Helping Children With Autism Engage in Symbolic Play

Abstract

Deficiencies in symbolic pretend play are early markers of ASD (Wetherby et al., 2004). Symbolic pretend play behaviors in children with ASD are usually limited, tend to be disconnected and different in form, and lack diversity when compared with the symbolic pretend play of children with typical development. Because symbolic pretend play is linked to language, cognitive, social-emotional, and self-regulation development, early childhood educators and speech-language pathologists (SLPs) often work to facilitate children’s development of these play skills. Developing these play skills is particularly difficult for children with ASD.

Several single-subject design studies with small numbers of older preschool children with ASD have employed a least-to-most prompting (LTM) protocol to teach symbolic play. These studies have reported some degree of success in increasing the frequency and diversity in the play of the children with ASD (Barton, 2015; Barton & Wolery, 2010; Saral & Ulke-Kurkcuoglu, 2020). LTM consists of at least a three-level prompt hierarchy in which the least intrusive prompt is followed by more intrusive prompts. LTM might be particularly effective for teaching pretend play because it (a) lets the child respond independently, (b) minimizes the possibility of overreliance on prompts, (c) can be embedded into play contexts, and (d) supports an effective interaction between the child and their playmate. In the play sessions, the adults contingently imitated the child and applied a system of from least to most prompts.

Saral and Ulke-Kurkcuoglu (2020) reported some success in the use of the LTM method to increase pretend play and symbolic behaviors in children with ASD. SLPs frequently use pretend play as an intervention context and goal. The LTM may be a useful therapeutic method for SLPs when working with children with ASD. Following is the LTM protocol used to promote four types of symbolic pretend play:

Level 1 (independent level; least prompting): Presentation of materials and the verbal statement “Let’s play” at the beginning of the session. The teacher waits 12 to 20 s while contingently imitating and observing the child.

Level 2 (model and verbal prompts): If the child does not do a pretend behavior, the teacher models a pretend behavior and labels the action related to the toy(s) that the child had touched, held, and looked at previously. For example, if the child was banging a spoon on the floor, the teacher imitated banging the spoon, waited 12 to 20 s, moved the spoon into a cup, made a stirring motion, and said, “I’m stirring.” If the child was not touching any toys but looking at the sponges, the teacher picked up a sponge, moved it back and forth on the carpet, and said, “It’s a fast car!”

Level 3 (most prompting; full physical and verbal prompts): If the child did not imitate the model or do a pretend behavior within 5 s, the teacher used full physical, hand-over-hand prompts (the controlling prompt) to assist the child in doing a pretend behavior.

When promoting symbolic/pretend play, adults model four types of symbolic pretend play: functional pretend, object substitution (OS), imagining absent object, and assigning absent attributes (AAA). See Table 1 for examples. If the child exhibited a pretend play behavior in a pretend play category (e.g., OS), the implementer tended to prompt a pretend play behavior in the other categories (e.g., AAA). The decisions on what category of pretend play to prompt were in-the-moment and appropriate to the context. Pretend play behaviors were organized in sequences. When the child attempted to exhibit the same behavior for the fourth time within a session, the adult interrupted the attempt and prompted another pretend play behavior immediately to increase different pretend play behaviors.

Table 1.

Examples of Symbolic Pretend Behaviors

Type of play	House play example	Doctor play	Farm play example
Functional play with pretend (FPP)	Feeds figure with pizza saying, “nom nom”	Presses syringe to doll’s arm	Toothbrush in back and forth brushing motion in cow’s mouth
Object substitution (OS)	Put ribbon in cardboard box while saying, “putting spaghetti”	Uses sponge as a stretcher for doll	Uses fence as if a blanket
Imagining absent object (IAO)	Connects index finger with thumb and moves round while saying, “locking the door”	Pats doll’s leg as though putting a cast on it	Moves hand as though picking fruit on tree
Assigning absent attributes (AAA)	Picks spaghetti from pan and says, “It’s burnt!”	Takes doll and says, “I put the band-aid on his cut.”	Stops tractor and says, “ouch, broken”

In all studies using the LTM, children with ASD exhibited increased instances of symbolic play that they generalized to nonintervention settings and toys (e.g., over 4 weeks and across different toys, home, and school). Although most children exhibited increases in all symbolic behaviors, they exhibited the greatest increases in functional play with pretend. Children also exhibited greater increases and generalization of symbolic behaviors with more familiar toys, such as a house set.

References

Barton

E. E.

(2015). Teaching generalized pretend play and related behaviors to young children with disabilities. Exceptional Children, 8(4), 489–506.

Barton

E. E.

Wolery

(2010). Training teachers to promote pretend play in young children with disabilities. Exceptional Children, 77(1), 85–106.

Saral

Ulke-Kurkcuoglu

(2020). Using least-to-most prompting to increase the frequency and diversity of pretend play in children with autism. Topics in Early Childhood Special Education. Advance online publication. https://doi.org/10.1177/0271121420942850

Wetherby

A. M.

Woods

Allen

Cleary

Dickinson

Lord

(2004). Early indicators of autism spectrum disorders in the second year of life. Journal of Autism and Developmental Disorders, 34(5), 473–493.