Improving Play Skills in Nonverbal Elementary-Age Children with Autism

Background: Research studies have found that children with autism often display deficits in play skills (Jarrold, Boucher, & Smith, 1993; Williams, Reddy, & Costall, 2001). Thus, play skills have been targeted by researchers, and some studies have found that play skills can improve and are associated with language development in children with autism (Kasari, Paparella, Freeman, & Jahromi, 2008; Toth, Munson, Meltzoff, & Dawson, 2006). However, nonverbal elementary-age children with autism are often excluded from these intervention trials, and there is limited information on effective interventions for this subgroup of children. 

Objectives: This study will examine the change in frequency of play acts in nonverbal elementary-age children (5-8 years old) during a three-month period, during their participation in an innovative intervention targeting spoken language that incorporates Joint Attention and Symbolic Play Engagement Regulation (JASPER; Kasari et al., 2006) and Enhanced Milieu Teaching (Kaiser, 1993).

Methods: A subset of 16 nonverbal elementary-age children (ages 5-8) with autism from a multi-site study based in Los Angeles was included in the study. All participants completed assessments on their cognitive skills (Leiter-R) and language abilities. (Peabody Picture Vocabulary Test, Test of Early Language Development). In addition, participants received two 60-minute JASPER/ EMT intervention sessions each week for three months. Once a month, the therapist and child are videotaped during their intervention sessions.

            Four 10-minute videotaped interactions of the child and therapist were collected for each child during the three month period: Entry, Month 1, Month 2, and Month 3. Each 10-minute interaction was a standardized segment (minute 2-12) from a monthly taped 60-minute intervention session. For each interaction, blind coders recorded the frequency of spontaneous functional and symbolic play acts.

Results: Children in this study did not show symbolic play acts at the beginning of intervention; most were at the combinations level of play.  Changes were noted in an increase in play acts considered pre-symbolic.  A repeated measures ANOVA with a Greenhouse-Geisser correction determined that the mean scores for the frequency of pre-symbolic play acts, specifically “child as agent” play acts, differed  statistically significantly between time points, F(1.590, 15) = 42.548, p < .05. Post hoc tests using the LSD correction revealed that children increased their frequency of “Child as Agent” play acts at Month 3 (after 24 treatment sessions) (M = 2.69, SD = 4.16, p < .05), which was statistically significantly different from Entry (M = 0.125, SD = 0.50, p < .05) and Month 1 (M = .250, SD = .58, p <.05).

Conclusions: Results of this study indicate that while participating in a language-targeted intervention, children showed significant increase in the frequency of functional play acts during a three month period (24 sessions). Specifically, participants are beginning to show an increase in pre-symbolic play skills (i.e., Child as Agent) over time. This preliminary finding shows that nonverbal elementary age children can benefit from a play-based intervention. Future studies should continue to develop interventions for this population of children to improve play and language skills.