Friday 28 September 2012

Pretend play and autism

A lightsaber in production @ Wikipedia
I'm leaving the heavy biochemistry of late behind in this post with a link to an interesting paper recently posted on Twitter by Prof. Graham Davey (Twitter: @GrahamCLDavey) reviewing the current evidence on the impact of pretend play on child development*.

To quote: "...existing evidence does not support strong causal claims about the unique importance of pretend play for development".

Whoa there... pretend play over just play might not be such a vital component to child development? Y'mean all those hours honing my Vader-like lightsaber skills with those stuck together toilet roll tubes were wasted?

On reading such a paper my mind almost immediately wanders back to autism and publications like this one from Christopher Jarrold** reviewing the pretend play research base in autism alongside quite a few hours learning about play - imaginative and/or pretend play - through schedules like the ADOS. Indeed, isn't a problem with imagination and, by inference, imaginative/pretend play supposed to be a key hallmark of an autism diagnosis separating autism from not-autism? That was one of the findings from the artificial intelligence boiling down ADI-R paper published recently. So logically, does this mean that an absence/limitation of pretend play in cases of autism might not necessarily have such dire consequences for future development?

OK, I don't want to get too carried away here on the basis of one review. Indeed even the lead author, Prof. Angeline Lillard in this media piece admits that whilst pretend play probably doesn't have the final say in aspects such as creativity and problem-solving, it might very well aid in skills like language and social development - both key points to diagnosing autism; indeed social affect rolled into one according to the DSM-V suggestion. She also notes the very fuzzy issue in linking how specifically pretend play contributes to child development independently and outside of all the other factors which combine in that process called growing up.

It does however make me wonder whether the rigidity with which psychology has seemingly applied the importance of pretend play both in the context of autism and more generally in child development has been 'overstated'. Indeed, if we go back to the pretend play -- perspective-taking link as described by articles like this one by Doris Bergen*** for example, which makes mention of Theory of Mind (ToM), it makes me also wonder whether one could also question the global importance of ToM for 'proper' development too?

Individual differences? Compensation strategies? Have I said too much? Should I perhaps also not mention the recent paper by Sachse and colleagues on executive dysfunction and (adult) autism****?


* Lillard AS. et al. The impact of pretend play on children's development: a review of the evidence. Psychological Bulletin. August 2012.

** Jarrold C. A review of research into pretend play in autism. Autism. 2003; 7: 379-390.

*** Bergen D. The role of pretend play in children's cognitive development. Early Childhood Research & Practice. 2002; 4.

**** Sachse M. et al. Executive and visuo-motor function in adolescents and adults with autism spectrum disorder. JADD. September 2012: PMID: 23011252

---------- Lillard AS, Lerner MD, Hopkins EJ, Dore RA, Smith ED, & Palmquist CM (2012). The Impact of Pretend Play on Children's Development: A Review of the Evidence. Psychological bulletin PMID: 22905949


  1. Just my own opinion here: Pretend play is how children apply the knowledge they learn. My brother is one of those stereotypical aspie/high functioning asd types who can tell you every detail about something he is interested in but is completely incapable to apply that knowledge and use it. I have always thought that the lack of pretend play for asd is a contributing factor to the "little professor" theory that Hans Asperger had.

  2. Thanks Mrs. Ed.

    An interesting thought. So pretend play is a sort of mental "flexibility" training programme? Mmm....

  3. Personally, I think we should be looking at the development of dynamic intelligence as the key factor in autism. Dynamic intelligence is a term coined by Gutstein (2009) to describe a collection of specific cognitive, self, interpersonal and communication abilities that facilitate flexible, adaptive thinking (and therefore, flexible, adaptive behaviour). Similar concepts are put forward by others: Sternberg (1996); Greenspan (1989), Salovey and Mayer (1990) and Goleman (1998). Some examples of how we use dynamic intelligence include: identifying innovative way to get something done; modifying plans and strategies when new information is introduced mid-stream; understanding, valuing and using different perspectives; remembering previous times when we recovered from setbacks and failures; putting things in perspective; ‘inoculating’ ourselves emotionally to prepare for potential negative outcomes. Dynamic intelligence is developed through interpersonal relatedness (Hobson, 2002). Vygotsky (1978) was the first Psychologist to show that mastery of lower level thinking milestones facilitate the development of higher level thinking competencies. For example, social referencing, joint attention, joint engagement, and perspective-taking underpin the higher level thinking competencies of reflection, critical analysis, self-awareness, simultaneous processing, seeing the ‘big picture’, using inference, appraisal, and integrating one’s own thinking with another’s. These are the ‘dynamic intelligence’ competencies that enable humans to work together in teams, to collaborate and cooperate, to elaborate on ideas where the sum of what we create together is greater than that which could be created by an individual in isolation. To me, the concept of dynamic intelligence is like an unbrella for all the other theories regarding what's at the heart of autism, including theory of mind, executive functioning, central embodies all of them. They're all mastered through interpersonal relatedness as part of the process of the development of flexible thinking. I think the description of pretend play as a 'sort of mental flexibility training programme' is spot on. Children have started to develop some of the lower level competencies of dynamic intelligence (e.g. perspective-taking, multiple options for how to do something, substituting one thing for another, using 'good enough' thinking) with close adults. This has become internalised in their thinking patterns and they start to externalise it in their play.

  4. Many thanks Zoe. I'll be doing a little more reading on this area of dynamic intelligence in light of all this.

  5. I did a report on the importance of play for a class once and found this neat pdf to hand out:

  6. Hmm, two out of three of my daughters who have autism have strong pretend play skills. Maybe it is different for girls than boys but it doesn't seem like those particular skills are badly impacted in these two. The third doesn't really lack the skills as much as she seems to prefer to spend her time getting other people to pay attention to her and/or playing with electronics.

    Where they do have problems, though, is in communicating what they are pretending about (functional communication) or trying to get others to participate (social ability). But whether it is rubber ducks sitting around a table with cake while twin A sings happy birthday or baby C having elmo teaching a class of his other sesame street characters, it is abundantly clear from just watching them that there is pretend play going on.

  7. Thanks for the comment MJ.

    Again with autism in mind, we seem to have a situation where the giant diagnostic marker pen seems to be pronouncing that all children with all autism are 'deficient' in pretend play when the reality is very much the opposite (same as with that old favourite ToM).

    I'm leaning more towards the view that play - encompassing pretend, functional, whatever - is the more important issue from a developmental point of view as per what happens when play is restricted (e.g. Rutter's study of Romanian orphans:


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