Symbolic play in children with autism spectrum disorder.

The team watched preschoolers with autism play. They scored how well the kids used toys to stand for other things, like pretending a block is a phone.

They also tested each child’s nonverbal IQ, expressive language, receptive language, and autism severity. Then they ran numbers to see which skills best predicted symbolic play scores.

Only two scores mattered: nonverbal IQ and expressive language. Kids who solved puzzles well and who could say lots of words also showed richer pretend play.

Receptive language and autism severity added no extra information. Social development was linked to play only through the child’s cognitive level.

Chang et al. (2018) extends this finding. They taught minimally verbal school-aged kids with autism to play symbolically and the children’s expressive language grew alongside play gains. The 2007 paper shows the link; the 2018 paper proves the link can be moved with intervention.

Rutherford et al. (2007) is a direct replication from the same year. They also tracked pretend play in preschoolers with autism but highlighted joint attention, not IQ, as the key predictor. The two studies do not clash—they simply weighed different variables. When joint attention, IQ, and language are all in the model, each adds unique value.

Marcu et al. (2009) adds another piece. They found organized attachment also boosts symbolic play scores. Put together, the picture is clear: play reflects many pillars—cognitive, language, social—all at once.

When you assess symbolic play, look past autism severity. A child who can’t speak much but solves puzzles may still surprise you in play. Target joint attention and expressive language together; both feed pretend skills. If a preschooler shows disorganized play, check attachment style and cognitive level before labeling it a core autism deficit.