Jumping the Hurdle: Children with ASD and Symbolic Play

Background:  

Children with autism spectrum disorder (ASD) demonstrate delays in social communication, play and language, and these abilities are targeted in early interventions.  While gains can be made after brief interventions of 3 to 6 months, gaining symbolic play skills are more difficult in children who begin intervention as minimally verbal (Goods et al, 2012; Kasari et al, 2013). Language abilities and social communication skills have both been associated with children’s mastery of symbolic play skills, and may travel alongside improvements in play skills.

Objectives:  

The current study investigates whether improvement in social communication helps children jump the hurdle from functional play to symbolic play in a sample of preschoolers all receiving the same targeted social communication intervention.

Methods:  

Participants included 85 children with autism spectrum disorder (M= 46.10 months; SD= 7.49 months) who have completed an evidenced-based early social communication intervention program, Joint Attention Symbolic Play Engagement Regulation (JASPER), that ranged from three to six months.

All children were administered the Autism Diagnostic Observation Schedule (ADOS) to confirm their autism diagnosis and to determine their verbal abilities. Children who had less than five spontaneous words on the ADOS were defined as “minimally verbal”. Children with more than five words, or children who scored “0” or “1” on Module 1 (using phrase speech and word combinations), or children who scored “0” or “1” on Module 2 and 3, were defined as “verbal”.

The Early Social Communication Scale (ESCS; Mundy et al., 2003) was used to measure spontaneous initiations of joint attention (IJA) skills. Children’s joint attention skills were categorized as “nonverbal IJA”, including gestures such as pointing, showing, and giving, or “IJA” which included both gestures and language.

The Structured Play Assessment (SPA; Ungerer & Sigman, 1981) was used to assess spontaneous play skills. Children’s play behaviors including the number of different spontaneous novel play types and frequency were coded from videotaped SPAs by blind raters. Children who demonstrated at least two types and five times of symbolic play acts were defined as mastered “symbolic play”.

Results:  

Forty-nine children were defined as “minimally verbal” and 36 were “verbal”. Sixty-nine percent of the children who were “verbal” mastered symbolic play at the end of their intervention, and only 38% of children who were “minimally verbal” mastered symbolic play.

Using logistic regression, nonverbal IJA was associated with increased odds of having any symbolic play after adjusting for language, entry symbolic play, and intervention dose (p=0.04).

Conclusions:  

These results suggest that it is more difficult for children who are minimally verbal (less than five words) to make that jump from functional play to symbolic than children who are more verbally skilled. This is in line with previous research that shows that language and symbolic play are associated. It is also promising to note that some children who were minimally verbal are making that jump from functional to symbolic. Future research should continue to target social communication and play skills in children who are minimally verbal.