Pretend Play and Children With ASD: Examining the Benefits of Playtime Activities

Play-time activities, specifically those involving pretend play, are characteristic of all children as their imaginations develop and run wild throughout the early stages of childhood. Those children with autism spectrum disorder (ASD), however, can especially benefit from pretend play in terms of improved verbal ability, feelings of enjoyment, and feelings of self-control. Dr. Kuan-Lin Chen and a team of researchers from various psychiatric and occupational therapy departments at Taiwan’s National Cheng Kung University set out to determine just how beneficial pretend play activities can be in the development of children with ASD. In their study, Chen et al. examined the correlation between pretend play and playfulness while controlling for the variables of autism behavior severity, age, and verbal comprehension.

The research team chose to study 72 children with ASD between the ages of 3 and 12, with an average age just over 6 years old. According to assessments of autism behavior severity (Childhood Autism Rating Scale, or CARS) and verbal comprehension (Verbal Comprehension Index, or VCI), the child participants on average maintained high symptom severity of ASD-related behaviors and moderate verbal comprehension ability. In examining the play-time activities of the participants, the researchers used two different observational assessments: the Child-Initiated Pretend Play Assessment (ChIPPA) and Test of Playfulness (ToP). In the ChIPPA exam, children were examined during two play sessions and scored among three different categories that measured the organization/complexity of their play, the number of times a child used a non-toy object in substitution of a real object, and the number of times the child imitated a modeled action from the assessor. The ToP, on the other hand, measured the children’s exhibited control over their play environment, their intrinsic motivation, suspension of reality, and their ability to give/read social cues. In their analysis of the test results, the researchers looked for correlations between the variables in both ChIPPA and ToP. They found that more complex pretend play and the number of object substitutions were both positively correlated with almost all variables of playfulness, further arguing that the sense of enjoyment derived from this correlation could potentially encourage a child to participate more in self-initiated and “symbolic” play (basically, increasing playfulness). There was also a negative correlation between the number of times a child imitated a previously-modeled action and their level of playfulness, indicating that children with ASD who only follow the models of others may feel less in control of their own actions and respond less to the social cues of others. It is important for them to self-generate their own play ideas, Chen et al. argued, as this sense of being in charge will encourage them to use their imaginations even more.

The primary strength in this study is how attentive the research team was in controlling for any factors that might have compromised their data. Primarily, the entire basis of their study was to account for a blip that previous studies with the same goal tended to overlook –– controlling for the factors of age, autism behavior severity, and verbal comprehension. This made it much easier for the results of each play-related assessment to be averaged and used in drawing conclusions. Additionally, another factor of this study I found to be quite strong is that the coders (those in charge of recording the results) of both the ChIPPA and ToP were blinded from knowing the severity of ASD in all of the participants as well as the hypothesis of the study. This way, there would be no bias in reporting the results of each assessment.

One of the biggest weaknesses of this study, which the researchers actually addressed in their discussion, was that the Test of Playfulness was not conducted in the participants’ home environments or typical play spaces. This may have had an effect on the comfort level of each participant and thus, their level of playfulness and scores on the assessment may have been inaccurate.

Overall, it would be useful to see what interventions health and occupational specialists come up with in addressing the beneficial effects of pretend play on levels of playfulness in children with ASD. Implementing play-time therapy or similar programs into the care regimens of these children may have a profound impact on their problem-solving, social, and decision-making skills.