Play skills: Not just for early childhood!

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As a school-based SLP, working on play skills is not often my top priority for minimally verbal children with ASD over the age of 5. Chang et al. report that the majority of research related to this population is focused on reducing challenging behaviors and increasing language, which I can definitely relate to. However, targeted interventions focusing specifically on symbolic play can be effective in both improving play skills and increasing expressive language skills.

Why is play important? Play is inherently motivating for children. It provides a context for learning, and most importantly, it is associated with stronger cognitive and language development. We know that children with autism often struggle with play. Their play tends to be more object focused, and they are often less jointly engaged with their social partners. When they do engage in symbolic play, it tends to be scripted or prompted.

The researchers behind this study found a group of children ages 5–8 with a diagnosis of autism and fewer than 20 spontaneous words. All children received targeted intervention focusing on symbolic play, a combination of approaches which the authors called JASPER + EMT (JASPER = Joint Attention, Symbolic Play, Engagement and Regulation; EMT = Enhanced Milieu Training). A detailed description of these interventions can be found here.

Some key features of the intervention approach include:

  • Creating meaningful opportunities for learning and communication by "responding to the child's actions and communication bids"
  • "Modeling and expanding play and communication"
  • Working on joint attention
  • Using motivating toys

After a 6-month intervention period, the children improved their play skills during therapy sessions. The children also generalized these gains to a novel environment—the Structured Play Assessment—where play skills were assessed by independent, blind testers. Symbolic play skills were also positively related to expressive language, as measured by:

  • The number of spontaneous communicative utterances, and
  • The total number of different words used by the child

Unfortunately, this study did not include a control group, so it’s hard to determine if this intervention would be more effective than another type of intervention. The authors also did not examine whether the effects generalized outside the clinic environment. Nevertheless, this article reminds us about the importance of play, even for school-aged children.

Chang, Y., Shih, W., Landa, R., Kaiser, A., & Kasari, C. (2018). Symbolic play in school-aged minimally verbal children with autism spectrum disorder. Journal of Autism and Developmental Disorders. Advance online publication. doi: https://doi.org/10.1007/s10803-017-3388-6.