Psychology

All instruction are attached below.

Online Activity 1

Introduction:

Pick a particular mental health condition that you’re interested in (eating

disorder, depression, anxiety, etc.) Write an introductory paragraph based on the

research you find on the topic.

Body: (3 Paragraphs)

for the next three paragraphs find something from each one of the three readings

that you can connect to the mental health condition you chose. Reference or

quote what you find from each reading that connects to your mental health

condition in your three paragraphs.

Conclusion

References:

Reference 3 online references you used for the introductory paragraph.

ARTICLE IN PRESS

Psychology of Sport and Exercise 9 (2008) 576–594

1469-0292/$ –

doi:10.1016/j.

�
Correspon

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www.elsevier.com/locate/psychsport

Narrative, identity and mental health: How men with serious
mental illness re-story their lives through sport and exercise

David Carless
a,�

, Kitrina Douglas
b

a
Carnegie Research Institute, Leeds Metropolitan University, Headingley Campus, Beckett Park, Leeds LS6 3QS, UK

b
University of Bristol, Bristol, UK

Received 1 June 2007; received in revised form 6 August 2007; accepted 23 August 2007

Available online 1 September 2007

Abstract

Objectives: It has been suggested that mental illness threatens identity and sense of self when one’s personal
story is displaced by dominant illness narratives focussing on deficit and dysfunction. One role of therapy,
therefore, is to allow individuals to re-story their life in a more positive way which facilitates the
reconstruction of a meaningful identity and sense of self. This research explores the ways in which
involvement in sport and exercise may play a part in this process.
Design: Qualitative analysis of narrative.
Method: We used an interpretive approach which included semi-structured interviews and participant
observation with 11 men with serious mental illness to gather stories of participants’ sport and exercise
experiences. We conducted an analysis of narrative to explore the more general narrative types which were
evident in participants’ accounts.
Findings: We identified three narrative types underlying participants’ talk about sport and exercise: (a) an
action narrative about ‘‘going places and doing stuff’’; (b) an achievement narrative about accomplishment
through effort, skill or courage; (c) a relationship narrative of shared experiences to talk about combined
with opportunities to talk about those experiences. We note that these narrative types differ significantly
from—and may be considered alternatives to—dominant illness narratives.
Conclusion: This study provides an alternative perspective on how sport and exercise can help men with
serious mental illness by providing the narrative resources which enabled participants to re-story aspects of

see front matter r 2007 Elsevier Ltd. All rights reserved.

psychsport.2007.08.002

ding author. Tel.: +44 7879 647227; fax: +44 113 283 7575.

ress: d.carless@leedsmet.ac.uk (D. Carless).

www.elsevier.com/locate/psychsport

dx.doi.org/10.1016/j.psychsport.2007.08.002

mailto:d.carless@leedsmet.ac.uk

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D. Carless, K. Douglas / Psychology of Sport and Exercise 9 (2008) 576–594 577

their lives through creating and sharing personal stories through which they rebuilt or maintained a positive
sense of self and identity.
r 2007 Elsevier Ltd. All rights reserved.

Keywords: Mental health; Identity; Physical activity; Schizophrenia; Narrative; Therapy

Introduction

In this article, we seek to contribute to dialogue regarding the psychological effects of sport and
exercise participation for people with serious mental health difficulties (e.g., Beebe et al., 2005;
Faulkner & Sparkes, 1999; Fogarty & Happell, 2005). As such, this work builds upon and
develops existing studies (Carless, 2007, in press; Carless & Douglas, 2004, in press; Carless &
Sparkes, 2007) which have explored the ways in which sport and exercise are experienced by men
with serious mental illness such as schizophrenia. A central focus of our ongoing interpretive
research is the ways in which involvement in sport and exercise can contribute to the process of
recovery in the context of serious mental illness.
In doing this work we are sharply aware of Davidson and Roe’s (2007) observation that the

‘‘dynamic interactions between the complexities involved in serious mental illness with those
complexities involved in the human beings who suffer from and recover from these illnesses result
in an extremely complex terrain, about which we still know very little’’ (p. 460). In recognition of
this uncertainty, we have chosen to utilise here a narrative psychological approach in an effort to
shed new light on the ways sport and exercise are experienced by men with serious mental illness.
Despite the increasingly widespread use of narrative approaches in mainstream psychology
(see Crossley, 2000; Dimaggio, 2006), there are few examples of its use in physical activity and
mental health research (see Carless & Sparkes, 2007) and narrative approaches remain relatively
rare in sport and exercise psychology in general (see Douglas & Carless, 2006, in press; Smith,
1999; Smith & Sparkes, 2002; Sparkes & Partington, 2003; Sparkes & Smith, 2003; Stelter, 2006).
However, as Sparkes (2005) notes, this approach has the potential to enrich our understanding
through developing ‘‘a more sophisticated appreciation of people as active social beings and focus
attention on the way personal and cultural realities are constructed through narrative and
storytelling’’ (p. 191). Before proceeding with this endeavour, it is first necessary to provide some
background on the concept of recovery in the context of serious mental illness and the narrative
theory which underlies our approach.

Recovery in the context of serious mental illness

According to several authors who have themselves experienced serious mental illness, there is
more to recovery than the alleviation of symptoms, deficits, and dysfunctions (e.g., Baker-Brown,
2006; Chadwick, 1997; Deegan, 1996; Repper & Perkins, 2003). When it comes to recovery,
Repper and Perkins (2003) suggest

The challenge facing people with mental health problems is to retain, or rebuild, a meaningful
and valued life, and, like everyone else, to grow and develop within and beyond the limits

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imposed by their cognitive and emotional difficulties. Recovery is not about ‘getting rid’ of
problems. It is about seeing people beyond their problems—their abilities, possibilities, interests
and dreams—and recovering the social roles and relationships that give life value and meaning.
(p. ix)

A similar perspective has been more recently voiced by Davidson, O’Connell, Tondora, Lawless,
and Evans (2005) who, in attempting to establish a conceptual framework for the concept of
recovery, write

we have learned that recovery from serious mental illness does not require remission of
symptoms or of other deficits. Rather, recovery involves incorporation of one’s illness within
the context of a sense of hopefulness about one’s future, particularly about one’s ability to
rebuild a positive sense of self and social identity. (p. 484, 485)

Rebuilding a sense of self and a social identity is an important aspect of Davidson and Roe’s
(2007) characterisation of recovery in serious mental illness which they suggest is needed to
overcome the ‘‘loss of valued social roles and identity, isolation, loss of sense of self and purpose
in life’’ (p. 462). A common theme in diverse conceptions of recovery, then, seems to us to revolve
around the rebuilding or recreation of a sense of self, an identity, and a sense of purpose within
meaningful social roles and relationships. In order to explore these complex issues, and begin to
develop an understanding of how these kinds of changes might come about through involvement
in sport and exercise, we now turn to consider the social constructionist conception of narrative
theory which underpins this research.

Narrative, identity, and mental health

Narrative theorists (e.g., Brooks, 1994; McLeod, 1997) have suggested that mental health is in
some way related to one’s ability to create a story of one’s life. If this is the case, it seems likely
that an important link between narrative and mental health concerns the way in which identity
and sense of self may be developed and maintained through telling stories of our lives.

1
According

to Crossley (2000), creating and telling stories of one’s life is a necessary part of developing and
maintaining a coherent identity and sense of self because it is ‘‘through narrative [that] we define
who we are, who we were and where we may be in the future’’ (p. 67). In this light, stories may be
considered a way of linking one’s past, present, and future which allows the development of a
coherent sense of self that ‘makes sense’ within the context of one’s life experiences. Spence (1982)
suggests that ‘‘we are all the time constructing narratives about our past and future y the core of
our identity is really a narrative thread that gives meaning to life provided—and this is the big if—
that it is never broken’’ (p. 458). The maintenance of a coherent narrative thread, according to
McAdams (1993), provides a sense of meaning and purpose to one’s life which helps avoid malaise
and stagnation. Indeed in Baldwin’s (2005) terms, ‘‘maintaining this sense of coherence is an
overarching feature of a life-project and productive of well-being and (arguably) its loss is a
feature of mental ill-health such as in schizophrenia or post-traumatic stress disorder’’ (p. 1023).

1
The terms narrative and story are used interchangeably by some authors. We follow Frank (2000) in using the term

story to refer to a personal experiential account as told by a specific individual and the term narrative to refer to the

more general structure underlying a particular story.

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Importantly however, meaning and coherence are not inherent features of narratives, but
instead are created in the act of telling stories. In their research with men who acquired spinal cord
injury playing sport, Smith and Sparkes (2002) have shown how ‘‘coherence and the meaning of
experience is artfully constructed, occasioned, circumstantially formed and influenced by the
cultural conventions of telling’’ (p. 167). This finding is significant in that it begs the question of
how a person might create meaning and coherence in the absence of storytelling opportunities.
This is a real concern, we suggest, in mental health contexts as according to Baldwin (2005) the
experience of serious mental illness can in itself deny individuals both the ability and the
opportunity to author their own life story. As Baldwin (2005) puts it, as a result of ‘‘cognitive
difficulties or loss of language, individuals may lose the ability to construct and articulate a
coherent narrative’’ (p. 1023). Similarly, he suggests, an ‘‘individual’s interactions with others may
be restricted by a condition that results in decreased opportunities to launch and maintain
narratives’’ (Baldwin, 2005, p. 1023). In this regard, problems with thought processes,
communication, social withdrawal, and/or inactivity can together conspire to deny a person
with serious mental illness the opportunity to both create and share stories of his or her life. A
likely consequence of this denial, narrative theorists such as McLeod (1997) and Crossley (2000)
suggest, is that individuals are thereby limited or restricted in terms of the avenues through which
they may maintain or develop a coherent, meaningful life story by which to preserve or renew
identity and sense of self.

Narratives and culture

It is significant that, while stories are personal, they are at the same time shaped by cultural
factors. According to McLeod (1997), ‘‘Even when a teller is recounting a unique set of individual,
personal events, he or she can only do so by drawing upon story structures and genres drawn from
the narrative resources of a culture’’ (p. 94). Thus, a person’s own story is shaped and constrained
by narratives that circulate within the culture in which he or she is immersed. Frank (1995) has
described these as narrative types which he characterises as ‘‘the most general storyline that can be
recognized underlying the plot and tensions of particular stories’’ (p. 75). In Frank’s terms,
‘‘People tell their own unique stories, but they compose these stories by adapting and combining
narrative types that cultures make available’’ (p. 75).
In the context of serious illness, a powerful medical narrative acts to shape and constrain an

individual’s story about (and experience of) illness. Frank (1995) describes how, ‘‘The story of
illness that trumps all others in the modern period is the medical narrative. The story told by the
physician becomes the one against which all others are ultimately judged true or false, useful or
not’’ (p. 5). In particular, Frank (1995) suggests, the restitution narrative, a storyline that is ‘‘filled
out with talk of tests and their interpretation, treatments and their possible outcomes, the
competence of physicians, and alternative treatments’’ (p. 77), influences many people’s
experience of illness. The plot of this story, Frank suggests, follows the basic storyline of
yesterday I was healthy, today I’m sick, but tomorrow I’ll be healthy again.
While a restitution story may work for some illness experiences, it can be problematic in the

context of serious or chronic illness for which a ‘cure’ (i.e., a return to previous health as it once
was) may not be forthcoming. Restitution stories no longer work, Frank (1995) suggests, in the
context of long-term impairment which equates to some people’s experience of serious mental

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illness when restitution is not inevitable and a focus on the future can be problematic—or even
hopeless—because a future free of illness cannot be envisaged. Frank (1995) and Smith and
Sparkes (2005a) suggest that individuals experiencing chronic illness therefore need alternative
narrative resources by which to story their lives in order to prevent narrative wreckage and
thereby preserve or reinstate sense of self, identity, and mental health. At these times, as Baldwin
(2005) puts it, ‘‘to challenge disabling master narratives, counterstories that are individual,
enabling and meaningful need to be both constructed and realised’’ (p. 1027).

The therapeutic potential of sport and exercise

According to McLeod (1997) and Baldwin (2005), an important component of therapeutic
interventions for people with mental health problems is the opportunity to launch and maintain
personal stories which reinstate a sense of meaning, identity and coherence in a person’s life. In
this regard, White and Epston (1990) suggest that therapy should ‘‘open space for persons to re-
author or constitute themselves, each other and their relationships according to alternative stories
or knowledges’’ (p. 75). In so doing, individuals are able to create and share a life story which
‘makes sense’ within the context of both their experience and the cultural narrative types available
to them. According to McLeod (1997), this task is fundamental to psychological well-being and
mental health in that ‘‘the task of being a person in a culture involves creating a satisfactory-
enough alignment between individual experience and ‘the story of which I find myself a part’’’
(p. 27).
How might involvement in sport and exercise contribute to this process? We suggest a key issue

concerns the way that involvement in sport and exercise differs from mainstream pharmaceutical
interventions in that it can go beyond removing problems by contributing something positive to a
person’s life. According to Anthony (1993), this distinction is important in recovery terms:

There is the possibility that efforts to positively affect the impact of severe mental illness can do
more than leave the person less impaired, less dysfunctional, less disabled, and less
disadvantaged. These interventions can leave a person with not only ‘‘less,’’ but ‘‘more’’—
more meaning, more purpose, more success and satisfaction with one’s life. (Anthony, 1993,
p. 20)

Several positive benefits of this kind have been identified in existing literature. First, it appears
that sport and exercise activities provide opportunities for social experiences and interaction
which is valued by some users of mental health services (Carless & Douglas, 2004; Carter-Morris
& Faulkner, 2003; Faulkner, 2005). Second, involvement in sport and exercise can bring a sense of
meaning, purpose, optimism, and hope to the lives of some people with mental health problems
(Carless & Douglas, in press; Carless & Sparkes, 2007; Raine, Truman, & Southerst, 2002). Third,
participation in sport or exercise can boost some people’s self-esteem (Faulkner, 2005; Faulkner &
Sparkes, 1999). Finally, sport and exercise helps some individuals rediscover a sense of identity
(Carless, 2007, in press; Carless & Douglas, in press).
While previous research suggests some important ways in which sport and exercise can help

people with serious mental health difficulties, the question of how these changes come about is far
from resolved. We suggest that the previously discussed social constructionist conception of
narrative theory has the potential to provide fruitful insights into this question. Given that this

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project represents the first use of a social constructionist narrative approach to physical activity
and mental health research, in keeping with the ethos of interpretive research we attempt to
illuminate rather than pin down what Davidson and Roe (2007) recognise as ‘‘an extremely
complex terrain, about which we still know very little’’ (p. 460). Our purpose therefore is to
explore the ways in which narrative, identity and mental health relate to one another within the
specific context of sport, exercise and serious mental illness. Specifically, we focus on developing
understanding of how sport and exercise involvement can help some men with serious mental
illness through providing opportunities for the creation and sharing of personal stories which
facilitate the narrative (re)construction of identity and sense of self. We hope to achieve this by
exploring the kinds of stories 11 men with serious mental illness told about their experiences of
sport and exercise.

Method

Participants and procedures

The interpretive approach used in this study was strongly influenced by our recognition of the
potential challenges, difficulties, and risks of conducting research in the context of serious mental
illness. In particular, given our desire to obtain first person narrative accounts of sport and
exercise within the context of serious mental illness, it was necessary to conduct interviews which
provided participants with opportunities to tell their own stories. According to Stone (2004),
however, there is a risk in telling these kinds of personal stories in the context of mental illness:

to formulate a narrative will necessitate a willed passage into and through the same spaces of
self—thought, memory and emotion—in which the illness has been, and possibly still is, manifest
y All of this, I want to suggest, means the narrative journey may be a perilous one. (p. 20)

In an effort to minimise the dangers which may arise from talking about and ‘revisiting’
potentially traumatic life phases, we employed two strategies of ethnographic research which we
believed would reduce the risk of participants experiencing distress.
The first strategy involved striving to develop a high degree of trust, rapport, and familiarity

with participants. Specifically, following ethical clearance from the NHS Trust Research Ethics
Committee, I (David Carless) engaged in prolonged immersion in the field over an 18 month
period where he participated in the daily life of a vocational rehabilitation centre for people with
serious mental illness. During this time, I took part in sport and exercise groups as well as social
and day-to-day activities which helped build trust and rapport with potential participants. For
Kitrina Douglas, trusting relationships and familiarity with participants were established through
Kitrina attending the centre on a weekly basis and coaching a golf activity group which was
developed, organised, and run by both authors and offered alongside other physical activity
sessions at the centre. Potential participants were identified on the basis of: (i) their personal
experience of both serious mental illness and sport/exercise participation; (ii) their willingness to
take part in the research; and (iii) mental health professionals’ assessment that the individual was
sufficiently mentally well to participate. In total, 11 participants agreed to take part in the research
and provided informed consent. At the time of the research participants were aged between 24 and
43 and all were considered to be experiencing severe and enduring mental illness.

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The second strategy involved utilising two distinct methods of data collection in an effort to
gain a rich and broad understanding of the background and context of participant’s experiences.
These methods were: (a) Participant observation. During sport and exercise activities and day-to-
day life at the rehabilitation centre field notes were compiled independently by both authors to
document observations, interpersonal exchanges, and personal reflections. (b) Semi-structured
interviews. A total of 16 interviews were conducted and each participant took part in between one
and three interviews each lasting from 20 to 90 min in duration. Participants were invited to talk
about: (i) their experiences in and through sport and exercise; (ii) particularly memorable sport or
exercise-related moments; (iii) their previous sport and exercise involvement; (iv) any ways in
which sport or exercise affected them. Prior to concluding the interview, participants were asked
whether there was anything else they would like to share regarding their experience of sport,
exercise, or mental health. Throughout the interviews, the researchers acted as ‘active listeners’ in
an attempt to assist the participant to talk about his own experiences in his own words. The
interviews were conducted within the familiar settings of the day centre or physical activity venue
and were audio recorded and transcribed verbatim with the exception of an interview with one
participant who did not want a tape recorder to be used.

Analysis of narrative

The first stage of analysis involved both researchers engaging in several close readings of the
interview transcripts and field notes to become immersed in the data. Next, we conducted a
content analysis using quotations as the unit of analysis (Sparkes, 2005) and following the process
described by Lieblich, Tuval-Mashiach, and Zilber (1998) as categorical-content analysis. The
findings of these analyses have been presented elsewhere (Carless, 2007; Carless & Douglas, 2004).
However, as Lieblich et al. (1998) note, ‘‘while the content is often more obvious and immediate to
grasp, researchers may prefer to explore the form of a life story because it seems to manifest
deeper layers of the narrator’s identity’’ (p. 13). Thus we conducted a third stage of analysis which
has been described by Smith and Sparkes (2006) as an analysis of narrative. These authors outline
several alternative analytical approaches to narrative research and suggest that researchers should
be clear in which approaches they employ in a particular study. For the purposes of this study, we
adopted the standpoint of story analyst who thinks about stories. From this standpoint we treat
stories as

‘data’ and use ‘analysis’ to arrive at, for instance, themes that hold across stories or delineate
types of stories. That is, story analysts step outside or back from the story, employ analytical
procedures, strategies, and techniques in order to explore certain features of the story (e.g.,
content or structure), and carefully engage in abstract theorization about the story from a
sociological, psychological and/or other disciplinary perspective. (Smith & Sparkes, 2006,
p. 185)

This standpoint contrasts with that of a storyteller ‘‘who performs a narrative analysis and thinks
with stories’’ (p. 185). In this class of inquiry, the product is a story which the researchers allow to
stand alone without further analysis or interpretation (see Carless & Sparkes, 2007 for an example
of narrative analysis in action).

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In this study, in Holstein and Gubrium’s (2000) terms, our interest was primarily in the whats of
storytelling (what happened to whom) as opposed to the hows (how the story is told). Thus, we
conducted what Sparkes (2005) calls an analysis of structure and form of participants’ stories in
recognition that ‘‘the formal aspects of structure, as much as the content, express the identity,
perceptions, and values of the storyteller’’ (Sparkes, 2005, p. 195). Specifically, this analysis
adhered to the process described in detail by Lieblich et al. (1998) as a holistic analysis of form
whereby we focused on ‘‘the formal plot and organisation of the narrative to tease out the distinct
structures that hold it together with a view to identifying it as a particular narrative type’’ (Smith
& Sparkes, 2007, p. 27). Through identifying common narrative types underlying participants’
stories of sport and exercise, we aimed to develop an understanding of the meaning of sport and
exercise within participants’ socio-cultural context.
Accordingly we now present our findings in the shape of three story types which were evident

within participants’ accounts of their sport and exercise experiences. We describe these as action,
achievement, and relationship narratives and illustrate the ways in which these narrative types
related to participants’ experiences in the context of sport and exercise activities.

Findings

An action narrative: ‘‘Going places and doing stuff’’

I like going out and about, like I said, people, you know, having a soft drink and stuff, playing
with people, enjoy yourself y keeping your mind busy, it’s going places and doing stuff.

A recurring motif around which participants’ stories and talk about their sport and exercise
involvement were structured was the concept of action. By ‘action’ we mean, in the words of one
participant above, ‘‘going places and doing stuff.’’ In this regard, the action narrative
incorporated an embodied experience of some kind, relating to some form of a physical process
or bodily movement. For some, taking action—having something to do and somewhere to go—
was expressed as being personally valued and meaningful even if only to the extent that it gave
them a reason to get out of the house:

It’s just that I’ve got an activity for the afternoon that I’m not sat watching TV something like
that. I watch so much it just sort of draws me. I need to sort of break away from a day indoors
and get out and do something y Its something to get me out of bed, get out of bed that
morning.

The action narrative is significant in that it differs markedly from the dominant narrative of
serious mental illness which often revolves around inactivity, of not doing much and not
having much to do, of withdrawing from life (see for example, Baker-Brown, 2006; Deegan, 1996;
Stone, 2006). For example, one participant described his experience of hospitalisation in a
psychiatric ward: ‘‘I was just bored in there—nothing to do. I didn’t do much. I was so bored.
I didn’t hardly do nothing. I just stayed in the ward and just went to bed and that was it.’’
Similarly, stories of other phases of illness were commonly characterised by inactivity: ‘‘Over at
my mother’s house I used to go to sleep a lot. I just switched off like y I used to sleep for hours
and hours.’’

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Participants told how taking action affected them in positive ways. One young man, for
example, told how playing football (and being involved with football) provided a more positive
focus for his thoughts because at these times,

my mind’s occupied. I think other things. I don’t really think about bad things that I might
think about if I wasn’t doing something y It can happen with other things but I think sport is
such an active thing it tends to have that effect on me.

Other participants’ action stories portray them as ‘‘keeping busy’’ through involvement in sport
and exercise. The importance of this is illustrated in the following exchange:

Depression was my main problem. I suffered from depression and a bit of stress like. I think
when I was young I overdone it like y and what with our dad passing away as well like, that
was another bout of depression I had as well like, went to the funeral and that sort of turned it
on again like, you know y but I feel good now. I feel OK now.

Interviewer: What do you thinks been able to change that?

Uh [pause]. Doing activities I think is the main thing—keeps me busy, you know.

Another individual elaborated on how keeping busy through sport and exercise gave him the
feeling that he was making good use of his time. Referring to his involvement with a five-a-side
football group, he said:

I enjoy it, have a sense of satisfaction that I actually played because I was doing something with
my time. That’s important I think—to actually be able to use your time properly y I know I
haven’t wasted my time, I’ve used my time constructively, doing something that’ll do me good.

For him, ‘‘using time properly’’ related to his belief that, through participating in sport and
exercise, he was engaging in an activity that would provide valued physical and psychological
health benefits.
For those individuals who maintained their involvement, sport and exercise activities came to

be a valued part of their weekly or daily routine or schedule. Referring to a community-based five-
a-side league in which he had become involved, one participant remarked that:

It’s a routine you get used to I think. Its like football, I get excited about football on a Monday.
When you turn up there and watch other people play before you go on there, you get confident
and you look forward to participating in the game like.

For some who voluntarily took part in sport and exercise groups, there was a sense that, in
addition to being ‘‘used,’’ time passed quickly. In this sense there was a perception among some
participants that through taking action and doing things, time sped up; that they no longer felt
that they had endless time on their hands. A short exchange between two members of a nine-week
golf programme, documented in our field notes, communicates a feel for this view: ‘‘Andrew
went on to remark that ‘These sessions seem to have gone ever so quickly.’ Peter agreed,
‘Yeah. I can’t believe it’s been two months since we started’’’ (16 July). In this regard, one
individual described an afternoon playing golf at a local municipal course as ‘‘the best birthday
I could have asked for.’’

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An achievement narrative: ‘‘That was way better than I ever thought I would have done’’

A second type of narrative which was evident in participants’ stories we characterise as an
achievement narrative. Central to the achievement narrative are descriptions and accounts that
focus on accomplishment, doing something well or of being successful, by virtue of effort, skill or
courage. One individual, for example, told an achievement story in the context of long-distance
running:

I went with a physio and done the Milwood 10 k not last year the year before, [we] both ran
round together y That was good, gave me something to aim for. I stopped last time. I stopped
in the Buxham as well. But this year I never stopped at all, I got all the way round on the
Buxham and the Milwood. So that’s an achievement isn’t it?

Importantly, achievement brought a range of positive feelings such as a sense of satisfaction from
learning and performing skills:

Well, I get satisfaction from playing football. If I score a goal I’m pleased with myself and it
gives satisfaction that way. Even if I didn’t score a goal, some weeks when I haven’t scored,
when I played well in defence or midfield y football skills like trapping the ball, bringing it
down and controlling the football and passing it using your alertness.

For others, a sense of achievement related to seeing their skills improve which subsequently
increased their enjoyment of the activity as the following exchange illustrates:

Interviewer: How do you feel about your own play?

Well today it was brilliant because I got two threes and I can’t ever remember getting that!
[laughs]

Interviewer: Do you feel you’ve changed over the two months at all in terms of golf?

Hmmm [in a tone of agreement] [pause]

Interviewer: What’s changed?

Um [pause]. I just think it’s got more enjoyable as it’s gone on.

Interviewer: What’s that down to then?

Getting a couple of threes! [laughs]

Through participant observation we witnessed the way in which achievements resulted in
displays of pleasure and satisfaction in individuals which were often shared with others in the
activity group. A change in mood and demeanour, as a result of a good putting performance, is
evident in the following description taken from our field notes:

In the second group, of Jerry, Peter and Harry it was Harry who particularly seemed pleased
with his successes. Having been noticeably quiet in the café [beforehand], mostly looking down
from under the peak of his cap towards the ground, he looked up, cheered and beamed a broad
smile following his first 50 point score. (4 June)

Achievements, for some we suggest, related to positive feelings which were directly connected to
an embodied sense of proficient movement, feel, and performance outcome. One participant, for

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example, described how making a good golf shot resulted in positive sensations of which he was
clearly aware and which he found enjoyable:

Interviewer: How does it make you feel when you hit the good shots?

Oh, lovely y yeah, feels good. You know that you can do it, like. It gives you a bit of
satisfaction y when you connect with the ball, when you follow through with the ball, and the
club, you make contact with the ball, it’s that sort of swing like, and when you know you hit
it—it’s that sound as well I think, you know, there’s a good sound.

Another individual linked his increasing competence at golf to a sense of optimism and hope
concerning his ongoing improvement:

playing the round today I enjoyed it as far as I got. I started to get some slightly better scores,
that didn’t seem fluke-ish y I feel that I’m making improvement and there’s no reason why, if I
carry on, I can’t improve my game.

Thus, achievements in the present often generalised to optimism and confidence regarding future
activity. As one participant put it, ‘‘When you hit the ball, if you do something right, it gives you
confidence, you feel as if you could do it again like. You get that feeling you could do it again.’’
Notwithstanding the challenges of learning new technical skills which any beginner will face,

participants often came to perceive themselves as competent, skilled, and proficient at sport-
related skills. This is illustrated by one participant’s description of his own golf ability:

I know how to drive the ball, definitely, down a fairway. Cause I’ve done that quite a few times
at the pitch and putt y That’s probably one thing I like about it—the driving shots I play. I get
good distance on my driving shots y When I’m driving, I think about distance and length—it’s
a good tip that for the serious golfer.

In this remark, the individual identifies himself as a competent and ‘serious’ golfer. In so doing, he
associates himself with both the culture of golf and with other golfers. This, we suggest, is
potentially significant in that he is thereby able to tell a story about his life which revolves around
achievement, success, and ‘being good at’ a specific activity which is culturally accepted and
endorsed by others. In telling this story, he is able to incorporate ‘being a golfer’ within his
identity and sense of self and, for this individual at least, this self-identification is positive because
he values golf and considers it to be a worthwhile activity. Thus, in creating and telling an
achievement story in the context of a popular sport, he has a story which is shared by, and can
potentially be shared with, many others in society.
A recurring motif within individual achievement stories was a sense of surprise at one’s own

achievements. This was particularly evident among members of the golf group who either had
never played golf before or who had not played since the onset of mental illness. As one individual
put it, ‘‘I was surprised I could do it at all y when I hit the ball I was amazed that it went
anywhere.’’ In this regard, participants’ achievements frequently exceeded their own self-
expectations as the following exchange illustrates:

Interviewer: Can you tell me about the most memorable shots that you’ve hit?

Yes. One, was it a week or a couple of weeks ago, where I putted and unexpectedly got the ball
into the hole! y I couldn’t believe it, what I saw y I felt chuffed—with disbelief!

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Likewise, another participant described being ‘‘amazed’’ by his most memorable golf shot:

I hit a lovely one last week with the six-iron, you know, when we were out at [names pitch and
putt course] y on the first one—I couldn’t believe it! I thought ‘How the hell did I do that?’
like. I thought, well I’ve got to try and remember what I’d actually done to hit that ball y just
sort of prepared for the shot, I just swung the club and it worked and I thought ‘Oh, hurray!’
like. Yeah, thought, you know, I’ve done it like y It was amazing, I amazed myself really.
I thought it wasn’t going to work out that way.

These moments of surprise were not unusual. Frequently, as the following excerpt from our field
notes illustrates, the pleasure and surprise at one’s own successful performance prompted verbal
interaction between the group members thus constituting a shared moment of celebration:

There was a great sense of excitement also among several individuals. Harry regularly called
out excitedly, ‘‘Whoa! It’s on the green!’’ while Andrew several times gasped ‘‘Ooooh!’’ in
response to his better shots. On the first hole, following a fairway shot, Andrew exclaimed,
‘‘Hey! That was way better than I ever thought I would have done!’’ (9 July)

A relationship narrative: ‘‘Sharing a common thing’’

Well you’re meeting other people that are sharing a common thing aren’t you really? Common
exercises, sharing that experience. That’s what I reckon anyway. So it’s good on that side of it
y all doing the same thing, got the same experience and got something to talk about.

The third type of narrative evident in participants’ talk about sport and exercise we characterise
as a relationship narrative. As the excerpt above suggests, shared experience and interaction with
others were hallmarks of these stories. For several participants, it was the opportunity of a social
time with others, of being with and sharing time and/or an activity with others, that served as their
primary motive for sport and exercise. This is illustrated in the following exchange:

Interviewer: So, have you played any golf before?

No. I have never played golf in my life. This is the first time.

Interviewer: Do you watch it on TV?

No I’d get bored.

Interviewer: So no interest in golf?

Not interested in golf, not really.

Interviewer: So why did you decide to join this group?

‘Cause there’s a lot of people—the social—you can enjoy. Otherwise, I’m bored, do you
understand me? There’s people there, that’s what I like to enjoy y I like being with people you
see, I like being social, I like having a laugh and stuff like that. I don’t like sitting on my own
with my thoughts, d’you understand me? y I like being with people. That’s it.

For this individual, it is quite clear that the activity was of little interest in itself. However, he
joined and regularly attended a golf programme on the basis of the social opportunities it
provided. Within his description is a sense that this form of social involvement provided a focus
for his thoughts that was preferable to spending time on his own.

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A social orientation was very common among many participants who valued the opportunity to
meet and make new friends through sport and exercise. When asked about his experience of being
a member of a sport group, one participant replied:

It’s a good social activity to be with them. It’s a good time, to be with them. And you can learn
by other people, what they’ve done as well I think, you can talk about it, you know. They’ll
probably ask, the other person, how you felt, and I think that’s how you learn y it’s a good
atmosphere y It’s different when you’re not with a group as well isn’t it like? You get cut off a
little bit don’t you? I mean the atmosphere’s not there so much, know what I mean?

This sense of social ‘‘atmosphere’’ or occasion was something that we observed during group-
based sports activities as the following excerpt from our field notes illustrates:

There seemed to be no inter-personal problems whatsoever. In fact, the group members were
hugely generous and supportive of each other. One example was when William hit the ball off
the tee ninety degrees into the rough. Immediately, Harry shouted out ‘‘You can have that
again.’’ Ronnie agreed, ‘‘Yeah, he can have it again!’’ Similarly, on Harry holing out, Ronnie
walked over and offered a ‘fist handshake’ and verbal congratulations. (9 July)

A sense of support and consideration towards each other was also characteristic of these
relationship stories and evident in many of the group activity sessions. One participant explicitly
described the support he felt he gained through the various sport and exercise groups he attended:

Well I’m sort of supported. I feel supported with other people there, yeah. It’s people that
I know mainly, especially like with the football team, its people that I never knew before but
I got friendly with—made good friends—and we all just participated in sport.

Often mutual support and consideration was unexpressed in verbal form during interviews being,
instead, something that we observed enacted or unfolding within the dynamics of a group. As
such, ‘miniature stories’ of consideration and generosity were not uncommon within day-to-day
exchanges between group members. One example of this kind of relational orientation is
demonstrated in the following excerpts from our field notes which, while referring to the same
event, were recorded by both researchers independently:

Prior to the round, Richard had offered Chris a roll-up cigarette. Chris had replied ‘‘Are you
sure? Thanks very much’’ with an air of pleasant surprise that suggested perhaps it was not
common for cigarettes to actually be offered round. On the 6th tee, Chris returned the
generosity by asking whether Richard or I would like a cigarette. (16 July)

There is a gentleness and mutual respect between the group members. Typical of this are simple
things like offering someone a cigarette y Richard offered Chris a cigarette and Chris humbly
looked and asked if Richard was sure. He asked in such a way that he gave away from his
question that he took nothing for granted, that Richard didn’t have to offer, it wasn’t expected.
(16 July)

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Discussion

Clearly, any research approach has inherent strengths and limitations. There are three
limitations which we feel are particularly relevant to this research. First, we have focussed
exclusively on men’s experience of sport and exercise. Further research is needed to explore the
ways in which women with serious mental health problems experience sport and exercise. In light
of generally lower participation rates among women, and the different socio-cultural significance
of sport and exercise for women, we suspect that women’s stories will differ markedly from men’s.
Second, as Smith and Sparkes (2005b) observe:

one potential weakness of this type of analysis by itself is that it often fails, if one is not careful,
to acknowledge or illuminate the manner in which narrative structures may be dynamic and
fluid, composed in the spaces between performer and audience, and thus situated in
accomplished social action. (p. 234)

One way of guarding against this weakness is to engage in repeated interviews in order to explore
how an individual’s stories might change over time and in different social contexts. Given the
challenges facing researchers in serious mental illness contexts (see Carless & Douglas, in press;
Carless & Faulkner, 2003; Faulkner & Carless, 2006; Faulkner & Sparkes, 1999 for discussion),
and in particular the risks of the narrative enterprise in this context (see Stone, 2004), ethical
issues prevented repeated interviews with most participants. In addition, ethical considerations
prohibited conducting interviews during the acute psychotic stage of illness. Among the 11
participants, several did not wish or were not able to engage in an extended series of interviews.
To guard against this potential weakness, our solution was to include observational data of a
more naturalistic kind in order to explore participants’ interactions, talk and social exchanges
outside interview contexts. We suggest, however, that further exploration of the dynamic and fluid
nature of narratives over time and in alternative social contexts is likely to be a fruitful topic for
future research.
A third potential limitation concerns our identification of specific narrative types which risk

‘‘creating yet another general unifying view that subsumes the particularity of individual
experience’’ (Smith & Sparkes, 2005b, p. 234). To counter this risk we emphasise that action,
achievement, and relationship narratives are not the only kinds of stories men might tell about
sport and exercise and share Frank’s (1995) view that other types of narratives can and should be
proposed. Following Frank (1995), we emphasise that our suggestion of three underlying
narrative types ‘‘does not deprecate the originality of the story any individual ill person tells,
because no actual telling conforms exclusively to any of the three narratives’’ (p. 76). In this
regard, participants’ stories are unique and, as Frank notes, different narrative types are told
alternately and repeatedly. Although participants often exhibited a preference for a particular
narrative type, all participants told different types of story at different moments in time. Thus we
hope these narrative types raise awareness of possible alternatives to the dominant medical
narrative and that they may be used as listening devices (Frank, 1995) to allow these stories to be
heard.
In terms of strengths, the three narrative types provide valuable insights into the ways sport and

exercise is experienced by men with serious mental illness. Of particular relevance, we suggest, is
that our analysis of participants’ stories shows how sport and exercise involvement can contribute

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to at least four of the nine common elements of recovery (redefining self, being involved in
meaningful activities, being supported by others, and renewing hope and commitment) identified
in the consumer/survivor and psychiatric rehabilitation literature by Davidson and colleagues
(2005). A further strength of this narrative approach is that it allows psychologists to understand
how sport and exercise came to be construed as meaningful activities by these men who are living
with mental illness. As Smith and Sparkes (2005b) note, a narrative analysis of structure and form
sheds light on the ways in which participants both create meaning and develop self and identity
through sharing stories of their experiences. Because, as Dimaggio (2006) notes, ‘‘individuals use
storytelling to give meaning to their experience, negotiate the meaning of events, make choices in
the social sphere, and build up an identity’’ (p. 103), analysis of their stories provides insights into
the constitutive process of meaning making and identity development in action. Finally, we
suggest that the narrative types are also potentially significant in the more general context of
enduring mental illness. We would like to explore this significance now by considering the three
narrative types in relation to existing literature and theory concerning the experience of psychosis
(Stone, 2006), illness narratives (Charmaz, 1991; Smith & Sparkes, 2005a; Sparkes & Smith,
2003), and the ways in which these narratives may be viewed from the perspective of social
constructionist conceptions of narrative therapy (McLeod, 1997).

The experience of psychosis

In terms of the relationship between narrative and mental illness, Stone (2006, p. 44) identifies
three (interrelated) themes in published stories of psychotic illness. First, ‘‘psychosis effects a
suspension from the social realm.’’ Second, this suspension is experienced as ‘‘a muting agent: it
involves the loss of speech y and this in turn absents [a person] from the consensual world of
discourse and action.’’ Third, many narrative accounts of psychotic illness communicate a ‘‘radical
disruption to a settled sense of identity, a felt impression that selfhood and being are under imminent
threat of complete disaggregation.’’ Narrative processes, Stone (2006) suggests, have the potential to
help tackle these challenges. By storying one’s experiences in the first person ‘I’, ‘‘a self, or a sense of
selfhood, is established which enables the speaker to look outside herself from that position’’ (p. 47).
Thus, an individual is able to reduce his or her self-focus and become more aware of others.
According to Stone (2006) this focussing outside the self, through attending to the external,
interpersonal realm, can act ‘‘as a counterweight to the internalizing energies of psychosis’’ (p. 47).
The points Stone (2006) identifies are demonstrated within participants’ stories of sport and

exercise. First, the participants’ stories are invariably told in the first person ‘I’. In itself this simple
act may be important in establishing a sense of selfhood based upon one’s own lived experience.
Second, group-based sport and exercise activities provided a way in which participants were able
to reconnect with the social realm. This connection is underscored by the relational focus inherent
in participants’ stories of sport and exercise. Lieblich and colleagues (1998) define the term
relational as ‘‘an emphasis on interpersonal dimensions rather than the separate self’’ (p. 87). The
presence of relationship stories within men’s accounts of sport and exercise suggest a high degree
of external focus on interpersonal dimensions which contrast with those narratives of serious
mental illness which may be characterised by a strong self-focus. Finally, as the preceding stories
evidence, sport and exercise provided concrete opportunities for speech and interaction which all
participants made use of.

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Chronic illness narratives

Charmaz (1991) describes a change in a woman who became chronically ill in the following
terms: ‘‘Before she became ill, she had worked towards future goals. Afterwards, she sought
valued moments and good days in the present’’ (p. 3). In many ways, participants’ stories of sport
and exercise have much in common with this description as, when they talked about activity, their
stories were almost exclusively focussed on the present—the here and now—and on valued
moments and good experiences within this present. Notably, this present focus was not only
inherent in participants’ talk during interviews (which might have arisen through the tense of our
questions) but was also documented through participant observation of informal interaction. A
focus on the present, as opposed to the past or the future, is significant in that it signifies a
departure from the dominant restitution story of illness. Restitution stories, Sparkes and Smith
(2003) suggest, with their focus on ‘cure’ and returning a person to ‘health’, are necessarily
oriented towards reinstating the past in the future—a future in which wellness is expected to
return. Implicit therefore within the restitution narrative is a sense that the ‘sick’ present is
undesirable, painful, and best avoided, to be replaced by a focus on a ‘healthy’ future.
The temporal focus of participants’ stories is significant in relation to Sparkes and Smith’s

(2003) discussion of the narrative construction of self in the context of chronic illness. In these
authors’ terms:

The restitution narrative frames biographical time within a philosophy of the future that
interweaves the three time tenses of Past in the future, the Present in the past, and the Future in
the past. Time experienced in such ways connects the individual to notions of a restored and
entrenched self that has its reference point firmly in the past, all of which makes it difficult to
develop different senses of self and explore alternative identities in the present. (p. 315)

By telling action, achievement, and relationship stories focussed on a present in which they kept
busy and used time effectively, the participants in this research distanced themselves from telling
potentially problematic future or past-oriented restitution stories. In so doing, we suggest each
participant was able, as Charmaz (1991) describes, to locate his sense of self, to a greater or lesser
extent, in a real and authentic present (rather than some previous remembered past or some hoped
for but distant future). Significantly, this real and authentic present became available for
narration through embodied involvement in sport and exercise.
We suggest that telling action, achievement, and relationship stories focussed on the present

enabled participants to re-story their lives in ways that allowed the exploration of alternative
identities and selves. In this way, as Smith and Sparkes (2005a) suggest in relation to their
narrative research with men who experienced spinal cord injury through sport, these three
narrative types may be considered as potential counterstories (Baldwin, 2005) or counter-
narratives (Nelson, 2001) to the illness-focussed restitution story which dominates many people’s
experience of chronic illness. According to Nelson (2001), counter-narratives are ‘‘tools designed
to repair the damage inflicted on identities by abusive power systems’’ which aim to ‘‘re-identify
such people as competent members of the moral community and in doing so enable their moral
agency’’ (p. xiii). Smith and Sparkes (2005a) suggest that ‘‘the potential for reconstructing self
stories is enhanced when access is gained to counter-narratives that provide alternative maps and
different emplotments regarding disability and impairment’’ (p. 1100). Given that mainstream

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culture provides few (if any) alternatives to restitution-focussed illness stories (Smith & Sparkes,
2007), we suggest that awareness of the three narrative types identified here may help some men
with serious mental illness develop alternative identities and notions of self.

Narrative resources and adventure

In terms of the narrative reconstruction of lives and identities, it is generally recognised that
people require resources, of some kind or another, in order to be able to re-story their lives
(McLeod, 1997). Of particular interest in the context of this study is Scheibe’s (1986) suggestion
that people require adventures in order to construct and maintain satisfactory life stories. The
Concise Oxford Dictionary defines adventure as ‘‘an unusual, exciting, or daring experience’’ and
we think this definition captures the place of sport and exercise held in some participants’ lives.
According to McLeod (1997):

Different people may draw upon different sources of adventure. However, each type of adventure
gives the person a ready supply of stories through which to create an identity both in the form of
an on-going self-narrative but also a narrative that is shared with, and co-constructed with, other
people. Adventurous activities also furnish a reference group of others willing to listen to these
stories, as in groups of anglers ‘swapping’ tales of fish caught and fish that got away. (p. 43)

As McLeod (1997) suggests, ‘adventure’ means different things to different people—football, for
example, may constitute an adventure for one but not for another. However, among the men in
this research, most were able to find a form of group-based sport or exercise which they
experienced as adventure and which provided concrete, embodied experiences to talk about (in the
form of action and achievement stories), alongside day-to-day opportunities to share these stories
with others (in the form of relationship stories). As such, sport and exercise activities were
simultaneously a shared experience to talk about and an opportunity to talk. In other words,
involvement in sport and exercise provided an arena in which personal stories, in the form of
action, achievement, and relationship narratives, were both created and told. For some, we
suggest, the opportunity to launch and maintain these self stories facilitated a new sense of
meaning and purpose through a reconstruction of identity and sense of self.

Conclusion

In summary, this article represents a modest attempt to bring the insights of social constructionist
narrative theory to the under-researched topic of sport and exercise among people with serious
mental health problems. Our findings highlight an alternative way in which involvement in sport and
exercise can enhance the lives of men with serious mental illness, namely through providing the
narrative resources which enables them to create and share positive personal stories which differ
markedly from dominant and more negative narratives of mental illness. Through telling present-
focused stories of their sport and exercise experiences, built around the notions of action,
achievement, and relationships, it seems to us that participants were able, to a greater or lesser extent,
to re-story their lives through reconstructing or sustaining a more positive, hopeful, and meaningful
identity and sense of self-independent of mental health culture.

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Acknowledgements

Thanks to the mental health professionals who facilitated this research and the two anonymous
reviewers for their comments. In particular, thanks to the participants for generously sharing with
us stories of their sport and exercise experiences.

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• Narrative, identity and mental health: How men with serious mental illness re-story their lives through sport and exercise

Introduction
Recovery in the context of serious mental illness
Narrative, identity, and mental health
Narratives and culture
The therapeutic potential of sport and exercise
Method
Participants and procedures
Analysis of narrative
Findings
An action narrative: ’’Going places and doing stuff’’
An achievement narrative: ’’That was way better than I ever thought I would have done’’
A relationship narrative: ’’Sharing a common thing’’
Discussion
The experience of psychosis
Chronic illness narratives
Narrative resources and adventure
Conclusion
Acknowledgements
References

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Special Education Classroom

Connie Wong • Connie Kasari

Published online: 17 February 2012

� Springer Science+Business Media, LLC 2012

Abstract The purpose of this study was to examine

play

and joint attention in children with autism (n=27) as

compared to children with other developmental delays

(n=28) in public preschool special education classrooms.

The participants were observed in their classroom envi-

ronment for 2 h over 3 separate days. Results show that

children with autism spent more of their time unengaged

and less time engaged in symbolic play and joint

attention

behaviors as compared to children with other develop-

mental delays. Additionally, teachers seldom focused

directly on symbolic play and joint attention in their

teaching. These findings suggest the importance of edu-

cating teachers to target play and joint attention skills in

their preschool special education classes, specifically for

children with autism.

Keywords Autism � Play � Joint attention � Engagement �
Preschool special education

Introduction

Young children with autism have significant social-com-

munication delays in symbolic play and joint attention.

Specific deficits in these areas distinguish children with

autism from typically developing children as well as from

children with intellectual disabilities (Mundy et al. 1986).

Furthermore, both symbolic play and joint attention are

significantly associated with later social (Sigman and Ru-

skin 1999), cognitive (Mundy et al. 2010; Stanley and

Konstantareas 2007) and communication development

(Charman et al. 2003; Kasari et al. 2008; Loveland and

Landry 1986; Mundy and Markus 1997; Mundy et al. 1986,

1990; Sigman and Ruskin 1999).

In symbolic play, children progress developmentally

from playing with toys functionally, such as in constructive

and manipulative play, to playing with toys symbolically

(Lifter et al. 1993). However, in comparison to typically

developing children, children with autism at the same

mental ages have significant delays in the development of

symbolic play (Jarrold et al. 1993; Baron-Cohen 1987).

Children with autism tend to manipulate toys or objects in a

rigid or stereotyped manner (Atlas 1990) and less often

spontaneously initiate creative symbolic play activities

(Jarrold et al. 1993; Libby et al. 1998). Beyond these

delays in play skills, children with autism are often object

focused with less frequent engagement of others into their

play activities (Kasari et al. 2010).

Joint attention, the ability to shift attention between

another person and an object or event, has a communica-

tive function in that these skills are used for the purpose of

sharing attention or interest with another person (Hobson

1989). Compared to MA-matched children with and with-

out intellectual disabilities, children with autism have

specific deficits in initiating and responding to joint

C. Wong (&)
Frank Porter Graham Child Development Institute, CB8040,

University of North Carolina at Chapel Hill, Chapel Hill, NC

27510, USA

e-mail: connie.wong@unc.edu

C. Wong

Psychological Studies in Education, University of California,

Los Angeles, CA, USA

C. Kasari

Semel Institute for Neuroscience and Human Behavior,

University of California, Los Angeles, CA, USA

123

J Autism Dev Disord (2012) 42:2152–2161

DOI 10.1007/s10803-012-1467-2

attention (Mundy et al. 1986). They are more likely to use

pointing and attention skills to regulate others’ behaviors

rather than to share interest (Mundy et al.).

The observed differences in play and joint attention

skills for children with autism are well documented, and

recent efforts to teach these skills have yielded positive

results (Jones et al. 2006; Lang et al. 2009; Martins and

Harris 2006; Stahmer 1995; Whalen and Schreibman

2003). There are few randomized controlled trials (RCTs)

in which joint attention and play skills have been examined

as outcomes of the intervention although the intervention

may have focused on these core areas of development

(Dawson et al. 2010; Green et al. 2010; Landa et al. 2011).

However, Kasari et al. (2006) showed that not only were

children with autism able to spontaneously generate sym-

bolic play activities and initiate joint attention with others

as a result of their focused RCT intervention, they also had

better language outcomes 1 year later (Kasari et al. 2008).

Obtaining change is critical on these areas of core deficit

for young children with autism since improvement is

linked to better developmental outcomes. However,

research studies have most often been conducted in labo-

ratory settings using skilled therapists to teach children.

While some recent studies demonstrate that parents can be

effective in improving play and joint attention outcomes

(Kasari et al. 2010; Rocha et al. 2007; Schertz and Odom

2007), children spend considerable time in preschool set-

tings with teachers.

It is not clear the extent to which teachers focus on these

core impairments for children with autism, even in class-

rooms that are autism-specific. For example, Sigman and

Ruskin (1999) reported that children with autism initiated

and participated in fewer social interactions with peers than

children with Down syndrome and children with other

developmental disabilities and tended to play in isolation.

Holmes and Willoughby (2005) also observed mostly sol-

itary or parallel functional play behaviors in seventeen 4- to

8-year old children with autism in the classroom. Addi-

tionally, Keen et al. (2002) reported that in their study of

eight children with autism, the children mostly requested

objects or protested; there were few instances of com-

menting. Further, teachers infrequently acknowledged

children’s communicative attempts (Keen et al. 2005).

The lack of focus given to symbolic play and joint

attention may be due to teachers’ lack of knowledge

regarding the importance of these skills. Although recent

reports identifying evidence-based practices for children

with autism include research support for the use of inter-

ventions that focus on play and joint attention (National

Research Council 2001; National Standards Project 2009;

Stansberry-Brusnahan and Collet-Klingenberg 2010),

teachers often have limited time and support to access

research findings (Closs and Lewin 1998). Furthermore,

there is limited research on classroom-based methods

(Brunner and Seung 2009). While Stahmer and Aarons

(2009) found that autism early intervention providers

generally reported favorable attitudes towards using evi-

dence-based practices, little is known regarding their actual

use of those strategies in practice. Finally, there is a lack of

emphasis on developing symbolic play and joint attention

in early childhood curricula. In a content analysis of

commonly adopted curricula for young children with aut-

ism, few contained symbolic play skills in an appropriate

developmental sequence and fewer curriculum guides

provided instruction for teaching joint attention skills.

When joint attention skills were mentioned, they were

often in the context of other goals such as pointing to show

receptive understanding rather than for sharing interest

(Wong and Kasari 2003).

Given the limited research in classrooms and with

teachers, the objective of this study was to build upon the

existing research focused on play and joint attention in

children with autism by examining those behaviors in the

preschool classroom setting as well as focusing on teach-

ers’ facilitation of play and joint attention. Specifically, we

asked (1) To what extent do children with autism initiate

play and joint attention across different types of settings in

the natural classroom environment? (2) What opportunities

do teachers provide for encouraging and/or developing

symbolic play and joint attention behaviors? (3) How do

teachers respond to children’s initiations of symbolic play

and joint attention in the classroom?

Methods

Participants

Recruited from a public early childhood learning center in

a suburban school district, participants included 55 pre-

schoolers analyzed in two groups: children with autism

(n = 27) and a mixed group of children with other dis-

abilities (n = 28). Children with autism all had a clinical

diagnosis of autism from a licensed psychologist or neu-

rologist. Though the majority of children in the mixed

group of other disabilities had speech/language delays,

other diagnoses included Down syndrome, cerebral palsy,

ADHD, and emotional/behavioral disorder.

Participating children ranged in age from 3 to 5 years

old with mental-age scores between 18.5 and 59 months as

calculated from the Mullen Scales of Early Learning

(Mullen 1995). The preschoolers were primarily boys, with

the proportion of males to females being higher in the

autism group, reflective of the gender ratio in autism.

Table 1 shows further demographic information. There

were no significant differences between the two groups.

J Autism Dev Disord (2012) 42:2152–2161 2153

123

The eleven participating classrooms had between six

and fourteen children taught by a certificated teacher and

two to four instructional assistants. All eleven teachers

were female and had between one and 32 years of expe-

rience teaching preschool special education. Table 2 pro-

vides further detailed background information. Nine of the

participating classrooms were self-contained non-categor-

ical classrooms and two were autism-specific; however, not

all children in the autism-specific classrooms had a diag-

nosis of autism. Regardless of class designation and child

diagnoses, the teachers all reported that classroom practices

were guided primarily by the school-designed curriculum

which was based off of state preschool standards and

supplemented by the Carolina Curriculum for Preschoolers

with Special Needs (Johnson Martin et al. 2004).

Measures

Classroom Observation

Children were observed in their classroom on three sepa-

rate mornings within a two-week period. Researchers blind

to children’s diagnosis continuously recorded the presence

of specific child behaviors and teacher behaviors towards

the target child in 5-min intervals for a total of approxi-

mately 2 h (M = 123.57, SD = 13.77 min) observation

time per child. Data was collected on a Palm V using Elan

2.0.1 (Sanders 2002), a shareware application designed for

behavioral data collection in educational settings. It is a

date and time-stamp recording application in which

templates can be created to record specific variables of

interest as well as anecdotal notes. When observed, all

participants had been in their classrooms for at least

3 months.

Table 3 describes the different play and joint attention

behaviors that were coded. In order to maintain higher

levels of interrater reliability, initiating joint attention

required the child to go beyond a coordinated joint look

(shifting gaze back and forth between an object/event and

another person) to also display a clear gesture of sharing

interest such as a show or a point. Thus, only higher level

joint attention skills were coded (Van Hecke et al. 2007).

Teacher behaviors were coded when they directly provided

any instruction in or prompts for play and joint attention as

well as if they responded to those behaviors. Researchers

recorded anecdotal notes to provide examples of the

behaviors. The average intraclass correlation coefficient

established between two independent coders was .86, with

a range of .81–.92 for the child and teacher play and joint

attention behaviors. Researchers also tracked children’s

engagement states (Adamson et al. 2004; Bakeman and

Adamson 1984) to calculate the percentage of time chil-

dren spent in each state. Intraclass correlation coefficients

for percent time in the different engagement states ranged

from .86 to .95.

Finally, the child’s activities in the classroom were

recorded as unstructured (e.g., free play, recess), structured

(e.g., circle, centers), or caregiving (e.g., toileting, snack).

Overall, children spent 56% of the time in structured

activities (M = 68.82, SD = 19.50 min), 32% in

Table 1 Child demographics

Autism (n = 27)

M (SD)/frequency (%)

Mixed disability (n = 28)

M (SD)/frequency (%)

V2/F

Chronological age (months) 51.70 (6.74) 49.76 (5.89) F(1,53) = .06, p = .80

Gender

Male 22 (82%) 18 (64%) V2(1) = 2.05, p = .15

Female 5 (18%) 10 (36%)

Ethnicity

Caucasian 13 (48%) 13(46%) V2(3) = .33, p = .95

Hispanic 3 (11%) 4 (14%)

Asian American 8 (30%) 7 (25%)

Other 3 (11%) 4 (14%)

Mullen scales of early learning

Mental age (months) 42.14 (9.19) 39.24 (9.42) F(1,52) = .16, p = .70

Receptive language age (months) 41.81 (9.77) 38.20 (10.42) F(1,52) = .27, p = .61

Expressive language age (months) 37.67 (10.70) 35.09 (9.26) F(1,52) = .12, p = .74

Mother’s highest level of education

High School 1 (4%) 1 (4%) V2(2) = .67, p = .72

Some College/Vocational Training 2 (7%) 4 (14%)

College/Professional/Graduate 24 (89%) 23 (82%)

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unstructured activities (M = 39.45, SD = 11.91 min), and

12% in caregiving activities (M = 14.78, SD = 9.07 min).

For ease of interpretation, data was transformed so that the

variables of interest were divided by the total time in the

activity. There were no significant differences in activity

times between the two groups of children.

Structured Play Assessment (SPA; Ungerer and Sigman

1981)

The frequency, type, and level of spontaneous play

behaviors were coded from this videotaped 15-min inter-

action to determine highest play level mastery. While the

child and tester sat facing each other at a table, the tester

presented four groups of related toys including a tea set,

baby bottle, dolls, telephone, brush, mirror, doll furniture,

tissue, blocks, dump truck, and a garage.

To master a play level, the child had to spontaneously

initiate three play acts at a specific level of three different

types. For example, to reach mastery at the substitution

level, the child displayed a substitution with three different

objects (e.g., block as a cookie, paper as a blanket, and toy

bed as an airplane). Thus, for each child, we determined the

highest mastered level of play they demonstrated on the

assessment (not just the highest level of play shown).

Early Social-Communication Scales

(ESCS; Mundy et al. 1986)

The child’s nonverbal initiations and responses to joint

attention were scored from this videotaped 15-min semi-

structured assessment. The child and tester sat across from

each other with a set of toys to the side that were visible but

beyond reaching distance of the child. The tester, who was

Table 2 Teacher/classroom demographics

Teachers/classrooms

(N = 11)

M (SD)/frequency (%)

Teacher age (years) 49.89 (6.33)

Teacher ethnicity

Caucasian 9 (82%)

Hispanic 1 (9%)

Asian American 1 (9%)

Years of teaching

In current position 8.20 (7.94)

Total in similar position 16.30 (12.13)

Class age designation

3- to 4-year olds 5 (46%)

4- to 5-year olds 6 (54%)

Class type

Non-categorical self-contained class 9 (82%)

Autism specific self-contained class 2 (18%)

Class size

# of child study participants in the class 5.00 (2.45)

Total # of children in the class 10.27 (2.32)

Total # of adults assigned to the class 3.45 (.69)

Ratio of children to instructors 3.06 (.84)

Table 3 Behaviors coded in the classroom observation

Behavior Definition

Engagement

states

(adapted from Adamson et al. 2004)

Unengaged The child appears uninvolved with any specific person or object

Person-engaged The child is engaged in an interaction with another person

Object-engaged The child is solely focused on an object. The child is not communicating with another person in any way

Supported joint The child and another person are actively involved in the same object or toy, but the joint engagement is actively maintained

by the other person.

Coordinated joint The child initiates or is actively involved with and coordinates attention to both another person and the object to share

attention

Play (adapted from Lifter et al. 1993; Ungerer and Sigman 1981)

Child functional

play

The child creates combinations of objects and/or may extend familiar actions with objects in a pretend quality to self, others,

or to doll figures

Child symbolic

play

The child extends familiar actions to two or more figures or moves the figures as if they are capable of action. The child may

use one object to stand in place for another or pretends to use something that is not there. The child may adopt various

familiar or fantasy roles in a play theme

Joint attention (adapted from Mundy et al. 1986)

Child RJA The child responds (attentional or behavioral) to another’s bid (show or point to an object) for joint attention

Child IJA The child initiates (show or point) a bid for joint attention towards another person for sharing purposes

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trained to elicit different responses, presented the different

toys one at a time.

From the assessment, the child’s mastery of responding

to and initiating joint attention was determined. To reach

mastery criteria of a specific skill, the child must have

demonstrated an act with at least two different objects on

the ESCS. In determining skill mastery for joint attention

initiations, only acts associated with eye contact were

considered intentional. We used these criteria to determine

what the child could demonstrate in joint attention at a

minimum ‘‘mastered’’ level across the assessment.

Mullen Scales of Early Learning (MSEL; Mullen 1995)

The MSEL assesses language, motor, and perceptual abil-

ities for children birth to about 5 years old. The visual

reception, fine motor, expressive language, and receptive

language subscales were used to calculate mental age.

Furthermore, the language subscales were used to report

receptive and expressive language age scores.

Demographic Information

The parents/guardians completed a demographic form to

obtain the child’s chronological age, gender, ethnicity, and

the parents’ highest level of education.

Teacher Survey

Teachers completed a questionnaire to collect teachers’

demographic information (age, gender, ethnicity, highest

level of education, and years of related teaching experi-

ence) as well as general classroom information (number of

students in the classroom and the number of adults in the

classroom).

Procedure

After obtaining informed parental consent to participate, all

assessments and observations were collected within

1 month for each child. Demographic forms and teacher

surveys were distributed, completed, and collected within

this same time frame.

Results

Primary analyses were conducted using ANCOVAs to

compare dependent variables of engagement, play, and

joint attention behaviors of children and teachers between

the autism and mixed disability groups and to explore if

there were differences across activities. Since Wong et al.

(2007) found that children with autism who had higher

mental age scores had higher rates of learning symbolic

play and joint attention skills when taught those skills, the

model included mental age as a covariate. Table 4 shows

the means and standard deviations of those behaviors in the

two groups and across activities.

Multilevel analyses were run using HLM 6.02 (Rau-

denbush et al. 2005) for dependent variables of play and

joint attention. While classroom differences were found,

the variance was primarily explained by individual child-

level variables rather than by classroom or teacher char-

acteristics; therefore, the following analyses were con-

ducted at the child level.

Engagement States

Children with autism spent more time in an unengaged

state than children in the mixed disability group

(F = 23.81, p \ .001), with significantly more time spent
unengaged during caregiving activities than in any of the

other activities (F = 6.01, p \ .05). Children with autism
were observed to be mostly eating/drinking or waiting in a

passive manner while children in the mixed

disability

group were more likely to engage themselves by watching,

playing with something, or engaging another person.

Compared to children with other disabilities, children

with autism spent a higher percentage of time being object-

engaged in structured than in unstructured activities

(F = 5.31, p \ .05). Regardless of activity, children with
autism spent a significantly lower percentage of time in

person engagement than children in the mixed disability

group (F = 14.32, p \ .001).
The percentage of time spent in each of the engagement

states was further examined for its relation to each of the

main play and joint attention variables of interest. Table 5

shows a summary of the regression analyses.

Play

Most functional play occurred during unstructured activi-

ties (F = 19.68, p \ .001). However, compared to children
in the mixed disability group, while children with autism

initiated fewer functional play acts in unstructured settings,

they displayed more functional play in structured activities

(F = 8.64, p \ .01).
For symbolic play, no significant differences were found

between children with autism and children with other dis-

abilities. Although symbolic play acts were observed more

frequently in unstructured settings (F = 14.51, p \ .001),
those behaviors were present at relatively low levels

overall. During structured activities, play was not the pri-

mary objective. In fact, anecdotal notes reflected that cre-

ativity was often stifled in favor of adhering to the goals of

the activity. For example, one of the teachers redirected a

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child to finish completing her puzzle when she started

moving the animal puzzle pieces as if they were walking

and making corresponding animal sounds.

Overall, children displayed more functional than sym-

bolic play acts in the classroom (t = 12.80, p \ .001). Of
the total play acts displayed in the classroom, approxi-

mately 94% were at the functional play level while only

about 6% were at the symbolic level. Furthermore, while

only 28 of the children displayed one or more play initia-

tions at the symbolic or dramatic level during the class-

room observations, 45 of the participants demonstrated

mastery criteria for playing at those levels during the

Structured Play Assessment.

Teachers did target more functional than symbolic play

skills with the children (t = 2.36, p \ .05). In examining
teachers’ teaching of functional play skills, a main effect of

activity type was found (F = 9.62, p \ .01) but no main
effect was found for the disability group. These results are

qualified by a significant interaction of group and activity

(F = 8.08, p \ .01). For children in the mixed disability

group, teachers targeted functional play more in unstruc-

tured activities than in structured activities. The pattern for

children with autism was the opposite, with more teacher

focus on functional play in structured settings and almost

none in unstructured activities. No significant effects were

found in teaching symbolic play.

An analysis on teachers’ responses to children’s play acts,

functional and symbolic, revealed that teachers responded at

higher proportions during structured activities than in any

unstructured and caregiving activities (F = 5.17, p \ .05).

Joint Attention

Although there were no significant differences in the fre-

quency of bids for joint attention between the two groups in

the classroom, children with autism responded to fewer

bids than children in the mixed disability group

(F = 17.40, p \ .001). While children with autism only
responded to 58.31% of opportunities, children in the

mixed disability group responded 74.94% of the time.

Table 4 Means and standard deviations of classroom behaviors across activities

Structured Unstructured Caregiving

Autism

M (SD)

Mixed

disability
M (SD)
Autism
M (SD)
Mixed
disability
M (SD)
Autism
M (SD)
Mixed
disability
M (SD)

Engagement states

% Unengagement 33.13 (13.58) 20.96 (10.92) 37.82 (21.05) 23.66 (13.44) 51.66 (22.52) 33.41 (20.77)

% Person engagement 6.99 (5.42) 11.74 (5.85) 6.93 (5.55) 12.25 (8.92) 2.92 (4.68) 7.01 (10.78)

% Object engagement 20.09 (8.76) 14.44 (7.65) 36.62 (12.79) 40.51 (14.64) 20.34 (17.63) 25.14 (17.72)

% Supported joint engagement 14.67 (5.69) 20.54 (11.96) 6.54 (5.24) 6.88 (4.50) 10.16 (7.88) 12.00 (18.92)

% Coordinated joint engagement 3.29 (3.78) 5.90 (6.25) 5.51 (7.52) 8.48 (10.07) 5.29 (6.53) 9.70 (13.92)

Play

Frequency of functional play acts 21.27 (17.75) 11.64 (14.84) 47.64 (52.94) 58.24 (44.95) 0 1.29 (5.81)

Frequency of symbolic play acts .96 (1.98) .56 (1.79) 3.33 (4.77) 5.47 (8.97) .22 (1.15) .27 (1.39)

Frequency of teacher prompts

for functional play

1.31 (3.00) .76 (2.24) .09 (.36) 2.00 (3.34) 0 0

Frequency of teacher prompts

for symbolic play

.29 (.63) .40 (1.12) .09 (.36) 1.02 (3.41) 0 0

% of teacher responses to child’s play acts .21 (.56) .27 (1.00) .10 (.48) .25 (1.01) – –

Responses to joint attention (RJA)

Frequency of teacher bids for JA 72.13 (36.61) 71.38 (25.19) 15.53 (13.21) 14.78 (8.84) 22.87 (29.13) 16.84 (12.67)

% of child RJA to bids for JA 62.82 (15.65) 75.22 (12.05) 59.60 (28.52) 69.92 (21.31) 44.55 (34.25) 77.73 (18.92)

Frequency of teacher prompts for RJA .58 (1.15) .44 (.81) .04 (.23) 0 0 0

% of teacher responses to child’s RJA 0 .60 (2.13) 0 0 0 0

Initiations of joint attention (IJA)

Frequency of IJA 17.44 (13.17) 31.02 (20.56) 18.98 (19.34) 31.38 (27.34) 19.40 (22.95) 39.56 (54.90)

Frequency of teacher prompts for IJA .73 (1.48) .87 (2.57) .38 (.94) 0 .11 (.58) 0

% of teacher responses to child’s IJA 49.89 (17.39) 43.45 (13.89) 41.38 (24.46) 35.18 (18.94) 41.97 (36.03) 48.71 (26.87)

Frequencies have been calculated as acts per second,

* p \ .05, ** p \ .01, *** p \ .001

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Teachers did initiate more joint attention acts towards

children during structured activities than in the other

activities (F = 5.50, p \ .05). However, the occurrence of
teachers instructing children to respond to their bids for joint

attention was very low. When teachers did teach children to

respond, they were mostly telling children to ‘‘look’’ when

they showed or pointed to something. Moreover, teachers

seldom responded to or praised children for attending to their

requests for joint attention.

Consistent with results from the ESCS, children with

autism initiated fewer joint attention skills than children in

the mixed disability group (F = 10.92, p \ .01) across all
activity types in the classroom. Furthermore, teachers

taught children to initiate joint attention acts at low fre-

quencies. Anecdotal notes suggest that when teachers did

teach children to initiate joint attention acts, it was usually

in the context of teaching other academic or language

skills. For instance, teachers would physically help shape a

child’s hand into a point for them to identify the correct

answer to their question. In such a case, the correct answer

would usually be an object or picture and the goal was

often to test comprehension (e.g., labeling, color/shape/

letter identification). No significant differences were found

between the teachers’ treatment of children with autism

and children in the mixed disability group.

In an examination of teachers’ responses to children’s

initiations of joint attention, no significant effects were

found. However, while teachers would respond by looking

towards what the child wanted to share, they rarely rec-

ognized and reinforced shows and points as joint attention

behaviors.

Discussion

The results of this study confirm that children with autism

showed fewer play and joint attention behaviors than

children with other disabilities in their classrooms as would

be predicted by previous assessment studies (e.g., Mundy

et al. 1986). Teachers in the classroom provided minimal

teaching of play and joint attention and responded to those

behaviors at low levels in the classroom setting. Of particular

note is that teachers did not adjust their teaching to address

these developmental domains and teacher and classroom

variables were not associated with teacher performance.

Engagement

Most striking, the results indicated that children with aut-

ism spent 37% of the observed time in an unengaged state,

where, by definition, they were not purposefully attending

to or interacting with objects or other people. Indeed, the

results of this study show that the greater percentage of

time spent in an unengaged state, the less likely children

displayed play and joint attention skills. Children with

autism likely have more difficulty sustaining attention to

some of the activities in the classroom than children with

other developmental delays, and probably require adult

facilitation.

Furthermore, children with autism also have increased

difficulty in initiating engagement with other people.

Although all children spent fairly equivalent amounts of

time engaged with objects, children with other disabilities

were more likely to initiate engagement with other people,

either teachers or other peers in the classroom. Conversely,

children with autism were more likely to slip from object-

engaged states to states of unengagement. Thus, children

with autism need greater environmental arrangements to

successfully engage with others in the classroom.

Play

Although capable of playing at symbolic levels, chil-

dren primarily played at functional levels of play.

Table 5 Summary of hierarchical regression analyses for unengaged, supported joint, and coordinated joint engagement states (N = 55)

Variable Unengaged b Object b Person b Supported joint b Coordinated joint b

Step 1 R
2

= .35* R
2

= .03 R
2

= .24** R
2

= .14* R
2

= .29***

Autism diagnosis .51*** .16 -.48*** -.31* -.31*

Mental age -.39** -.11 -.08 .26* .49***

Step 2 R
2

= .66* R
2

= .72*** R
2

= .61** R
2

= .50*** R
2

= .75***

Autism diagnosis .27** .02 -.30* -.10 .001

Mental age -.18 .18 -.25 .03 .17

Functional play -.24** .72*** -.16 .13 -.02

Symbolic play -.05 -.05 .13 -.26* .20*

Response to JA -.11 -.17 -.16 -.13 .04

Initiations of JA -.51*** -.29* .32* .68*** .69***

* p \ .05, ** p \ .01, *** p \ .001

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Developmentally, it may be simpler for children to engage

in functional play than putting forth the effort to create more

complex, symbolic play. Additionally, some of the func-

tional play toys may be more attractive as battery-powered

sound effects and lights increasingly accompany them. Due

to the lack of symbolic play displayed during the classroom

observations, there was not enough power to detect differ-

ences in symbolic play between the two groups of children.

Teachers rarely facilitated the play of children in the

classroom. When they did, the focus was on functional play

despite the child’s mastered play level. However, it was

difficult to determine whether teachers’ responses to chil-

dren’s play had any effect because they responded at such

low levels. During unstructured times, teachers allowed

children to engage in play activities independently with

minimal feedback. In structured settings, when teachers did

respond, it was often negative because play at that time

usually meant that the children were not completing their

assigned task. Teachers often discouraged playing crea-

tively for the sake of maintaining classroom order and

completing the objectives of the activity. Regardless, in

general, teachers did not recognize or support children’s

play during structured or unstructured periods.

Joint Attention

Consistent with the literature, children with autism respon-

ded to and initiated fewer bids for joint attention in both the

classroom and assessment setting when compared to chil-

dren with other disabilities (Mundy et al. 1986). The finding

remained significant even when considering the children’s

developmental levels and their classroom environments.

Teachers presented more opportunities for children, with

or without autism, to respond to their joint attention acts in

structured rather than unstructured activities. As expected,

in circle or at centers, teachers would use more showing

and pointing to teach children than in unstructured and

caregiving settings. Although teachers provided opportu-

nities for children to respond, they generally did not pro-

vide specific instruction about responding and initiating to

increase their joint attention abilities.

While teachers did respond naturally to children’s ini-

tiation of joint attention skills, they rarely responded to

them with the intent of reinforcing those behaviors. Nor

were teachers attempting to specifically teach nonverbal or

verbal joint attention skills.

Implications

The findings from this study highlight several factors that

need to be considered in translating research on play and

joint attention to practice for children with autism. First,

children with autism are spending a significant amount of

time unengaged in the classroom. Without decreasing the

percentage of unengagement, it would be difficult to

intervene on and increase children’s symbolic play and

joint attention behaviors.

Second, as teachers were not recognizing symbolic play

and joint attention acts, it may be that these skills should be

treated as separate skill domains to be specifically taught

and reinforced, especially for children with autism. One of

the issues for teachers is the lack of available resources on

play and joint attention (Wong and Kasari 2003). Early

childhood curriculum guides need to be more explicit in

describing these domain areas.

Another issue for teachers is that in typical preschools,

the goal is to foster independence and thus, teachers take

the role of a facilitator by setting up stimulating environ-

ments and providing functional assistance like obtaining

materials and problem solving (Fleming et al. 1991).

However, children with autism may need more social

assistance, requiring additional guidance and structure to

engage with others. While children with other disabilities

may naturally engage and interact with other people,

children with autism may have too much independence in

that they are not seeking out others in the classroom.

Therefore, teachers may need greater support in learning

about evidence-based practices targeting play and joint

attention for young children with autism in the classroom.

These data are among the first to examine play and joint

attention skills in a classroom setting for children with aut-

ism. However, a limitation of this research was that these data

were gathered from one school district in a fairly homoge-

neous area with respect to ethnicity and socioeconomic sta-

tus. Data collected in a more diverse area with teachers using

different curricular models may be useful in determining if

these results can be generalized to other children and class-

rooms. Regardless, teacher training and future research

practice should focus more on symbolic play and joint

attention in the school setting because of the importance of

these skills on later language and social development.

Acknowledgments The authors thank the children, families, and
teachers who participated in this study and the research assistants who

helped gather and code these data: Eric Ishijima, Kimberly Ochs, and

Alisha Patel. This article is based on a doctoral dissertation submitted

by the first author, under supervision of the second author, at the

University of California, Los Angeles. This research was supported in

part by a training grant from the National Institutes of Health, NIMH

grant MH064927(Connie Kasari), and Autism Speaks grant 2373

(Connie Wong).

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• Play and Joint Attention of Children with Autism in the Preschool Special Education Classroom

Abstract
Introduction
Methods
Participants
Measures
Classroom Observation
Structured Play Assessment (SPA; Ungerer and Sigman 1981)
Early Social-Communication Scales (ESCS; Mundy et al. 1986)
Mullen Scales of Early Learning (MSEL; Mullen 1995)
Demographic Information
Teacher Survey
Procedure
Results
Engagement States
Play
Joint Attention
Discussion
Engagement
Play
Joint Attention
Implications
Acknowledgments
References

Attractiveness and Rivalry in Women’s Friendships
with Women

April Bleske-Rechek & Melissa Lighthall

Published online: 9 March 2010
# Springer Science+Business Media, LLC 2010

Abstract Past research suggests that young women perceive their same-sex friends
as both facilitating the pursuit of desirable mates and competing for access to
desirable mates. We propose that similar levels of physical attractiveness between
young adult female friends might be one explanation for the opposing forces in their
friendships. Forty-six female friendship pairs completed questionnaires about
themselves, their friend, and their friendship; in addition, each woman’s picture
was rated by a set of nine naive judges. Friends were similar in both self-rated and
other-rated level of attractiveness. Within-pair analyses revealed that women agreed
on which friend was more attractive, and the less attractive members of each
friendship pair (by pair consensus as well as outside judges’ ratings) perceived more
mating rivalry in their friendship than did the more attractive members of each
friendship pair. We offer directions for research on women’s friendships over the
lifespan.

Keywords Women’s friendships . Same-sex friendship . Physical attractiveness .

Rivalry

Bestselling novels in the United States and elsewhere, such as The Jane Austen Book
Club, Reading Lolita in Tehran, Memoirs of a Geisha, and A Thousand Splendid
Suns, celebrate the unique architecture of friendships between women. Scholarly
books on friendship, too, are numerous, with more of them devoted to women’s
friendships than to men’s. Books on women’s friendships emphasize the opposing
forces that appear to define these relationships. Three of the top Amazon.com
(January 2009) hits for books on female friendships, for example, portray juxtaposed
forces in women’s friendships: Secrets and Confidences: The Complicated Truth
about Women’s Friendships (Eng 2004), Between Women: Love, Envy and

Hum Nat (2010) 21:82–97
DOI 10.1007/s12110-010-9081-5

A. Bleske-Rechek (*) : M. Lighthall
Department of Psychology, University of Wisconsin-Eau Claire, Eau Claire, WI 54702–4004, USA
e-mail: bleskeal@uwec.edu

Competition in Women’s Friendships (Eichenbaum and Orbach 1989), and Best
Friends: The Pleasures and Perils of Girls’ and Women’s Friendships (Apter and
Josselson 1998).

Empirical research on emerging and young adults corroborates what literary
scholars have suggested: Women perceive both benefits and costs in their friendships
with women (Bleske and Buss 2000). On one hand, young women frequently report
that their female friendships provide companionship and emotional support (Rose
1985), and that their female friends give them mating advice and accompany them in
mate-seeking endeavors (Bleske and Buss 2000; Gottman and Mettetal 1986). On
the other hand, women also report that their female friendships take up a lot of time
and are emotionally draining (Hays 1988; Micke et al. 2008), and that their female
friends make them feel bad about themselves and compete with them for attention
from desirable potential romantic partners (Bleske and Buss 2000). We conducted
the current study to test the proposal that similar levels of physical attractiveness
between female friends is one factor underlying the opposing forces in women’s
friendships.

One reason to expect that female friends are similar in physical attractiveness is
data showing that friends are similar on a variety of other dimensions, some of
which may be linked to similarity in attractiveness. For example, friends tend to
have similar interests and values, which may be tied to similarity in health-
promoting or appearance-enhancing behaviors. Friends tend also to be similar in age,
level of education, family background, income, religious views, political views, and
the activities they enjoy (Johnson 1989; Tolson and Urberg 1993; see Fehr 1996 for
a review).

There are multiple, related explanations for previously observed similarities
observed among friends. First, according to theories of cognitive consistency (Heider
1958), humans are driven by a need for balance, and thus we prefer to be around
individuals who perceive issues and other people the same way we do. Relatedly, the
logic of Strategic Interference Theory (Buss 2004) suggests that we are oriented
toward interaction partners who will help us achieve our goals. From this
perspective, we are more likely to achieve our goals when we are allied with others
who are moving toward those same goals. For example, it may be easier for women
to find and meet potential long-term mates with certain qualities (such as financial
capacity and high levels of commitment intent) if they ally themselves with another
woman looking for those qualities, even if they might have to compete with her later
for access to one or more of those mates.

A second explanation of observed similarities between friends comes from an
individual differences perspective. Individuals’ education, abilities, interests, and
values guide the environments they select for themselves and so they are more likely
to spend time with similar others than with dissimilar others (Scarr and McCartney
1983). This idea of “niche-seeking” may be important for friendship formation,
because individuals increasingly like those with whom they come in frequent contact
(Hamm et al. 1975; Morinaga and Matsumura 1987). For example, women who
report less willingness to engage in casual sex differ from their unrestricted
counterparts in the tactics they use to attract mates, such as dressing conservatively
(Bleske-Rechek and Buss 2006). These women may come into contact with each
other more frequently than expected by chance and develop friendly attitudes toward

Hum Nat (2010) 21:82–97 8383

each other as a product of their more frequent contact. In indirect support of this
possibility, female friends report similar attitudes toward engaging in casual sex
(Preder et al 2006).

The demands of mate attraction and competition might provide the best
explanation for why we would expect female friends to be similar in their level of
physical attractiveness. Because men place a premium on physical attractiveness,
competition among women to attract men centers heavily on their level of
attractiveness (Buss 2003); thus, women should not want a friend to be much more
attractive than they are because then they might look less desirable in comparison to
their friend, but at the same time women should not want a friend to be much less
attractive than they are because that might inhibit their ability to gain attention or
interest from men when together. Women should prefer friends who are attractive
enough to attract desirable males, yet not so attractive that they steal all the attention
of those desirable males.

Very little research has actually addressed the question of friends’ similarity in
attractiveness. The most reliable study (Cash and Derlega 1978), which involved 24
pairs of close female friends rated by two observers, showed a friendship pair-wise
correlation of 0.40. In another study (McKillip and Riedel 1983), two groups of
close and casual female friend dyads were rated by just one observer and yielded
pair-wise associations of 0.01 and 0.13, respectively. Finally, Murstein (1971)
describes a study of a girls’ cooperative at a New England college in which 26
women ranked every other person in attractiveness; reciprocal best friends were
actually dissimilar in ranked attractiveness (r=−0.49). Besides the potential for
restricted range operating in any select sample of women living together, the sample
size of 26 and requirement of reciprocal best friend nominations suggests that the
exact number of dyads was no more than 13 and probably less than that (no specifics
are offered in the original text). Overall, the previous studies do not provide a clear
pattern of findings (Feingold 1988). Thus, we designed the current study to provide
a sound test of the hypothesis that female friends are similar in both their self-
perceived and other-perceived levels of attractiveness.

Similar levels of attractiveness would indicate that two female friends are more
similar to each other in attractiveness than are two women paired at random (Cash
and Derlega 1978). Such similarity, however, would not indicate identical levels of
attractiveness, and in each friendship pair there is likely to be one friend who is
(even slightly) more attractive than the other. As mentioned previously, women
compete intensely over physical attractiveness to attract and keep their mates (Buss
1988, 2003; Buss and Dedden 1990; Buunk and Dijkstra 2004; Dijkstra and Buunk
2002; Tooke and Camire 1991), so friend asymmetries in attractiveness have the
potential to create mating rivalry between two female friends. In support of this
possibility, Tesser and colleagues (Tesser and Campbell 1982; Tesser et al. 1989)
showed that individuals are threatened by having a friend perform better than them
on characteristics that are important to their sense of self (in their research, for
example, social sensitivity). Physical attractiveness is important to women’s own
perception of their desirability as well as others’ perception of their desirability;
therefore, having a friend who is more attractive might exert a negative contrast
effect on women’s perceptions of themselves as well as force them to put forth more
costly effort to attract a mate. Given that it should be threatening and perhaps even

84 Hum Nat (2010) 21:82–97

costly, then, for women to have a friend who is more attractive than themselves, we
hypothesize that women who perceive themselves as less attractive than their friends
perceive their friends as mating rivals. We predict that (1) Women who perceive
themselves as less attractive than their female friend will perceive more mating
rivalry in their friendship than will women who perceive themselves as more
attractive than their female friend; (2) Within friendship pairs, the woman whom
both friends say is less attractive will perceive more mating rivalry in the friendship
than will the woman whom both friends say is more attractive; and (3) Within
friendship pairs, the woman rated as less attractive by outside judges will perceive
more mating rivalry in the friendship than will the woman rated as more attractive by
outside judges.

Method

Participants

Forty-six pairs of female friends from a large Midwestern university in the United
States participated. The 92 women were all heterosexual and of traditional college
student age (19.3±1.2 years). Their friendships varied from 2 weeks to 10 years of
duration; the median friendship duration was 13 months (M=21.5 months, SD=
22.9 months). Ninety-one women were Caucasian; one was Asian. Of the 92
women, 63 (68%) were single or casually dating and 29 were in a committed
romantic relationship. Friends were not similar in relationship status, #24 ¼ 3:14,
p=0.53.

Forty-six women participated in partial fulfillment of a course research
participation requirement of several lower-level psychology courses. The study
was advertised as an investigation of “sources of content and contention in women’s
friendships,” and women signed up to participate under the requirement that a same-
sex friend who was not a dating partner or family member would accompany them
to the one-hour session.

Materials and Procedure

Friendship pairs were run in small group sessions. Pairs arrived at the session
together. Each woman was given a friendship number and letter (e.g., “4A” and
“4B”) and then pairs were separated and taken to different rooms to complete
questionnaires that were pre-identified with the friendship numbers and letters. As
part of a broader questionnaire about themselves, their friend, and the friendship,
participants responded to several items to assess perceptions of attractiveness. They
responded to the question, “Compared with other women your age, how physically
attractive are you?” The nine-point scale ranged from “Not at all Attractive” to
“Average” to “Extremely Attractive.” Later on in the questionnaire, they also
responded to that question about their friend: “Compared with other women her age,
how physically attractive is your friend?” The nine-point scale ranged from “Not at
all Attractive” to “Average” to “Extremely Attractive.” At another point in the
questionnaire, participants compared themselves with their friend: “Which of the

Hum Nat (2010) 21:82–97 8585

following best describes how you and your friend compare in physical attractiveness?”
The seven-point scale ranged from “I Am Much More Attractive than She Is” to “We
are the Same” to “She Is Much More Attractive than I Am.” We used both seven-point
and nine-point scales because students who piloted our questionnaires told us that
varied scales prevented them from falling into a response set.

In the middle of the questionnaire, participants reported the degree to which they
thought 87 different forms of confluence and conflict characterized their friendship
(e.g., “I can trust her with my secrets” and “She doesn’t always tell me the truth”).
Embedded within the 87 statements were five of particular interest to this study
because they assessed mating rivalry. These items were as follows: “She flirts with
guys I am interested in,” “It is harder to meet guys when she is around,” “I feel
undesirable when she’s around,” “I feel in competition with her for attention from
members of the opposite sex” and “I feel unattractive in comparison to her.” The
seven-point scale ranged from “Disagree Entirely” to “Neither Agree nor Disagree”
to “Agree Entirely.” Responses to the five rivalry statements showed high internal
consistency (α=0.80) and so were averaged for primary analyses.

Upon completion of the questionnaire, and with their consent, participants were
photographed against a white wall along a well-lit hallway. The photo was in color
and of the head and neck only. In previous studies our lab found that women smiled
unless told otherwise. Hence, to go with women’s default tendency and to obtain
some degree of consistency in expression, we instructed the women to smile. Photos
were cropped so that no picture showed anything beyond the neck. Ninety of the 92
participants (the two dissenters were friends) consented to having their photos
judged for subsequent research purposes.

Two years after data collection was complete, a naive set of five female and four
male undergraduate students from lower-level psychology courses rated the 90
pictures. These judges were 19 and 20 years old, and therefore of the same general
age as our original participants were when photographed. Judges did not know they
were rating women who had come in as members of friendship pairs. In addition,
pictures were shuffled so women in the same friendship pair were not judged
immediately before or after one another. Three female and two male judges viewed
the pictures in one order; two female and two male judges viewed the pictures in
exact reverse order. Judges rated each woman on apparent intelligence, physical
attractiveness, and sexiness (e.g., “Compared with other women her age, how
physically attractive is this woman?”). Judges provided their responses on nine-point
scales ranging from “Not at all” to “Average” to “Extremely.” Judges were instructed
to place an “X” through the rating form for any woman they had seen before, but
they left no “X” marks and in the post-rating session debriefings we clarified that the
judges did not recognize any of the women they had rated.

Attractiveness and sexiness ratings were highly correlated, r90=0.89, p<0.001; however, in order to compare them directly with women’s self-ratings, we used only the physical attractiveness ratings. Male and female judges’ ratings of the women’s physical attractiveness were highly reliable (male α=0.80, female α=0.78), so they were averaged (overall α=0.87). The nine judges’ ratings of sexiness demonstrated a similar degree of consensus (α=0.86); however, judges did not demonstrate consensus in their impressions of intelligence (α=0.62). Hence, analyses below involving intelligence include only self-reports from the original female participants.

86 Hum Nat (2010) 21:82–97

Results

We first generated descriptive statistics on the variables of interest in this study: self-
perceived attractiveness, other-perceived attractiveness, and self-reported mating
rivalry in the friendship. On each of these variables, the women identified as “Friend
A” (this was by chance, depending on which friend the researcher approached first
when the friendship pair entered the lab) did not differ, on average, from the women
identified as “Friend B” (paired-samples t-test p values > 0.28). Thus, we report
descriptive statistics for the sample as a whole.

Women’s ratings of their own attractiveness (M=5.70, SD=1.26) were higher
than judges’ ratings of their attractiveness (M=4.45, SD=1.43), t89=7.09, p<0.001. However, women’s self-rated attractiveness levels were positively associated with judges’ ratings of their attractiveness, r90=0.36, p<0.001. Women reported relatively low levels of mating rivalry in their friendships (M=2.30, SD=1.15). Women’s relationship status (involved versus not involved) was not related to their own or their friend’s perception of mating rivalry in the friendship, nor was women’s sexual history (reported number of sex partners) or discrepancy between friends in sexual history (all p values >0.11).

Similarity in Physical Attractiveness

Our first hypothesis was that women friends would be similar in both self-perceived
and other-rated levels of attractiveness. This hypothesis was supported. Female
friends’ self-rated levels of physical attractiveness were moderately and positively
associated, r46=0.30, p=0.04. This effect was verified via scatter plot; moreover,
when we reassembled the data into twenty different sets of random friendship pairs
(see Luo and Klohnen 2005), the correlation coefficients ranged from−0.22 to +0.32,
with a mean coefficient of−0.003. The positive association between friends’ self-
rated attractiveness also does not appear to be a product of women perceiving
themselves as similar to their friends, because women’s ratings of their own
attractiveness correlated only weakly with their ratings of their friends’ attractive-
ness, r92=0.22, p=0.04.

Outside judges’ ratings of female friends’ levels of attractiveness were strongly
correlated, r45=0.61, p<0.001. Again, this effect was verified via scatter plot, as displayed in Fig. 1. In further validation of the effect, correlation coefficients from twenty sets of randomly constructed friendship pairs ranged from−0.34 to +0.24, with a mean coefficient of−0.01.

Attractiveness Discrepancies and Rivalry

Our second hypothesis was that women who perceive themselves as less attractive
than their friends perceive their friends as mating rivals. The first prediction to
follow from this hypothesis is that women who perceive themselves as less attractive
than their female friend will perceive more mating rivalry in their friendship than
will women who perceive themselves as more attractive than their female friend.
Indeed, women’s perception of their friend’s attractiveness, relative to their own, was
associated with their perception of rivalry in the friendship, r91=0.47, p<0.001. This

Hum Nat (2010) 21:82–97 8787

effect replicated within each of the individual items comprising the mating rivalry
composite (all p values<0.06). Notably, and in support of the specificity of the predicted effect, women’s perception of mating rivalry in their friendship was not linked to perceived discrepancy between their own and their friend’s level of intelligence, r91=−0.07, p=0.51.

We also explored discrepant attractiveness and perceptions of rivalry by splitting the
women into three groups according to their response to the question comparing their
own and their friend’s attractiveness. The original scale had seven check boxes ranging
from “I Am Much More Attractive than She Is” (scored as 1) to “We are the Same”
(scored as 4) to “She Is Much More Attractive than I Am” (scored as 7). We placed
women who checked one of the first three boxes (1 to 3) in the self > friend group,
women who checked the fourth box in the self = friend group, and women who checked
one of the last three boxes (5 to 7) in the self < friend group. As displayed in Fig. 2, women’s perception of their own attractiveness, relative to their friend’s attractiveness, was tied to their perception of rivalry in the friendship, F2, 88=15.23, p<0.001, partial η2=0.26. Post hoc analyses revealed that women who thought their friend was more attractive felt more rivalry in their friendship (M=3.35, SD=1.48) than did women who thought they and their friend were equally attractive (M=2.35, SD=1.04), p= 0.05, and more rivalry than did women who thought they were more attractive than their friend (M=1.85, SD=0.70), p=0.001. In contrast to what we expected on the basis of literature showing costly competition among closely matched non-human rivals (Enquist and Jakobsson 1986; Leimar et al. 1991), women who thought they and their friend were equally attractive did not report significantly more rivalry compared with women who thought they were more attractive than their friend, p=0.11.

Fig. 1 Scatterplot of the similarity between female friends’ levels of physical attractiveness, as rated by
naive judges

88 Hum Nat (2010) 21:82–97

Our second prediction to follow from the hypothesis that attractiveness
discrepancies are tied to rivalry is that, within friendship pairs, the woman whom
both friends say is less attractive will perceive more mating rivalry in the friendship
than will the woman whom both friends say is more attractive. Indeed, female
friends did not report similar levels of rivalry in their friendship, r45=0.04, p=0.81.
We conducted comparisons to determine if differences in perceptions of rivalry
within friendship pairs varied systematically according to perceived differences in
attractiveness. To do this, we first created a variable that reflected the discrepancy
between Friend A’s and Friend B’s reports of rivalry in the friendship. On this
variable, which we call Rivalry Discrepancy Score (RDS), a positive (+) value
indicates that Friend A perceives more rivalry than does Friend B, and a negative
value (−) indicates that Friend B perceives more rivalry. We calculated the mean
RDS for friendship pairs in which the friends agreed that Friend B is more attractive
(RDS is predicted to be positive) and the mean RDS for friendship pairs in which the
friends agreed that Friend A is more attractive (RDS is predicted to be negative). The
results of these analyses are displayed in Fig. 3. As shown in the figure, friends’
perceptions of rivalry differed systematically as a function of perceived differences
in attractiveness, F2, 42=4.92, p=0.01, partial η

2= 0.19. Among the pairs who
agreed that Friend B was more attractive, the mean rivalry discrepancy score (M=
0.76, SD=1.51) was significantly above zero, one-sample t16=2.09, p=0.03. Among
the pairs who agreed that Friend A was more attractive, the mean rivalry discrepancy
score (M=−0.94, SD=1.60) was significantly below zero, one-sample t12=2.11, p=
0.03. Among the 15 pairs who disagreed about who was more attractive, the mean
rivalry discrepancy score (M=0.16, SD=1.33) was not significantly different from
zero, t14=0.47, p=0.68.

Fig. 2 Women’s perceptions of rivalry in their friendship, as a function of whether they believe they are
more attractive than, equally as attractive as, or less attractive than their friend

Hum Nat (2010) 21:82–97 8989

The third prediction to follow from the hypothesis that attractiveness discrep-
ancies are tied to rivalry is that, within friendship pairs, the woman rated as less
attractive by outside judges will perceive more mating rivalry in the friendship than
will the woman rated as more attractive by outside judges. To test this prediction, we
computed a new variable to index the magnitude and direction of discrepancy in
judges’ ratings of Friend A versus Friend B for each pair of friends. To the extent
that judges rated Friend A as more attractive than Friend B, the Rated Attractiveness
Discrepancy Score was positive, and to the extent that judges rated Friend B as more
attractive than Friend A, the Rated Attractiveness Discrepancy Score was negative.
In confirmation of our prediction, Rated Attractiveness Discrepancy Score and
Rivalry Discrepancy Score were negatively correlated, r44=−0.36, p=0.02. As
displayed in Fig. 4, the more that judges’ attractiveness ratings favored Friend A
over Friend B (a positive attractiveness discrepancy score), the more rivalry was
reported by Friend B relative to Friend A (a negative rivalry discrepancy score);
likewise, the more that judges’ attractiveness ratings favored Friend B over Friend A
(a negative attractiveness discrepancy score), the more rivalry was reported by
Friend A relative to Friend B (a positive rivalry discrepancy score).

Discussion

In the current research, we predicted and documented that young adult female
friends are similar to each other in their level of physical attractiveness. Our
prediction was founded in various theoretical perspectives (Cognitive Consistency

Fig. 3 Discrepancies in friends’ perceptions of mating rivalry in the friendship, as a function of friends’
reports of which friend is more attractive

90 Hum Nat (2010) 21:82–97

Theories, Strategic Interference Theory) and the logic of mate attraction, which
emphasize the interpersonal benefits associated with allying oneself with similar
others. Our prediction also was founded in past research showing that friends are
similar on other dimensions, such as their interests, social attitudes, and education
level (see Fehr 1996 for a review). Similarity between romantic partners is quite
substantial as well (e.g., Bleske-Rechek et al. 2009; Luo and Klohnen 2005;
Vandenberg 1972); taken together with previous research on friend and romantic
partner similarity on a variety of dimensions, our findings on friend similarity in
attractiveness suggest that similarity is a defining characteristic of both friendships
and mateships.

We also hypothesized that, although young female friends may be similar to each
other in their level of attractiveness, the perception of any discrepancies between
them in attractiveness would be tied to perceptions of their friendship as involving
mating rivalry. In line with this prediction, we documented that less-attractive friends
experience more rivalry in their friendship than do their more-attractive counterparts.
Indeed, our association between female friends’ reports of rivalry in their friendship
and judges’ ratings of female friends’ attractiveness levels suggests that outsiders are
likely to identify which member of a given pair of friends experiences more mating
rivalry—merely through judgments of the women’s physical attractiveness.

Self- and Others’ Judgments of Attractiveness

Friends’ self-ratings of attractiveness were moderately correlated (r=0.30), and friends’
attractiveness ratings from outside observers were highly correlated (r=0.61); the

Fig. 4 Scatterplot of the association between discrepancies in judges’ ratings of friends and discrepancies
in friends’ perceptions of mating rivalry in the friendship

Hum Nat (2010) 21:82–97 9191

difference between these two correlation coefficients tends toward significance (p=
0.07) and raises the question of what exactly is similar between women friends, or
what exactly is perceived similarly. Friends’ ratings of their own attractiveness, which
were moderately similar, likely included not only their perceptions of their facial
attractiveness, but also their perceptions of their bodily strengths and weaknesses. In
addition, women’s appraisals of their own facial and bodily attractiveness were likely
weighed against various other factors we did not measure, such as women’s
perceptions of their own personality and recent interpersonal successes and failures.
To the extent that women’s self-evaluations of their attractiveness included their
perceptions of their character and social behaviors, the moderate correlation coefficient
between friends’ self-ratings might represent, in some part, similarity between friends
in self-perceived personality and behavior. We also cannot know the specific group of
women that came to mind when women read the phrase “other women your age.”
Some may have thought of their closest friends, some may have thought of others they
saw in class that day, and so forth. Given all the potential noise, it is perhaps
impressive that women’s self-ratings were, indeed, correlated.

In contrast to the situation for our original female participants, the judges who
provided attractiveness ratings were naive to the friendship status of the women they
were rating. Judges made their ratings on the basis of a single head shot. It is
possible that they used a variety of cues: hair and hairstyle (Bereczkei and Mesko
2006; Mesko and Bereczkei 2004), makeup, genuineness of smile, and various facial
features, such as skin, shape of face, and eye size and position (Paunonen et al.
1999). Some characteristics, such as apparent attention to appearance and
genuineness of smile, can impact attractiveness ratings (e.g., Bleske-Rechek et al.
2008; Mehu et al. 2008); these same characteristics may also be actual expressions
of women’s personalities. Thus, future researchers could determine whether judges’
impressions of female friends’ personality traits, such as friendliness and extraversion,
are correlated.

We did not ask or determine what judges attended to first or most as they viewed
each picture; however, we observed while running the rating sessions that judges
made their attractiveness ratings quickly and easily. So, despite the fact that judges
viewed a mere headshot of each woman for no more than 15–20 s, their ratings of
female friends were highly correlated (and their ratings of women paired randomly
were not at all correlated). Thus, we would like in future research to determine
whether naive observers rate friends as similarly in other conditions. For example,
the extent to which judges use similarity in apparent care in appearance, such as hair
and makeup and dress, could be tested by taking both facial and full-body shots of
women dressed in their own clothes or in a neutral outfit worn by all.

Judges’ ratings of women’s attractiveness were as highly correlated with those
women’s self-ratings (r=0.36) as they were with ratings from the women’s friends
(r=0.45). In other words, if Jenni and Anna are friends, outside raters agree with
Jenni about how attractive Anna is to the same degree that outside raters agree with
Anna’s rating of herself. This pattern of associations lends validity to the idea that
perceptions of attractiveness are robust, regardless of who is making the judgment.
As described above, judges made their ratings on the basis of a single head shot.
Friends have a variety of privileged information about each other’s personality and
behavior, both good and bad, which may have factored into their judgments. In the

92 Hum Nat (2010) 21:82–97

end, different judges of attractiveness—self, friend, outside observers—all have their
own sources of error and bias, yet the judgments are intercorrelated. As has been
demonstrated many times (for reviews, see Gangestad and Scheyd 2005; Langlois et
al. 2000), humans show consensus in their perceptions of what is and is not
attractive.

Attractiveness and Self-Evaluation Maintenance

One of the nuances of the data, displayed in Fig. 2, is that about half of the women
thought they were more attractive than their friend was, and just 20% (19 of 92)
thought they were less attractive than their friend was. Thus, although friends agreed
on which woman was more attractive in 30 of the 46 friendship pairs (more than
expected by chance, p=0.01), the majority of discrepancies occurred when both
friends said they were the more attractive woman. Past research has shown that both
men and women evaluate themselves, relative to their existing friends, in a self-
serving manner (Morry 2005, 2007). In addition, Vigil (2007) documented that
women prefer prospective friends who exhibited slightly higher capacity cues than
they themselves exhibited except for when the cue was related to physical
attractiveness; that is, women do not prefer their friends to be more attractive than
themselves. According to Tesser’s (e.g., Tesser and Campbell 1982) theory of self-
evaluation maintenance, individuals are threatened by a close other outperforming
them on a trait they value highly and, in response, evaluate that close other
negatively on the valued trait. If women are threatened by having a female friend
who is potentially more attractive than they are, a characteristic valued highly by
women, then women’s evaluations of their friends’ attractiveness should be biased
downward when pitted against themselves. We checked our participants’ pattern of
responses against this logic. When women evaluated their friend’s attractiveness
“compared to other women your age,” women’s mean rating for their friends was 6.4
of 9 (well above the theoretical midpoint of 5.0, which was given a text anchor of
“average”), whereas their evaluations of their own attractiveness “compared to other
women your age” were still favorable but hovered closer to the theoretical midpoint,
at 5.6. When women evaluated their friend’s attractiveness in direct comparison to
their own attractiveness, however, women evaluated themselves as more attractive
than their friend (M=−0.51, SD=1.17; the scale went from−3 to +3, with−3 being “I
am much more attractive than she is”). Assuming a population value of zero, one-
sample t91=4.25, p<0.001. These mean comparisons suggest that “others” may be less of an immediate threat to women than their friends are, and that women may engage in judgment processes that protect them from the potential negative effects to self of appraising themselves negatively relative to a friend.

Limitations and Future Directions

Future research in this area might improve upon a couple of the primary limitations
of the current study. One possible limitation, for example, is that our sample
consisted only of college-aged women. Competition and rivalry occur among men
and therefore are likely to occur in men’s friendships with men, as well. Given
women’s mate preferences, we speculate that rivalry between male friends might

Hum Nat (2010) 21:82–97 9393

hinge less on physical attractiveness and more on men’s perceptions of their own and
their friends’ levels of social dominance and physical prowess (Buss 2004).

Popular press books and scholarly books on the pleasures and perils of women’s
friendships with women do not focus exclusively on young adult women; if
anything, they offer a lifespan perspective. Thus, future research on rivalry between
female friends needs to extend beyond traditional college student samples. In our
student sample, the young women were of limited life circumstance. For example,
not one woman was married; in fact, the majority of women were not involved in a
serious relationship. Although attractiveness levels varied widely in our sample and
were tied to perceptions of rivalry, it is possible that the links between attractiveness
and “rivalry” would operate differently among older young adults and middle-aged
women, who are more likely (compared with the women of our sample) to be
married, raising children, and struggling to find time for their female friendships at
all. For example, some research has established that even among married middle-
aged adults, romantic attraction occurs between opposite-sex friends (Micke et al.
2008; Sapadin 1988). Thus, we might expect that the threat of an attractive female is
not limited to just young adulthood or just same-sex friendships. If a middle-aged
married woman has a highly attractive friend, how much she invests in the friendship
or how extensively she involves that friend in her and her spouse’s life might be
related to her perception of that woman’s trustworthiness and the degree to which
that woman is committed to her own relationship partner. Likewise, assuming that
women are aware of the romantic attraction that can occur between opposite-sex
friends, women should be especially sensitive to the attractiveness level of their
mates’ opposite-sex friends. Specifically, women’s feelings of jealousy and distrust
toward their mates’ opposite-sex friendships should be positively correlated with the
degree to which they perceive those women as more attractive than themselves.

A second potential limitation of the current study is our restricted ability to infer
from our data whether and how rivalry impacts these women’s friendship dynamics.
Overall, levels of rivalry were very low, but a minority of women did report
moderate levels of rivalry. We also did not ask whether women perceived rivalry
from their friends (and those reports could have been a bit higher because they would
not involve threat to self). We speculated at the beginning of this paper that rivalry
might be a necessary, costly by-product of women allying themselves with others
who are similar to themselves and who will attract mates at their level. Past research
suggests that women do mention rivalry as a cost of their same-sex friendships
(Bleske and Buss 2000). Research also suggests that exposure to pictures of highly
attractive women has a negative effect on women’s perceptions of their own
attractiveness (Gutierres et al. 1999). Thus, it is possible that having a friend who is
more attractive than oneself may have negative effects on women’s perception of
their own attractiveness and, in turn, their psychological well-being. However, it is
not clear that the rivalry from having a more-attractive friend is entirely costly; in
fact, it is likely outweighed by substantial benefits. Having a more-attractive friend
can increase one’s contact with desirable, potential romantic partners; provide high-
quality information about how to attract romantic partners; and heighten one’s access
to valued resources (such as other desirable friends). Indeed, competitive women, in
particular, might actually seek out friendships with women who are more attractive
than they are, especially if having a more attractive friend serves some motivating

94 Hum Nat (2010) 21:82–97

function. For example, we did not ask our participants about this, but perhaps
perceptions of friends’ attractiveness are related to the extent to which women strive
to improve their own level of attractiveness. We can note, in support of our
speculation that the costs of mating rivalry may be outweighed by the benefits, that
in the current sample neither mating rivalry nor the degree to which women
perceived their friend as more attractive than them was related to their perception of
how close the friendship was, how “true” the friendship was, or how long they
expected the friendship to last.

Conclusion

In the current research we documented that young adult female friends are similarly
attractive, as perceived by both themselves and others. Although similar, friends are
not entirely the same in their levels of attractiveness, and less-attractive members
within friendship pairs perceive more mating rivalry in their friendship than do their
more attractive counterparts. It seems we have barely scratched the surface in this
exploration of the complexities involved in women’s friendships with women. We
hope that our theoretically driven study of attractiveness and rivalry in young
women’s friendships will spur more investigations of the ties between attractiveness
and friendship dynamics in both sexes, in both same-sex and opposite-sex
friendships, over the lifespan.

Acknowledgments We thank Sarah Hubert and Stephanie Maves for help with data collection and entry.
For helpful comments on previous versions of this manuscript, we thank two anonymous reviewers,
Kendra Ahlquist, Mitchell Bunker, Eric Fuerstenberg, Jeffrey Goodman, Sarah Hammon, Lyndsay Nelson,
Philip Rechek, Amy Steffes, and Joseph Westlin.

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April Bleske-Rechek received her PhD in 2001 from the University of Texas at Austin, served for 2 years
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and then moved to the University of Wisconsin-Eau Claire, where she is an associate professor of
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Melissa Lighthall is an undergraduate psychology major at the University of Wisconsin-Eau Claire. She
lives in Eau Claire, Wisconsin, and plans to pursue an advanced degree in psychology.

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