Characterizing Play in Children with ASD: Differences in Joint Attention and Requesting Across Play Levels

Background:   Joint attention and play are often reported as intervention targets in many studies, but there has been little research that investigates the relationship between social communication variables (e.g., joint attention and requesting) and play. It is important to understand the role that social communication may have in play skills, as these both represent primary deficits in children with an autism spectrum disorder (ASD). 

Objectives:   The aim of this study was to investigate the differences in children’s quality of responding and initiating joint attention and requesting skills depending on a child’s highest level of play mastered (e.g., simple, combination, presymbolic, or symbolic play).

Methods:  Baseline data was collected from six studies between 2007 to 2014 that measured children’s social communication and play skills. Participants included 488 children with ASD, ages 1.8 to 5.75 years, with a mean age of 3 and half years old (SD = 9.213 months), 75% of the sample was male, and parents came from varied educational backgrounds. Children in the study came from diverse ethnic backgrounds (35.5% Caucasian, 18% Hispanic, 16.6% African American, 14.1% Asian, and 15.9% other/mixed). The Structured Play Assessment (Ungerer and Sigman, 1984) was used to measure the highest level of complex play mastered based on flexibility and frequency coding, and then children were classified into four major groups of play: simple, combination, presymbolic, and symbolic play (Lifter, 2000). The Early Social Communication Scale (Mundy et al., 2003) was used to measure high and low complexity levels of initiating and responding to joint attention (JA), and initiating requesting.

Results:   Regression analyses revealed that there were significant differences in social-communication skills across play levels, except for low level requesting, holding study differences constant(p<.0001). Children that played at a simple or combination level did not differ in frequency of the JA or requesting variables, except for responding to high complexity JA points. Children that played pre-symbolically had greater frequency of initiating JA skills, responding to JA, and high level requesting compared to children that played at a simple or combination level. Children that mastered a level of symbolic play had greater frequency of all high level skills (initiating and responding to JA and requesting) compared to children of all other play levels. Children that played presymbolically or symbolically had the same frequencies of initiating and responding to low level JA. Overall, as children mastered higher levels of play, they demonstrated more social communication skills.

Conclusions:  These results suggest that there is a strong relationship between social communication and play skills. Initiating low level JA and requesting skills, such as eye contact or reaching, are not frequently used by children that use higher level skills. The relationship between joint attention and play was more significant than the relationship between requesting and play. These data suggest that targeting these developmental deficits in young children with ASD may accelerate change in both play and social communication skills (Kasari, Freeman, & Paparella, 2006).