Symbolic play of preschoolers with severe communication impairments with autism and other developmental delays: more similarities than differences.

Researchers watched 3- to 5-year-olds with almost no words. Half had autism, half had other delays. They scored how the kids played with dolls, blocks, and toy foods.

No extra teaching was given. The team just wanted to know if autism itself made play different when language was super low.

The two groups looked the same. Kids with autism used the same number of pretend steps as kids with other delays. The only thing that mattered was overall language age, not the autism label.

If a child understood more words, their play was richer, no matter the diagnosis.

Nittrouer et al. (2016) found the opposite pattern in verbal preschoolers with autism. For kids who could talk, stronger executive function predicted better play later. The new study shows that when words are minimal, diagnosis stops mattering and language level takes over.

Voss et al. (2019) also measured play in children with delays, but they used sound-augmented toys with older, visually-impaired pupils. Both papers used similar play coding, yet the 2019 kids were school-age and got an intervention, while the 2012 kids were simply observed.

Together the papers say: check the child’s language age first, then decide if you need an autism-specific plan or a general developmental boost.

Stop sorting minimally-verbal preschoolers by diagnosis alone. Use their language or cognitive age to pick play goals. A child at 24-month language level needs 24-month play targets, whether the file says autism or global delay. Save the autism-specific strategies for kids who already have words.