Helping Children With Autism Engage in Symbolic Play

Deficiencies in symbolic pretend play are early markers of ASD (Wetherby et al., 2004). Symbolic pretend play behaviors in children with ASD are usually limited, tend to be disconnected and different in form, and lack diversity when compared with the symbolic pretend play of children with typical development. Because symbolic pretend play is linked to language, cognitive, social-emotional, and self-regulation development, early childhood educators and speech-language pathologists (SLPs) often work to facilitate children’s development of these play skills. Developing these play skills is particularly difficult for children with ASD. Several single-subject design studies with small numbers of older preschool children with ASD have employed a least-to-most prompting (LTM) protocol to teach symbolic play. These studies have reported some degree of success in increasing the frequency and diversity in the play of the children with ASD (Barton, 2015; Barton & Wolery, 2010; Saral & Ulke-Kurkcuoglu, 2020). LTM consists of at least a three-level prompt hierarchy in which the least intrusive prompt is followed by more intrusive prompts. LTM might be particularly effective for teaching pretend play because it (a) lets the child respond independently, (b) minimizes the possibility of overreliance on prompts, (c) can be embedded into play contexts, and (d) supports an effective interaction between the child and their playmate. In the play sessions, the adults contingently imitated the child and applied a system of from least to most prompts. Saral and Ulke-Kurkcuoglu (2020) reported some success in the use of the LTM method to increase pretend play and symbolic behaviors in children with ASD. SLPs frequently use pretend play as an intervention context and goal. The LTM may be a useful therapeutic method for SLPs when working with children with ASD. Following is the LTM protocol used to promote four types of symbolic pretend play: