The Relationship Between Pretend Play and Playfulness in Children With Autism Spectrum Disorder

PURPOSE: Play can be manifested by external performance, such as pretend play, and internal experience, or playfulness. Children with autism spectrum disorder (ASD) often exhibit deficits in both pretend play and playfulness. However, there has been little examination of the link between pretend play and playfulness in children with ASD. The purpose of this study was to examine the relationship between pretend play and playfulness in children with ASD.

DESIGN: This was a descriptive study. Children with ASD ages 3–12 yr were recruited from hospitals or pediatric rehabilitation centers in southern Taiwan. The inclusion criterion was a diagnosis of autistic disorder or Asperger’s disorder by a trained psychiatrist or pediatrician. Exclusion criteria were (1) inability to follow orders or complete the procedures, (2) uncorrected hearing or visual impairment, and (3) symptoms associated with organic brain dysfunction or chromosomal abnormality.

METHOD: This study used the Child-Initiated Pretend Play Assessment (ChIPPA), Test of Playfulness (ToP), and Childhood Autism Rating Scale (CARS). The ChIPPA has two sessions: conventional–imaginative play and symbolic play. Three items are scored: (1) percentage of elaborate pretend play actions (PEPA), (2) number of object substitutions (NOS), and (3) number of imitated actions (NIA). Scoring the three items for two sessions yielded six scores. The ToP has 30 items scored on a four-point scale assessing four elements: internal locus of control (ILC), intrinsic motivation (IM), suspension of reality (SR), and framing (FR). The CARS has 15 items scored from 1 to 4. Higher scores indicate greater severity of autistic behaviors. Pearson’s r was used to examine correlations between the six pretend play variables and the four playfulness variables. Multiple regression analyses were used to investigate the relationships between pretend play and playfulness.

RESULTS: Pearson’s r for pretend play and playfulness revealed that PEPA–conventional (PEPA–con), PEPA–symbolic (PEPA–sym), and NOS–symbolic (NOS–sym) had mild to moderate positive correlations (r =.44–.72) with all playfulness variables. NOS–conventional (NOS–con) had mild positive correlations (r = .28–.31) with all playfulness variables but SR. Multiple regression analyses showed IM and FR to be significant predictors of PEPA–con, explaining 48% of the variance. FR and ILC were significant predictors of PEPA–sym, together explaining 56% of the variance. ILC was a significant predictor of NOS–con, NOS–sym, and NIA–con, explaining 12%, 39%, and 7% of the variance, respectively. Multiple regression analyses showed PEPA–sym, NOS–sym, and NIA–con to be significant predictors of ILC, together explaining 69% of the variance. PEPA–sym, NOS–con, NIA–con, NIA–sym, PEPA–con*NIA–con, NOS–sym*NIA–con, and NOS–con*NOS–sym were significant main and interaction effects for IM, jointly explaining 61% of the variance. PEPA–sym was a significant predictor of SR, explaining 33% of the variance. PEPA–con and NOS–sym were significant predictors of FR, jointly explaining 53% of the variance.

CONCLUSION: Our findings support the existence of a relationship between pretend play and playfulness in children with ASD, providing further evidence that pretend play facilitates playfulness in children with ASD. Engaging in pretend play benefits such children, for initiating pretend play themes improves their inner control of experiences and interaction with others. In addition, the inner control of experiences was the important predictor of pretend play performance. Clinicians can help children with ASD improve their feeling of being in charge of their play to help them develop better performance in pretend play.

References

Jung, S., & Sainato, D. M. (2013). Teaching play skills to young children with autism. Journal of Intellectual and Developmental Disability, 38, 74–90. https://doi.org/10.3109/13668250.2012.732220

Lee, Y.-C., Chan, P.-C., Lin, S.-K., Chen, C.-T., Huang, C.-Y., & Chen, K.-L. (2016). Correlation patterns between pretend play and playfulness in children with autism spectrum disorder, developmental delay, and typical development. Research in Autism Spectrum Disorders, 24, 29–38. https://doi.org/10.1016/j.rasd.2016.01.006

Stanley, G. C., & Konstantareas, M. M. (2007). Symbolic play in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 37, 1215–1223. https://doi.org/10.1007/s10803-006-0263-2