008; Kloosterman et al., 2011; Stewart & Austin, 2009). The internal consistency of an imagination subscale is usually low (Hurst, Mitchell, Kimbrel, Kwapil, & Nelson-Gray, 2007; Kloosterman et al., 2011; Stewart & Austin, 2009) and not all factor analyses even identify an imagination

subscale (Austin, 2005). Nevertheless, it is the only measure of ASD traits that includes several items relevant to imagination that are not solely concerned with ToM or

empathy. As such, the AQ was used as a measure of imagination but I will interpret findings from this scale with caution. Notably, this will also address the issue I raised earlier of comparing questionnaire and task measures, as this enables the RBQ-2A to be compared to a questionnaire measure of imagination.

2.5.2.3 Design and ideational fluency: The Torrance Tests of Creative Thinking

I initially chose to use two subtests from the TTCT (Torrance, 2008) to assess design fluency. The TTCT is available in two Forms, A and B; these subtests were taken from Form A as these particular subtests have been used in previous studies with ASD participants (e.g. Pring et al., 2012). The main reason I chose to use this version of the design fluency task was because they are standardised tests with normative data available. However, I only included two subtests rather than the whole test in order to reduce the length of time for participants, given the amount of other measures

included in the study (see pages 140-147).

As discussed earlier, standardised norms were unfortunately not available for the TTCT tasks. However, these tasks are still useful as they are similar to other measures of design fluency with the benefit of standardisation in terms of

administration and scoring; such that originality scoring is based on normative data rather than the responses of the sample, which could lead to circularity in

78

studies with ASD participants (Pring et al., 2012; Craig & Baron-Cohen, 1999). Having decided to include these two design fluency tasks, I also chose to include an ideational fluency measure from the TTCT, equivalent to a use of objects task but with written rather than spoken responses. I considered including a more conventional use of objects task; however, I decided upon this task to complement the figural TTCT

subtests. There were two available ideational fluency tasks, one based around unusual uses for a cardboard box (Form A) and one based around unusual uses for a tin can (Form B). I initially planned to include both forms of the task; however, when piloting Study Five with an autistic individual, the study session was overly long. I therefore decided to only include the cardboard box task as this originates from the TTCT Form A along with the chosen design fluency tasks.

2.5.2.4 Thinking about the future: The personal future task

When deciding on what tasks to include in this thesis, I reviewed a wide range of future thinking tasks that have been used both within and outside the ASD

population. Having chosen fluency tasks for two other measures of imagination, I identified a widely used future thinking fluency task that has not yet been used with autistic individuals, to the best of my knowledge; the personal future task ([PFT] e.g. MacLeod & Byrne, 1996; MacLeod et al., 1993). The PFT asks participants to generate positive and negative future events across different time periods (see page 270 for task instructions). This task has been used in other clinical populations and is conceptually similar to an ideational fluency task, so is a good analogue for that particular task.

One potential limitation of the personal future task is the fact that previous studies have found that anxiety and/or depression affects performance on the PFT; for example individuals with anxiety generate more negative events than non-anxious participants, whereas those with both anxiety and depression generate fewer positive events than those with anxiety alone (e.g. MacLeod & Byrne, 1996; MacLeod,

Pankhania, Lee & Mitchell, 1997). This may present an issue given that mental health problems are elevated in the ASD population (e.g. Leyfer et al., 2006) and so

participants may generate more negative events and/or fewer positive events as a result of their mental health rather than ASD traits. Previous research using other

79

methods has demonstrated that depression does not account for differences between autistic and NT participants’ performance on future thinking tasks (Crane et al., 2013). However, Crane et al. (2013) did not distinguish between positive and negative future thinking as the PFT does and did not include a measure of anxiety; therefore I decided to include a measure of both anxiety and depression for this sample in order to test whether there was any relationship between mental health symptoms and

performance on this task.

The time given for each condition varies across studies from thirty seconds (e.g. MacLeod et al., 1993) to three minutes (e.g. Quoidbach, Hansenne & Mottet, 2008). Initially I planned to allow two and a half minutes time limit, which is commonly used in the UOT to which the PFT is analogous. However, the autistic individual I piloted this study with suggested it was too long and so was reduced to two minutes per condition. Finally, as I am interested in the relationship between imagination measures, and both the PFT and ideational fluency tasks are verbal (albeit one spoken and the other written), any relationship between the two may be entirely explained by verbal fluency. Therefore I included a verbal fluency measure to control for this, based on previous studies (Benton, 1968; Lezak et al., 2004; Turner, 1999b).