Assessment of Play In Toddlers with Autism: An Integrated Perspective and Implications for Intervention

Background:  A hallmark of early childhood development is the ability to play.  Many studies have noted differences in the play skills of children with autism when compared to typically developing children and children with other intellectual disabilities (Baron-Cohen, 1987; Jarrold et al., 1996; Libby et al., 1998; Sigman & Ungerer, 1984).  In particular, symbolic play is delayed in children with autism; these play acts are produced less often than their typically developing peers, if at all (Baron-Cohen, 1987; Charman & Baron-Cohen, 1997; Jarrold, 2003; Mundy et al., 1986; Rutherford et al, 2007; Sigman & Ungerer, 1984).  This body of evidence provides a striking profile of play in children with autism that is different from typical children and children with other disabilities.

Objectives:  This study describes developmental play in 50 toddlers diagnosed with ASD.  First, we used a developmental play assessment (Ungerer & Sigman, 1981) to provide a detailed description of all play levels, including levels within functional play, in toddlers with autism.  Second, we examined developmental differences in a cross-sectional sample of toddlers with autism.  

Methods:  A total of 50 toddlers with an autism spectrum disorder (ASD), with an average chronological age of 30.28 months and average mental age of 20.91, participated in the study.  The child’s play behaviors during the Structured Play Assessment were coded for frequency and types of functional and symbolic spontaneous play acts (Kasari et al., 2006; Lifter et al., 1993; Ungerer & Sigman, 1981). The children were grouped into developmental play profiles based on mastery, emergence or absence of play (Lifter & Bloom,1989).  

Results:  Most frequently toddlers engaged in functional play that appears to become more diverse and frequent with increasing developmental age.  A similar trend does not exist for symbolic play, that remains at low levels despite increasing developmental age.  Four distinct play profiles emerged for the toddlers with autism based upon their mastered and emerging levels of play. While children in each profile did not differ in terms of chronological age, they significantly differed in terms of play and mental age. These groupings revealed that over half of the sample had non-sequential play development. That is, they either did not have any mastered play, and/or there were large discrepancies between their mastered and emerging play levels.   

Conclusions:  Research on the development of the earliest play levels are important to better inform treatment goals for interventions targeting, or utilizing, play in toddlers with autism. The play skills of young children with ASD can best be described as both delayed and discrepant.  Their play skills are delayed in timing relative to typical child development.  Their play was discrepant in that typical children show mastery in one level of play and emergence in higher levels of play, toddlers with ASD in this study were often not emerging in the next higher levels of play.