A longitudinal study of pretend play in autism.

Researchers followed 2- to young learners for two years. Half had autism, half had delays, half rest were typical.

They filmed kids during free play every six months. They scored how often each child used pretend play like feeding a doll or flying a plane.

They also tracked joint attention—moments when child and adult looked at the same toy together.

Kids with autism started far behind in pretend play and stayed behind.

The big surprise: joint attention at was the only score that predicted later pretend play. Language level and IQ did not.

If a child shared looks and smiles about toys early, he later fed the doll or built block towers.

Eisenhower et al. (2006) showed you can teach joint attention with short drills and rewards. Rutherford et al. (2007) now shows why that matters—early joint attention fuels later pretend play.

Barbaro et al. (2013) looked even younger. They found missing pretend play at 12-18 months forecasts autism by age 2. Together, the three studies draw one line: joint attention gaps show up first, then pretend play stalls.

Anbar et al. (2024) stretched the line into grade school. They proved joint attention at 14-24 months predicts real-life conversation skills at 7-10 years. The message stays the same: fix joint attention early, unlock later social skills.

Before you run play scripts, check joint attention. Spend five minutes in each session getting shared looks, points, and smiles about toys. Once that clicks, pretend play often grows on its own.