Teaching Symbolic Play in the Classroom to Young Children with Autism

Background: Symbolic play skills represent a core social-communication deficit in young children with autism according to the Diagnostic and Statistical Manual-IV-Text Revision (DSM-IV-TR; APA, 2000). For these children, play is developmentally related to two other DSM-IV-TR diagnostic criteria – language and repetitive and stereotyped behaviors (RSB). Recommended practices for early childhood education and special education encourage developmentally appropriate play interventions linking assessment to intervention. Such interventions set in the context of a child’s natural classroom environment are lacking, specifically how to integrate these interventions into the preschool curriculum.

Objectives: This study questioned whether teaching young children with autism appropriate play skills within the context of their classrooms would influence their play types, RSB, language skills, and challenging behaviors across time. The researcher hypothesized the children would demonstrate: (a) increased frequency of symbolic play acts on the DPA and increased expressive language from pretest to posttest, (b) increased rates and types of targeted play acts within the intervention that would generalize into the classroom setting, and (c) decreased rates of RSB and challenging behaviors at the onset of intervention that would maintain at lower rates during generalization into the classroom.

Methods: A multiple baseline design across participants was employed. Five preschoolers with autism, aged 44-63 months, enrolled in an early childhood special education (ECSE) program offered by the local school district, participated in this study. Play skills were taught individually through a combined approach of direct and naturalistic instruction within the classroom setting. All sessions were videotaped for later analysis. Observational measures of play types and frequency were based upon the Developmental Play Assessment (Lifter, 2000). Measures of RSB were based upon Watt, Wetherby, Barber, and Morgan (in press). Children’s language development was monitored with the Early Communication Indicator (Luze et al., 2001), an IGDI measure.

Results: Children increased their frequency of symbolic play on the DPA and expressive language from pretest to posttest. During baseline, the children’s non-symbolic and symbolic play skills remained low and stable. Intervention’s onset showed an immediate rise in the target play behavior (non-symbolic or symbolic play) in each child. All children generalized these rates into the classroom and showed maintenance in 1-, 2-, and 4-week follow-up probes. Rates of RSB remained high for all children in baseline. The start of intervention showed an immediate decline in children’s rates of RSB that continued across the treatment phase. Challenging behaviors, if present during baseline, showed an immediate decline after the onset of intervention.

Conclusions: This developmentally appropriate play intervention demonstrated the importance and benefits of linking assessment to practice in the natural environment. It revealed a relation between increased play skills and decreased RSB in the children during intervention that generalized into the classroom setting. Results from this study contribute to interventions supporting functional, social, and communication outcomes for young children with autism in school settings.