Symbolic play in autistic, Down's, and normal children of equivalent mental age.

Researchers watched autistic, Down syndrome, and typical preschoolers play. All kids had the same mental age.

The team scored how often each child used pretend play and copied simple actions. They wanted to see if autism alone lowers these skills when brain age is held steady.

Autistic children used far less symbolic play than both other groups. They also imitated fewer actions.

Down syndrome and typical kids looked alike on both skills. The gap points to a autism-specific symbolic block, not just slow development.

Saunders et al. (2005) repeated the same check 24 years later and still saw the play gap. They added that autistic kids’ pretend scenes are messy and disorganized, updating the 1981 picture.

Sherratt (2002) and Kok et al. (2002) flip the story: they teach symbolic play instead of just measuring it. After short adult-led play sessions, autistic preschoolers produced new pretend acts and more words. The old deficit becomes a teachable target.

Vanvuchelen (2016) looked only at Down syndrome imitation and found quirky error patterns. That detail helps explain why, in the 1981 study, Down kids kept up with typical peers even though their overall development was delayed.

You can stop asking “Can this child pretend yet?” and start teaching it. Use brief, highly structured play routines, then fade your help just like Dave and John did. Track new pretend acts each week; they signal wider language and social growth.