Developmental Psychology Copyright 1984 by the

1984, Vol. 20, No 2, 293-302 American Psychological Association. Inc

Cognitive and Language Skills in Autistic,

Mentally Retarded, and Normal Children
Marian Sigman and Judy A. Ungerer
Department of Psychiatry
University of California, Los Angeles, School of Medicine

The sensorimotor skills and play behaviors of autistic, mentally retarded, and normal
children were compared to identify deficits in object knowledge specific to autism.
There were no differences in sensorimotor skills between the three groups matched
on mental age except that the autistic children were deficient in the capacity to
imitate gestures and vocalizations. Autistic children showed less diverse functional
play, particularly directed toward dolls, and less symbolic play both spontaneously
and after cueing. Although functional and symbolic play and the ability to imitate
were correlated with receptive language for all three groups, sensorimotor skills
were associated with receptive language only for the normal and the mentally
retarded groups. Thus the autistic children in this study seem to be a distinct group
with specific deficits in imitation and symbolic abilities. The observation that the
disorder involves deficits in certain cognitive concepts and not others suggests that
representational thought may be manifested in two systems, only one of which is
impaired in the autistic child. Another hypothesis is that the cognitive deficits
manifested by autistic children may be related to their impaired social development,
because all the areas of cognitive deficit involve significant social components.

The aim of this study is to identify early
cognitive deficits specific to the syndrome of
autism. The majority of autistic children are
also mentally retarded, so specification of cog-
nitive deficits depends on a comparison of the
behaviors of autistic children with those shown
by children at similar developmental levels. In
recent years, some clinicians and researchers
have begun to question the value of the di-
agnosis of autism and to suggest that the di-
Support for this research was provided by Grant 12-41
from the March of Dimes, Biobehavioral Research Support
Grant 516, National Institute of Mental Health (NIMH)
Grant MH 33815, and NIMH Postdoctoral Fellowship 1
F32 MH 07550. Subjects were recruited from the Uni-
versity of California, Los Angeles Clinical Research Center
(CRC) for the Study of Childhood Psychosis, funded by
NIMH Grant MH 30897. We thank members of the CRC,
particularly Peter Tanguay, Barbara Fish, and B. J. Freeman
for their support of our research efforts. We also thank
Mary Beth Sorensen and M. Holly Hackman for their
assistance in data collection and analysis, Luisa Castillo
for her help in the preparation of the manuscript, and
Dolores Adams for her assistance in data analysis. In ad-
dition, Peter Mundy, Rosa Needleman, and Tracy Sherman
contributed significantly to this project.
Requests for reprints should be sent to Marian Sigman,
Department of Psychiatry, University of California, Los
Angeles, School of Medicine, 760 Wesrwood Plaza, Los
Angeles, California 90024.
293
versity of the group makes differentiation be-
tween autistic children and other children with
retardation difficult (Sherman, Shapiro, &
Glassman, 1981; Wing & Gould, 1979). On
the other hand, Rutter (1978) conceives of au-
tism as a specific disorder involving a primary
disturbance of symbolic capacities. Thus a
comparison of the cognitive skills of autistic
children with those of mentally retarded chil-
dren has implications both for the definition
and specificity of the syndrome.
The cognitive skills selected for comparison
were those that normally develop during in-
fancy because autism involves disorders that
are manifested before 30 months of age. In
several previous studies, we have attempted to
describe the concepts of autistic children in
two different domains: operational object con-
cepts as manifested in sensorimotor problem-
solving skills and presymbolic object concepts
as manifested in functional and symbolic use
of objects in play. When the performance of
autistic children on sensorimotor tasks was
compared to that of normal children, matched
as a group on mental age, the scores of the
two groups were surprisingly similar (Sigman
& Ungerer, 1981). On the other hand, the play
behaviors of the autistic children (Ungerer &
294 MARIAN SIGMAN AND JUDY A UNGERER
Sigman, 1981) appeared to differ from those
usually observed in normal children of com-
parable mental ages (Fenson, Kagan, Kearsley,
& Zelazo, 1976; Fenson & Ramsey, 1980; In-
helder, Lezine, Sinclair, & Stambak, 1972;
Largo & Howard, 1979; Lowe, 1975; Nicolich,
1977; Rosenblatt, 1977; Sinclair, 1970). Al-
though there appeared to be deficits in the
presymbolic skills of autistic children, these
deficits could not be definitively identified be-
cause the play behaviors of a normal mental
aged matched control group had not been ob-
served. Thus a major goal of this research was
to identify specific deficits in autistic children
by comparing sensorimotor and play behaviors
to those shown by mentally retarded children,
matched on both mental and chronological
age, and normal children, matched on mental
age. Imitation skills were also assessed because
these have been described as deficient, al-
though some imitation of body movements
and actions with objects has been noted
(DeMyer et al., 1972).
A second goal of this research was to de-
termine whether relationships found between
object concepts and language in autistic chil-
dren are the same as those found in mentally
retarded and normal groups. Comparisons
with mentally retarded and normal children
are necessary to determine whether differences
found are specific to autism or derive from
general delays in cognitive development. A few
studies have reported relationships between
language and object concepts as expressed in
sensorimotor and play skills in autistic chil-
dren. Ungerer and Sigman (1981) found that
autistic children who were able to comprehend
verbal labels demonstrated more functional
and symbolic play and longer sequences of
meaningfully integrated play acts than did au-
tistic children with minimal or no compre-
hension of verbal labels. In addition, Wing,
Gould, Yeates, and Brierley (1977) found re-
lationships between language comprehension
age and play in a mixed group of autistic and
retarded children. Curcio (1978) reported that
Stage 5 performance on the means and cau-
sality subscales and Stage 3 performance on
the imitation subscale of the Uzgiris-Hunt
scales (1975) were minimal prerequisites for
nonverbal intentional communication in a
group of mute autistic children. On the other
hand, Sigman and Ungerer (1981) found few
relationships between language and sensori-
motor skills for autistic children. The present
research determined whether these same re-
lationships between play and sensorimotor be-
havior and language were found with normal
control subjects matched individually on
mental age and extended the comparisons to
include young, mentally retarded children.
To summarize, the goals of this research
were (a) to compare the development of sen-
sorimotor behavior, imitation, and play in au-
tistic, mentally retarded, and normal children
in order to identify cognitive deficits specific
to the autistic syndrome and (b) to examine
the relationship between sensorimotor and
play behaviors and language in mentally re-
tarded and normal children to determine
whether the correspondences between these
domains are different for autistic as compared
to mentally retarded and normal children.
Method
Subjects
The autistic sample consisted of 16 children who were
mpatients in the Neuropsychiatric Institute at the Uni-
versity of California, Los Angeles and were subjects in the
Clinical Research Center (CRC) for the Study of Childhood
Psychosis and have been described in previous papers (Sig-
man & Ungerer, 1981). The experimenters in this study
were unaware at the time of assessment whether a child
was diagnosed as autistic, mentally retarded, or aphasic.
Diagnoses were made independently by several CRC psy-
chiatrists using the Diagnostic and Statistical Manual of
Mental Disorders (3rd ed.) criteria (American Psychiatric
Association, 1980) The 16 children, 15 boys and 1 girl,
ranged in age from 39 to 74 months, with a mean age of
51 7 months Mean mental ages and developmental quo-
tients are presented in Table 1
Each of the 16 mentally retarded children was selected
to match an autistic child on mental age, chronological
age, and developmental quotient (Table 1). Because of the
priority of identifying subjects who matched on chrono-
logical and mental age with the autistic children, the nature
of the condition associated with mental retardation and
the sex of the subject were allowed to vary. Half the children
had Down's syndrome, three had organic dysfunctions
including arrested hydrocephalus and seizure disorders,
and five suffered from retardation of unidentified origin.
There were 10 boys and 6 girls. Four of these children
were subjects in the Clinical Research Center.
Each child in the normal sample of 15 boys and 1 girl
was selected to match on mental age with one autistic and
mentally retarded child (see Table 1). The mental age scores
used for matching the autistic, mentally retarded, and nor-
mal groups were based on a general intelligence scale (Cat-
tell)
 COGNITIVE AND LANGUAGE SKILLS IN AUTISTIC CHILDREN 295

Assessment of Play in an Unstructured and Table 1

Structured Setting Age and Standardized Test Data for Autistic,
Mentally Retarded, and Normal Children
Play was assessed in two test sessions described in a
previous publication (Ungerer & Sigman, 1981) The child's Mentally
play behavior was videotaped and recorded by the exper- Variable Autistic retarded Normal
imenter seated in the playroom using a time-sampling
procedure with a checklist that included the behaviors Chronological age
most frequently observed with this set of toys. Play be- (in months)
haviors not included in the checklist were separately noted. 51.7 50.7 20.8
Following the play session, the videotaped record was re- SD 10.7 12.6 3.0
viewed to clarify any ambiguities in the checklist completed Range 39-74 32-80 16-25
by the experimenter.
Measures The child's play behaviors were grouped Cattell/Stanford Binet
into the following categories: Mental age
1 Simple manipulation Each instance of mouthing, (in months) 24.8 26.6 24.6
waving, banging,fingering,or throwing of a single toy was
SD 5.1 7.2 5.2
recorded.
Range 18-38 17-38 17-35
2. Relational play This category included nonfunctional 48.1 48.0 116.0
combinations of objects uke touching or banging two ob- IQ
SD 8.1 119 12.8
jects together, stacking objects, and using one object as a Range 35-62 28-71 92-147
container to hold another object The last two categories
excluded those behaviors considered functional associations
of objects, for example, placing a cup on a saucer or putting
a spoon in a cup. example, the experimenter told the child "Feed the baby
3. Functional play Four different types of functional with the bottle." If the child did not respond to the verbal
acts were recorded, object-directed (e.g., placing the top cues, the experimenter then modeled the appropriate
on the teapot or pushing the truck into the garage), self- functional acts for the child The child's responses to both
directed (e.g., brushing one's hair), doll-directed (e.g., verbal cueing and modeling were recorded on the checklist
feeding a doll with a spoon), and other-directed (e.g., hold- by the experimenter This play interaction lasted approx-
ing a telephone receiver to the mother's ear) imately 30 min. and the categories of play measured were
the same as those described above. (One child was un-
4 Symbolic play Three types of symbolic acts were
available for testing with this procedure.) The structured
recorded: substitution play, defined as the use of one object
play assessment was always conducted after the unstruc-
as if it were another different object (e.g., using a teacup
tured play assessment so that spontaneous play in the un-
as a telephone receiver), agent play, defined as the use of
structured setting would not be influenced by the extensive
a doll as an independent agent of action (e.g., propping a
verbal cueing and modeling procedures used in the struc-
bottle in a doll's arms as if it could feed itself), and imag-
tured setting. The duration of play by category was not
inary play, defined as the creation of objects or people
measured in the structured setting, because the experi-
having no physical representation in the immediate en-
menter largely determined the duration of a child's play
vironment (e.g, making pouring sounds and saying "tea"
with the different toys. Diversity of play was measured in
as imaginary tea is poured from a teapot into a cup)
the same way as in the unstructured play assessment. Re-
Measures of play integration were also obtained. The liability for the diversity play measures was good. The
total number of different sequences of related functional mean correlation for the diversity play measures for the
and symbolic acts was scored, as well as the number of two observers was .92 (SD = .13).
different acts included in each sequence
The duration of play by category was measured by the
total number of 10-sec intervals in which each category Assessment of Sensonmotor Behavior
of play was recorded. Diversity of play was measured by
the number of different instances recorded for each category Sensonmotor behaviors were assessed using the "Stages
of relational, functional, and symbolic play. Reliability for of Sensonmotor Intelligence in the Child" developed by
the duration and diversity play measures was computed Casati and Leztne( 1968) These scales and their reliability
separately for each play category and was good (Ungerer have been described previously (Kopp, Sigman, & Par-
& Sigman, 1981). melee, 1974; Sigman & Ungerer, 1981).
A second, more structured play assessment was also The skills of autistic children are often difficult to assess
conducted to ensure that the child's optimal play skills reliably because their readiness to perform varies widely.
would be recorded. Toys used in the unstructured play For this reason, all items failed by a child in any of the
assessment were presented to the child one at a time or three groups were readministered in a second testing to
in small groups by an experimenter who then recorded ensure that the child's maximal level of skill was obtained.
the child's spontaneous use of objects on a checklist spe-
cifically designed for this play assessment Vocal and Gestural Imitation
If the child did not spontaneously use the objects in a
functionally appropriate manner, the experimenter directed The vocal and gestural imitation subtests of the Uzgjris-
the child verbally in the functional use of the toys. For Hunt Ordinal Scales of Psychological Development (1975)
 296 MARIAN SIGMAN AND JUDY A. UNGERER
were administered to each child. These tests require the
child to imitate familiar and novel gestures made by the
experimenter as well as familiar and novel sounds and
words. Each subtest item was administered three times,
and the child received one score on each subtest repre-
senting the highest level of imitation achieved.
Language Assessments
A receptive language measure developed by Beckwith
and Thompson (1976) and described in previous publi-
cations was administered. The child's receptive language
score was determined by the number of slides verbally
labeled by the experimenter that the child pointed to or
touched correctly from 34 pairs of slides. In addition, each
child was administered a clinical language evaluation,
which was carried out independently by a linguist Re-
ceptive and expressive language were assessed based on
the child's responses to questions, requests, and prompts
in a sermstructured play setting The assessment focused
on the child's understanding and use of concepts of pos-
session, existence, attribution, and location, and the ability
to understand and use labels. The child was assigned a
receptive language age and an expressive language age (in
months) based on behavior and speech recorded during
several interactions. The relationship between the receptive
language slide measure and the independently administered
clinical assessment of receptive language was high for all
groups. r( 13) = .86, p < .01, for the autistic group; r( 12) =
.74, p < .01, for the mentally retarded group; and r( 13) =
.72, p < .01, for the normal group. Therefore, only scores
from the receptive language slide measure and the clinical
assessment of expressive language were used in the data
analyses.
Results
Comparison of Autistic, Mentally Retarded,
and Normal Children
The purpose of the first analysis was to
identify deficits in cognitive functioning spe-
cific to the autistic syndrome. The perfor-
mances of the autistic, mentally retarded, and
normal children on the different tasks were
compared with analysis of variance (ANOVA)
statistics. Deficits on a task were considered
specific to autism only if the performance of
the autistic children was significantly poorer
than that of both the mentally retarded and
normal groups. For this reason, individual
group means were compared using t tests
whenever the ANOVAS showed significant group
effects. Because three groups were compared,
alpha levels were raised to control for the effects
of performing multiple t tests (see Dunn &
Clark, 1974).
Unstructured play One-way ANOVAS were
used to compare the three groups on each of
four measures of play duration (the total num-
Table 2
Mean Duration of Play Behaviors in an
Unstructured Setting (No of 10-Sec Units)
Mentally
Play behaviors Autistic retarded Normal
Simple manipulation 19.3 13.3 12.9
Relational 21.2 14.9 19.7
Symbolic 1.3 5.6 4.0
Functional 16.8"-b 40.1 31.5
Sequences
2 acts 1.6 2.6 3.3
3 or more acts 0.7' 3.2 2.3
1
For means significantly different for autistic and mentally
retarded groups, p < .05
b
For means significantly different for autistic and normal
groups, p < .05
ber of 10-sec units recorded for simple ma-
nipulation, relational, functional, and sym-
bolic play) and on the two measures of play
integration (the number of different sequences
of two related acts and the number of different
sequences of three or more related acts). Sig-
nificant group effects were found for the num-
ber of 10-sec units of functional play, F(2,
45) = 5.70, p < .01, and the number of dif-
ferent sequences of three or more related acts,
F(2, 45) = 3.22, p < .05 (see Table 2). The
individual group comparisons indicated that
the autistic children were engaged in functional
play for fewer 10-sec units than were either
the mentally retarded, t(26A) = 3.20, p < .01,
or normal groups, *(29.7) = 2.43, p < .05. In
addition, the autistic children demonstrated
fewer sequences of three or more related acts,
r(19.0) = 2.78, p < .05, than did the mentally
retarded children.
One-way ANOVAS were used to compare the
three measures of play diversity (the number
of different acts recorded for relational, func-
tional, and symbolic play). Significant group
effects were found for two diversity of play
measures: the number of different functional
acts, F(2,45) = 5.72, p < .01, and the number
of different symbolic acts, 7=1(2, 45) = 3.61,
p < .05). The individual group means were
compared for these variables. The autistic
children demonstrated fewer different func-
tional acts than did either of the other two
groups, <(27.7) = 2.95, p < .05, for the mentally
retarded group, and /(29.9) = 3.01, p < .01,
for the normal group, and fewer different sym-
 COGNITIVE AND LANGUAGE SKILLS IN AUTISTIC CHILDREN 297

bolic acts than did the mentally retarded chil- Table 3

dren,/(17.2) = 3.36, p< .01. Mean Number of Different Play Behaviors
Thus both the total duration and diversity in an Unstructured Setting
of the autistic children's functional play was Mentally
less than that of the normal and mentally re- Play behaviors Autistic retarded Normal
tarded children. To determine the particular
types of functional play that varied among the Relational 7.9 6.0 11.1
groups, the number of different functional acts Total functional 5.1"-" 11.1 10.1
Object-directed 2.8* 5.9 4.5
was subdivided into four categories (object- Self-directed 1.4 26 2.4
directed, self-directed, doll-directed, and other- Doll-directed 0.9b 2.3 2.8
directed), and group comparisons for each Other-directed 0 1 0.4 0.4
category were conducted using t tests. Two t- Symbolic 0.6' 2.9 2.6
test comparisons were significant. The autistic
* For means significantly different for autistic and mentally
children demonstrated fewer doll-directed retarded groups, p < .05.
functional acts than did the normal children, b
For means significantly different for autistic and normal
/(24.3) = 2.62, p < .05, and fewer object-di- groups, p < .05.
rected functional acts than did the mentally
retarded children, /(24.2) = 2.46, p < .05 (see pendent variables: number of different acts re-
Table 3). corded for simple manipulation, relational,
The distribution of play time across the cat- functional, and symbolic play. Only acts pro-
egories of functional, relational, and simple duced spontaneously by the children were in-
manipulation play was different for the three cluded in these analyses. There were significant
groups of children (see Table 2). Within each group effects for the number of different simple
group, the number of 10-sec units recorded manipulation acts, F\2, 42) = 3.14, p < .05,
for the three play categories was compared functional acts, F(2, 42) = 9.26, p < .001, and
using one-way ANOVAS. There was a significant symbolic acts, F(2, 42) = 7.34, p < .01 (see
main effect for category of play (ps < .01) for Table 4).
the mentally retarded and normal children but To determine whether the performance of
not for the autistic children. The mentally re- the autistic children was significantly poorer
tarded children produced more functional play than that of the other two groups, group means
than either relational, /(14) = 3.24, p < .01, were compared using t tests. In these analyses,
or simple manipulation play, t( 14) = 3.19, p < the number of different acts performed spon-
.01. The results for the normal children were taneously was compared, as was the total
similar for functional versus relational, t( 14) = number of different acts performed sponta-
1.90, p < .08; for functional versus simple neously and after verbal cueing and modeling.
manipulation, /(14) = 3.54, p < .01. In con- Comparisons for the four subcategories of
trast, the autistic children were engaged for functional play were also included. As can be
about the same amount of time in functional, seen from Table 4, the greatest variation be-
relational, and simple manipulation play. For tween groups was shown in spontaneous play.
the mentally retarded and normal children, The autistic children produced fewer different
more sophisticated forms of play, like func- total functional and doll-directed functional
tional play, tended to dominate less sophisti- acts and fewer different symbolic acts than did
cated play behaviors, like relational or simple either the mentally retarded or normal children
manipulation play. Although many autistic (ps < .05). These results are consistent with
children were capable of performing more so- findings from the unstructured play assess-
phisticated play, they used this skill less fre- ment. Following verbal cueing and modeling
quently than did normal or mentally retarded in the structured play task, the autistic children
children of comparable mental age. were able to increase their functional play so
Structured play. One-way ANOVAS were that the means for the autistic and normal
used to compare the play of the autistic, men- samples were more similar. However, the au-
tally retarded, and normal groups during the tistic children still produced fewer different
second, structured play assessment. A separate symbolic acts than did the other two groups,
ANOVA was conducted for each of four de- even after modeling.
298 MARIAN SIGMAN AND JUDY A. UNGERER
Table 4
Mean Number of Different Play Behaviors in a Structured Setting
Autistic
Play behaviors Spontaneous Elicited
Simple manipulation 4.9
Total functional 10.6*-" 17.9*
Object-directed 5.2" 8.7"
Self-directed 2.6 3.3
Doll-directed 2.6*-b 5.7
Other-directed 02 0.3
Symbolic 0.5"-" 2.8"-b
• For means significantly different for autistic and mentally retarded groups, p < .05
b
For means significantly different for autistic and normal groups, p < .05.
Sensonmotor behaviors. One-way ANOVAS
were used to compare the scores of the three
groups on the seven subtests of the Casati-
Lezine Scale. A separate ANOVA was conducted
for each subtest score for both the first and
the second administration of the scale. There
were no significant group differences on any
subtest for either test administration. Thus the
autistic, mentally retarded, and normal chil-
dren were quite similar in their performance
on the sensorimotor scale. The lack of group
differences was not due to ceiling effects.
Vocal and gestural imitation. The scores
on the Uzgiris-Hunt vocal and gestural imi-
tation subtests were compared using Kruskal-
Wallis tests. There were significant group dif-
ferences for both vocal imitation, x2(2) =
11.12, p < .01, and gestural imitation scores,
X2(2) = 12.23, p < .01. On the vocal imitation
subtest, the mean scores of the normal and
mentally retarded children were nearly iden-
tical and significantly higher than were the
mean score of the autistic children. On the
gestural imitation subtest, the mentally re-
tarded children performed less well than did
the normal children, but the difference was
not statistically significant. However, the au-
tistic children performed significantly more
poorly than did both the mentally retarded,
/(22.3) = 2.68, p < .01, and normal groups,
t(l6.5) = 4.01, p < .001. Thus the autistic
children were significantly less able to imitate
both gestures and vocalizations than were the
mentally retarded and normal children.
Language. The receptive language scores
and expressive language ages were compared
for the three groups using ANOVAS. There were
significant group main effects for both the re-
Mentally retarded Normal
Spontaneous Elicited Spontaneous Elicited
1.8 2.9
17.8 24.5 16.1 22.6
8.4 11.8 71 10.8
3.6 4.3 2.6 2.8
5.0 7.6 50 7.8
0.8 0.9 1.3 1.3
3 1 6.5 3.1 6.0
ceptive and expressive language measures.
Comparison of group means using / tests in-
dicated that the autistic children scored sig-
nificantly lower in both language areas than
did the normal children and lower in receptive
language than did the mentally retarded chil-
dren (/7s < .05). The receptive language of the
mentally retarded children was comparable to
that of the normal children, but their ability
to express themselves verbally was somewhat
less mature, r(27) = 1.79, p < .08. This dif-
ference could not be attributed to particular
deficits in the Down's syndrome infants, be-
cause the mean expressive language age for
the children with Down's syndrome (M = 14.7
months) was nearly identical to that of the
children with other developmental disabilities
(M = 14.5 months).
The relationship between receptive and ex-
pressive language abilities was very high for
the autistic children, r(13) = .68, p< .01, and
the normal children, r( 13) = .71, p < .01, but
less robust for the mentally retarded children,
r(12) = .36, p < .10. Within the mentally
retarded group, the relationships were equally
low for Down's syndrome and the other de-
velopmentally delayed children. The high cor-
relations found for the autistic children were
not surprising because so many gave no in-
dication of either understanding or using lan-
guage.
The Significance of the Diagnosis of Autism
To assess the specificity of the symbolic dis-
order associated with autism, it was necessary
to determine whether the language delays of
the autistic and mentally retarded children
 COGNITIVE AND LANGUAGE SKILLS IN AUTISTIC CHILDREN
were sufficient to explain their performance
in other symbolic domains like play, or whether
deficits in play were also a function of diag-
nosis. If the play behaviors of autistic and
mentally retarded children were predicted fully
by the children's language skills, we could
conclude that the symbolic deficits observed
in both groups were similar and related pri-
marily to delays in language. However, if di-
agnosis improved the prediction of play be-
yond that achieved by language alone, we could
conclude that the symbolic impairment of the
autistic children was unique and not solely the
result of delayed language skills.
The autistic and mentally retarded children
were divided into groups based on diagnosis
and language capacity. Children who re-
sponded correctly to three or fewer words on
the receptive language tasks were placed in a
low-language group (N = 13), whereas the re-
maining children who responded correctly to
11 or more words were placed in a high-lan-
guage group (N = 19). Individual 2 X 2 (Di-
agnosis X Language Group) ANOVAS were car-
ried out for each of six play variables from
the unstructured play task. These play vari-
ables were the number of different object-di-
rected, self-directed, doll-directed, and other-
directed functional acts, the total number of
different functional acts, and the total number
of different symbolic acts. The results showed
a significant main effect for diagnosis (autism
vs. mental retardation) for all analyses except
other-directed functional play, and a significant
main effect for language group for all analyses
except other-directed and self-directed func-
tional play. Most important, the interaction of
Diagnosis X Language Group was not signif-
icant in any analysis. These results indicate
that both diagnosis and the capacity to un-
derstand verbal labels independently discrim-
inate play patterns and thus yield support for
Rutter's proposal of a unique symbolic deficit
in autistic children. The diagnosis of autism
does imply a deficit in symbolic skills over and
above the deficit in language comprehension.
The best illustration is that the mean number
of different functional and symbolic acts for
the seven A/^A-language autistic children was
slightly lower than the mean number of dif-
ferent functional and symbolic acts for the
four /ow-language retarded children. In other
words, the retarded children who did not re-
299
spond to verbal labels still showed more diverse
functional and symbolic play than did the au-
tistic children who responded correctly to ver-
bal labels.
Relationships Between Cognition
and Language
Play and language For the purpose of
contrasting relationships between play and
language within the autistic, mentally retarded,
and normal groups, the data were analyzed
with Pearson product-moment correlations.
For each group, receptive language scores and
expressive language ages were correlated with
the number of different functional and sym-
bolic acts in the unstructured and structured
play tasks, and the number of different se-
quences of three or more related acts in un-
structured play. The structured play variables
were composed of acts carried out sponta-
neously and after verbal cueing and modeling.
The correlations between play and receptive
language for the three groups are shown in
Table 5. For relationships between play and
expressive language, only correlations for the
autistic children are given because correlations
within the other two groups were not signif-
icant. The results for the autistic children in-
dicated a relationship between functional play
demonstrated in the unstructured setting and
receptive language. The number of functional
play acts also correlated with expressive lan-
guage age, as did the sequencing of related acts
in play.
The number of different symbolic acts per-
formed by autistic children in the unstructured
play task did not relate to language. However,
there was a significant relationship between
receptive language and the total number of
different spontaneous and elicited symbolic
acts in the structured play assessment. To de-
termine whether the effects of verbal cueing
and modeling were responsible for the rela-
tionship, the correlations between spontaneous
symbolic play in the structured task and the
two language measures were calculated. The
number of different spontaneously performed
symbolic acts was related significantly to re-
ceptive language, r(13) = .56, p < .05, and
somewhat to expressive language, r(12) = .52,
p < . 10. Thus the more verbally adept autistic
children did perform more symbolic acts when
 300 MARIAN SIGMAN AND JUDY A. UNGERER
Table 5
Correlations Between Number of Play Acts and Language Abilities for Autistic,
Mentally Retarded, and Normal Children'
Autistic
Receptive
Play behaviors language
Unstructured play
Functional .57
Symbolic — —
Sequences (3 or more acts) .65
Structured play*
Functional .73
Symbolic .50
• For all correlations reported, p < .05.
b
The total number of spontaneous and elicited acts were used in these analyses.
their behavior was structured, and they did
not require verbal cues or modeling to do so.
The relationship between play and language
for the mentally retarded and normal children
was similar although less robust than that seen
in the autistic group. For both the mentally
retarded and normal groups, symbolic play
was related to receptive language, and for the
normal children a relationship to functional
play was also found. However, in neither group
were relationships between expressive language
and play observed.
Ungerer and Sigman (1981) reported that
autistic children with minimal or no receptive
language showed fewer doll-directed functional
acts and fewer symbolic acts in a structured
play task than did autistic children with better
receptive language skills. Among the mentally
retarded children in this study, four gave no
indication of recognizing word meanings. The
following play behaviors were compared for
the 12 mentally retarded children with lan-
guage comprehension and the 4 who showed
no word recognition: the number of different
other-directed, object-directed, self-directed,
and doll-directed functional acts, and the
number of different symbolic acts in the un-
structured play task, as well as the same be-
haviors elicited in the structured play assess-
ment. The four mentally retarded children
without language showed significantly less
spontaneous doll-directed functional play,
/(13.9) = 3.59, p < .01, and more elicited self-
directed functional play, /(12.8) = 5.24, p <
.001, than did children who recognized verbal
Mentally
retarded Normal
Expressive Receptive Receptive
language language language
.60 .65
.49 .65
.54
.56
— .52 .65
labels. Thus the ability to generalize functional
play acts to dolls was associated with the pres-
ence of at least elementary knowledge of lan-
guage in both the autistic and mentally re-
tarded groups.
Sensonmotor skills and language. There
were few relationships between performance
on the sensorimotor tasks and either receptive
or expressive language for the autistic children.
The only significant relationships found were
negative correlations between both language
measures and performance on the extension
and object and support subtests (rs = —.54 to
-.69). Jn contrast, the mentally retarded chil-
dren showed strong positive associations be-
tween sensorimotor abilities and receptive
language. All the sensorimotor subtests, except
exploration of objects, were significantly re-
lated to receptive language scores (rs ranged
from .53 to .79). There were no significant
relationships between expressive language and
sensorimotor abilities for the mentally retarded
children. The pattern was nearly identical for
normal children, with five of the seven subtests
showing significant relationships with receptive
language (rs ranged from .50 to .80). Only use
of the rake to obtain a toy hidden in a tube,
the hardest task on the scale, was related to
expressive language, r( 13) = .81, p < .01. Thus
the mentally retarded and normal children
showed a correspondence between sensori-
motor and receptive language development not
manifested by the autistic children.
Imitation and language. The relationship
between gestural and vocal imitations and re-
 COGNITIVE AND LANGUAGE SKILLS IN AUTISTIC CHILDREN
ceptive language was significant for all groups
(rs ranged from .55 to .67). For the autistic
and normal children, the capacity to imitate
vocally was also related to expressive language
age (rs = .72 and .62, respectively). Imitative
skills were tied to language capacity for all
groups in this study.
Discussion
Several deficits in functioning specific to
autistic children were identified in this re-
search. In spontaneous play, autistic children
demonstrated less diverse functional play, par-
ticularly functional play directed toward dolls,
than did normal or mentally retarded children
of comparable mental age. Symbolic play pro-
duced spontaneously and after cueing also was
deficient in the autistic group, as was the ability
to comprehend verbal labels and imitate words
and gestures. In contrast, the autistic children
were not deficient in sensorimotor skills when
compared to mentally retarded and normal
groups.
The patterns of relationships between cog-
nitive skills and language indicated similarities
and differences among the three groups. Al-
though the complexity of play and imitation
varied among the autistic, mentally retarded,
and normal children, the relationships between
these variables and language within the three
groups were similar. Functional and symbolic
play were associated with more advanced re-
ceptive language in all three groups, as was
the ability to imitate gestures and vocaliza-
tions. In contrast, sensorimotor skills and lan-
guage were clearly positively associated for the
mentally retarded and normal children but
negatively associated or unrelated for the au-
tistic children. These results indicate that a
defining characteristic of the syndrome of au-
tism may be significantly more proficient sen-
sorimotor capacities than symbolic and imi-
tative skills.
The lack of positive association between
sensorimotor skills and language in the autistic
children has implications for understanding
normal language development. Although sen-
sorimotor knowledge may be necessary for
language acquisition, the impressive sensori-
motor skills of the autistic children in contrast
to their extreme deficits in language demon-
strate that sensorimotor knowledge is far from
301
sufficient for language development. Watching
a young autistic child who skillfully manip-
ulates a rake to obtain a hidden object but
who responds in no way to spoken language
is convincing evidence that the development
of sensorimotor and symbolic knowledge can
be very divergent.
The autistic children in this study do seem
to be a distinct group with specific deficits in
imitation and symbolic abilities (Rutter, 1978;
Wing et al., 1977). Even when their general
developmental delay is taken into account by
comparing their performance to mental-age
matched normal and mentally retarded chil-
dren, they show specific deficits in play, imi-
tation, and language. On the other hand, we
have no evidence that sensorimotor intelli-
gence is deficient in autistic children when their
overall level of mental retardation is taken into
account. Thus the disorder seems to involve
deficits in certain object concepts and not in
others.
One hypothesis for the variation in deficits
is that representational thought may be man-
ifested in two different systems, one more ad-
vanced than the other. One system, reflected
in the development of sensorimotor skills, may
involve the capacity to recall information that
then is accessible for problem solving. The
capacity to translate experience into language
and play symbols that are manipulated in-
dependently may reflect a second system (Wolf
& Gardner, 1981). For the normal and men-
tally retarded child, the two systems may de-
velop together, so that progress in the senso-
rimotor representation of absent objects may
be associated with advances in symbolic skills,
although neither system may be dependent on
the other. For the autistic child, these systems
do not cohere. It is in the second system, the
ability to form and manipulate symbols, that
the autistic child may have a major impair-
ment.
A second hypothesis is that the cognitive
deficits seen in autistic children are secondary
to their impaired social development. All the
areas of specific cognitive deficit identified to
date depend on social interaction for their de-
velopment. For example, functional object use
as demonstrated in play is learned from ob-
servation of others, and the generalization of
functional object use to dolls entails an ad-
ditional social component. The development
302 MARIAN SIGMAN AND JUDY A. UNGERER
of imitation and language necessarily involves
the responsive interaction of others. In con-
trast, sensorimotor object knowledge may de-
velop without social involvement, although in
normal development social facilitation of sen-
sorimotor learning often may occur. These two
hypotheses may not be independent, because
symbolic and social development in young
children are necessarily intertwined. However,
they do provide an approach for understanding
the diversity of cognitive and social deficits
that have been found to characterize the au-
tistic syndrome.
References
American Psychiatric Association. (1980). Diagnostic and
statistical manual of mental disorders (3rd ed). Wash-
ington, DC: Author.
Beckwith, L., & Thompson, S. (1976). Recognition of
verbal labels of pictured objects and events by 17- to
30-raonth-old infants Journal of Speech and Hearing
Research, 19. 690-699
Casati, I., & Lezme, I. (1968) Les etapes de 1'intelligence
sensori-motnce [The stages of sensorimotor intelligence].
Paris: Les Editions de Centre de Psychologie Apphquee
Curcio, F. (1978) Sensorimotor functioning and com-
munication in mute autistic children. Journal of Autism
and Childhood Schizophrenia, 8. 281-292
DeMyer, M. K.., Alpem, G. D., Barton, S.. DeMyer,
W. E., Churchill, D. W., Hingtgen, ) N., Bryson,
C. Q., Pontius, W., & Kimberlin, C. (1972). Imitation
in autistic, early schizophrenic, and non-psychotic sub-
normal children. Journal of Autism and Childhood
Schizophrenia. 2, 264-287
Dunn, Q, & Clark, V. (1974) Applied statistics Analysis
of variance and regression New York- Wiley.
Fenson, L., Kagan, J., Kearsley, R., & Zelazo, P. (1976)
The developmental progression of manipulative play in
the first two years. Child Development. 47. 232-236
Fenson, L., & Ramsey, D. (1980). Decentration and in-
tegration of the child's play in the second year. Child
Development. 51, 171-178.
Inhelder, B., Lezine, I., Sinclair, H , & Stambak, M. (1972).
Les debuts de la fonction symbohque [The beginnings
of the symbolic function] Archives de Psychologie, 41,
187-243.
Kopp, C B., Sigman, M, & Parmelee, A. H. (1974). Lon-
gitudinal study of sensorimotor development. Devel-
opmental Psychology, 10, 687-695
Largo, R., & Howard, J. (1979). Developmental progression
in play behavior of children between nine and thirty
months. Developmental Medicine and Child Neurology.
21. 299-310
Lowe, M (1975). Trends in the development of represen-
tational play in infants from one to three years. Journal
of Child Psychology and Psychiatry, 16, 33-47.
Nicohch, L (1977) Beyond sensorimotor intelligence.
Merrill-Palmer Quarterly. 23. 89-99.
Rosenblatt, D. (1977). Developmental trends in infant play.
In B Tizard & D Harvey (Eds.), Biology of play (pp
33-44). London- Heinemann
Rutter, M (1978) Language disorder and infantile autism.
In M Rutter & E. Schopler (Eds.), Autism (pp. 85-
104). New York Plenum Press.
Sherman, M., Shapiro, T, & Glassman, M. (1981, Oc-
tober) Play and language in developmental!)' disordered
preschoolers—a new approach Paper presented at the
annual meeting of the American Academy of Child
Psychiatry, Dallas, TX.
Sigman, M , & Ungerer, J (1981). Sensorimotor skills and
language comprehension in autistic children. Journal
of Abnormal Child Psychology'. 9, 149-165
Sinclair, H (1970). The transition from sensory-motor
behavior to symbolic activity. Interchange, 1, 119-125.
Ungerer, J , & Sigman, M. (1981). Symbolic play and lan-
guage comprehension in autistic children. .Journal of
the American Academv of Child Psychiatry, 20, 318—
337.
Uzgins, I C, & Hunt, J. McV. (1975). Assessment in
infancy Urbana University of Illinois Press
Wing. L.. & Gould, J. (1979). Severe impairments of social
interaction and associated abnormalities in children:
Epidemiology and classification. Journal ofAutism and
Developmental Disorders, 9, 11-31
Wing, L, Gould, J., Yeates, S., & Bnerley, L. (1977).
Symbolic play in severely mentally retarded and in au-
tistic children. Journal of Child Psychology and Psy-
chiatry, 18. 167-178.
Wolf, D , & Gardner. H. (1981). On the structure of early
symbohzation In R. L. Schiefelbusch & D O. Bricker
(Eds.), Early language Acquisition and intervention (pp.
287-329). Baltimore, MD. University Park Press.
Received May 18, 1982
Revision received February 4, 1983