Pretend play predicts language development in young children with Autism Spectrum Disorder

ABSTRACT

This quantitative study uses longitudinal caregiver surveys to explore the relationship between pretend play and development in children with ASD. Caregivers assessed the development of 7069 young children quarterly for three years on five subscales: combinatorial receptive language, expressive language, sociability, sensory awareness, and health. Pretend play was associated with superior developmental trajectories: 1.9-fold greater improvement of combinatorial receptive language (p < 0.0001), 1.4-fold greater improvement of expressive language (p < 0.0001), and 1.3-fold greater improvement of sensory awareness (p = 0.0009). Pretend play did not account for a significant amount of the variability in children’s sociability and health. The strong association of pretend play with combinatorial receptive language remained significant even when controlling for expressive language. Similarly, the strong association of pretend play with expressive language remained significant even when controlling for combinatorial receptive language. The association of pretend play with combinatorial receptive language was stronger than the association of seizures, sleep problems, or high-TV exposure. These findings support earlier studies suggesting that pretend play may be an important stepping stone for language acquisition and highlight a potential for pretend play therapeutic interventions.

KEYWORDS:

• Autism Spectrum Disorder
• pretend play
• make believe
• receptive language
• language comprehension

Acknowledgements

We wish to thank all participants’ caregivers who courageously fight for their children’s intellect and found time to complete quarterly assessments. We also thank Dr. Petr Ilyinskii for his scrupulous editing of this manuscript. A.V. and E.K. designed the study. A.V. analyzed the data. A.V. wrote the paper. Code is available from the corresponding author upon reasonable request. Caregivers have consented to anonymized data analysis and publication of the results. The study was conducted in compliance with the Declaration of Helsinki (World Medical Association, 2013). Using the Department of Health and Human Services regulations found at 45 CFR 46.101(b)(4), the Biomedical Research Alliance of New York LLC Institutional Review Board (IRB) determined that this research project is exempt from IRB oversight.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability

De-identified raw data from this manuscript are available from the corresponding author upon reasonable request.