J Autism Dev Disord (2007) 37:1024–1039
DOI 10.1007/s10803-006-0240-9
ORIGINAL PAPER
A Longitudinal Study of Pretend Play in Autism
M. D. Rutherford Æ Gregory S. Young Æ
Susan Hepburn Æ Sally J. Rogers
Published online: 5 December 2006

Springer Science+Business Media, LLC 2006
Abstract This study describes a longitudinal design
(following subjects described in Rutherford & Rogers
[2003, Journal of Autism and Developmental Disorder,
33, 289–302]) to test for predictors of pretend play
competence in a group of children with autism. We
tested the hypothesis that developmental change in
pretend play performance can be predicted by earlier
measures of either executive function, intersubjectivity,
imitation, or general development. Participants at the
time of follow-up testing were 28 children with autistic
disorder (mean chronological age (CA) 57.6 months),
18 children with other developmental disorders (mean
CA 59.0 months), and 27 typically developing children
(mean CA 30.1 months). Children with autism were
profoundly delayed given both competence (prompted)
measures as well as performance (spontaneous) mea-
sures. Joint attention at time 1 strongly and uniquely
predicted pretend play development.
Keywords Autism Æ Pretend play Æ
Longitudinal study
M. D. Rutherford (&)
Department of Psychology, Neuroscience and Behaviour,
McMaster University, 1280 Main Street West, Hamilton,
ON, CanadaL8S 4K1
e-mail: rutherm@mcmaster.ca
G. S. Young Æ S. J. Rogers
The M.I.N.D. Institute, University of California Davis,
Sacramento, CA, USA
S. Hepburn
Department of Psychiatry, University of Colorado Health
Sciences Center, Denver, CO, USA
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Introduction
Autism is a disorder that affects development of
reciprocal social relations, communicative ability, and
flexible, appropriate use of objects beginning in the
first three years of life (DSM-IV). Engagement in
pretend play is one of the areas of development most
profoundly affected by autism, and a large number of
studies of pretend play in autism have been published
over the past two decades, with the consistent finding
that children with autism show decreased frequency,
complexity, and novelty of spontaneous pretend play
behavior. Pretend play deficits are so widely recog-
nized in autism that a failure to use toys symbolically is
an item on many diagnostic systems for autism (e.g. the
ADOS; Lord et al., 2000 and the ADI; Lord, Rutter, &
LeCouteur, 1994).
Because of its primacy as a symptom of autism,
theories that attempt to explain the nature of the
cognitive impairments in autism need to account for
the problems with pretend play. However, few theories
have actually tested empirically their accounts for the
deficiency in pretend play in autism. In addition, the
actual developmental acquisition of pretend play skills
over time has never been examined. There have been
relatively few longitudinal studies involving children
with autism, generally focused on the stability of the
diagnosis, the stability of the severity of symptoms, or
prediction of long-term outcomes (Cantwell, Baker,
Rutter, & Mawhood, 1989; Chung, Luk, & Lee, 1990;
DeMyer et al., 1973; Eisenberg, 1956; Gillberg &
Steffenburg, 1987; Kanner, 1971, 1992; Lord & Scho-
pler, 1989; Lotter, 1978; Venter, Lord, & Schopler,
1992). However, longitudinal approaches allow for the
examination of causal influences on developmental
J Autism Dev Disord (2007) 37:1024–1039
outcomes (Dawson, Toth, Abbott, Osterling, Munson,
Estes, & Liaw, 2004).
The present study was designed to accomplish sev-
eral goals: (1) to compare competing theories con-
cerning the cause of the pretend play deficit in autism,
(2) to examine the specificity of the pretend play
problems by comparing sensorimotor to pretend
play development and (3) to examine the questions of
delay versus difference and the question of compe-
tence versus performance, of the developmental
aspects of pretend play through the use of a longitu-
dinal design and multiple, carefully matched compari-
son groups. By studying atypical development, in this
case development in autism, we hope to learn more
about autism and more about typical development.
This study allows us to selectively test for develop-
mental relationships in cognitive skills that, although
not measurable in typical development, nonetheless
informs us about typical development.
Pretend Play
Play might be the predominant waking activity of
typically developing children (Sutton-Smith, 1976) and
typically developing children develop play skills with-
out explicit instruction (Garvey, 1991; Moyles, 1994).
Here we will define play as the purposeful manipulation
of objects in which exploration and practice of effects
appear to be the child’s goals. Piaget (1952) made a
distinction between sensorimotor play, involving object
manipulation as a means for practice and mastery of
action schemas, and symbolic, or pretend play, which
involved the use of actions on objects to represent real
life or imagined objects, characters, and actions. Piaget
suggested that pretend play provided the child an
opportunity to practice and understand the events
occurring in his or her life and in the child’s social
world. Pretend play generally appears by the age of
18 months and becomes more and more elaborate over
the preschool years (McCune-Nicolich, 1981).
The earliest examples of pretending often include
conventional acts on real, realistic, or miniature objects
outside of typical contexts, like ‘‘drinking’’ from an
empty cup, or rolling a toy car across the floor and
making engine noises. While this kind of play repre-
sents an early stage of pretend play development,
previous autism research has typically categorized this
kind of play as ‘‘functional’’ rather than ‘‘pretend’’
(Baron-Cohen, 1987; Ungerer & Sigman, 1981).
Functional play is theoretically separated from more
sophisticated play because a miniature replica may be
perceived as a small but real object and does not
clearly indicate that the child is using the object to
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symbolize something else (Jarrold, Boucher, & Smith,
1994; Malone & Langone, 1998). Pretend play has been
defined in the developmental literature outside of the
autism literature as simulative or non-literal play (Fein,
1981) or acting as if something is the case when it is
not. For our purposes in this project, we have followed
these latter traditions, classifying as pretend play object
substitution, (the child pretends that some object
stands for another object) attribution of absent prop-
erties, pretending that an imaginary object is present,
and the attribution of animacy and agency to a doll or
other toy (McCune-Nicolich, 1981) without using a
separate category for functional play.
Pretend Play in Children with Autism
It is a well-replicated finding that children with autism
show reduced frequency, complexity, novelty and
spontaneity in pretend play compared to both children
with other kinds of delays and to typically developing
children (Baron-Cohen, 1987; Bernabei, Camaioni, &
Levi, 1999; Doherty & Rosenfeld, 1984; Gould, 1986;
Riguet, Taylor, Benaroya, & Klein, 1981; Ungerer &
Sigman, 1981; Wing, Gould, Yeates, & Brierley, 1977).
In 1975, Ricks and Wing provided the first review of
the play literature in autism and concluded that the
central problem in autism was a difficulty in general
symbolic capacity, affecting language, gesture, and
pretend play. In the first major research paper that
directly examined pretend play in autism, Wing (Wing
et al., 1977) reported decreased frequency of sponta-
neous pretend play in children with autism. In addition,
their pretend play was repetitive and stereotypic
compared to that of children of similar mental ages.
Sigman and Ungerer (Sigman & Ungerer, 1984) and
colleagues (Mundy, Sigman, Ungerer, & Sherman,
1986) reported autism-specific deficits in preschoolers
with autism in three related areas: frequency of spon-
taneous pretend play acts, frequency and complexity
of symbolic sequences, and frequency of different
symbolic acts, produced spontaneously and also in
response to an adult play model. Similar findings have
also been reported from studies of older children when
spontaneous pretend play has been examined (Baron-
Cohen, 1987).
Intersubjective Development and Pretend Play
While the initial interpretation of the pretend play
findings in autism focused on a general difficulty with
symbolization, a very influential paper by Alan Leslie in
1987 (Leslie, 1987) suggested that pretend play required
the same type of cognitive meta-representational
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capacity that understanding other minds requires.
Understanding of other minds or ‘‘Theory of mind’’ is
thought to involve the capacity to understand another’s
mental states and predict behavior based on an appre-
ciation of these mental states (Astington, Harris, &
Olson, 1988; Baron-Cohen, Leslie, & Frith, 1985;
Wimmer & Perner, 1983). Theory of mind (ToM)
theorists have suggested that this capacity develops from
the understanding of other people as subjective beings,
with their own experiences and perspectives. This
intersubjective understanding begins to develop in the
latter half of the first year, as seen in the use of social
referencing, JA behaviors, and intentional communica-
tion to coordinate attention with another and share
experiences (Tomasello & Rakoczy, 2003).
Both theory of mind capacity and pretend play are
specifically impaired in autism, and Leslie has sug-
gested that both of these skills required the capacity to
represent another’s representations, a capacity that he
called metarepresentation. Leslie described the meta-
representational challenge as follows: in pretend play
the child needs to simultaneously hold two represen-
tations in mind, the primary, or veridical representa-
tion and the newly assigned pretend identity (termed
meta-representation), in order to either produce or
understand others’ pretend play.
While this view of pretend play is not universally
accepted among cognitive psychologists, the theoretical
links among pretend play, theory of mind, and JA
behavior have some empirical support in normal
development (Charman et al., 2003) and are further
strengthened by the repeated findings of autism-
specific deficits in all three areas (Volkmar, Lord, Bai-
ley, Schultz, & Klin, 2004). For these reasons, one
purpose of this study was to test the affect of inter-
subjective development on pretend play development.
There is little disagreement in the field that JA
behaviors reflect young children’s awareness of some
‘‘mental’’ processes in others, particularly others’
attention, intention, and affect. Joint Attention (JA) is
the triadic coordination of attention between the child,
another person, and an object or event. Children with
autism are known to be impaired in the production and
comprehension of JA gestures (Curcio, 1978; Ricks &
Wing, 1975), and in their ability to follow or monitor
someone’s gaze (Leekam, Hunnisett, & Moore, 1998).
JA behaviors may be a good measure of the develop-
ment of a precursor of ToM, and it has been argued
that JA behaviors directly reflect a capacity for meta-
representation (Baron-Cohen, 1989), are a precursor of
the theory of mind ability (Rochat & Stiano, 1999) and
are thus markers of the developing ToM. Thus, JA is
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J Autism Dev Disord (2007) 37:1024–1039
the most appropriate measure of ‘‘mental’’ under-
standing in children as young as those in our study.
Executive Function and Pretend Play in Autism
A series of studies have challenged the view that chil-
dren with autism are specifically impaired in the ability
to create pretend play representations (Lewis & Bou-
cher, 1988; Morgan, Maybery, & Durkin, 2003) These
and additional studies using other paradigms have
revealed similar findings: that children with autism
recognize, remember, select and produce symbolically
transformed scenes and props when an adult scaffolds
the situation, leaving vulnerable the intersubjective
account of pretend play development. These findings
provided the first real challenge to the metarepresen-
tational account of the pretend play deficit in autism.
Jarrold and colleagues (Jarrold, Boucher, & Smith,
1996) suggested that this was better understood as a
problem of generating the play ideas rather than a
difficulty with understanding the underlying represen-
tation. Generativity is one of the executive functions,
others of which include the ability to plan ahead in a
sequence of actions, the formulation and initiation of
goal directed behavior, inhibitory control, working
memory and the ability to generate novel behaviors,
and flexible control of attentional processes (Penning-
ton et al., 1997). Pretend play requires inhibition of the
real world interpretations, generativity of new ideas,
and shifting attention from one interpretation of toys
to another. Children with autism show deficits on a
variety of EF tasks (Hughes & Russell, 1993; McEvoy,
Roger, & Pennington, 1993; Ozonoff & McEvoy, 1994;
Ozonoff, Pennington, & Roger, 1991), including set
shift tasks and planning tasks, such as the Tower of
London task (Hughes, Russell, & Robbins, 1994), the
Wisconsin Card Sort task, and the Windows task
(Russell, Mauthner, Sharpe, & Tidswell, 1991). Thus, a
difficulty with one of the executive functions provides
an alternative theory to account for competence–
performance differences in pretend play.
A Social Learning Interpretation of Pretend
Play Problems in Autism
There is one further explanatory theory that has been
suggested, this one based on the lack of dyadic
engagement and social learning that children with
autism experience through imitating and being scaf-
folded more experienced play partners. Imitative or
observational learning has not been thought to depend
on JA or other triadic processes, though it may
J Autism Dev Disord (2007) 37:1024–1039
contribute to them (Rogers and Pennington, 1991:
Rogers et al, 2003). While developmentalists tend to
think of play as developing through cognitive matura-
tion, several authors have emphasized the importance
of imitative, or observational learning in the develop-
ment of pretend play. Piaget theorized that symbolic
play developed from imitation of the social world, as
deferred imitation (Piaget, 1952). Note that the social
learning view implicitly weighs the role of both
immediate and deferred imitation heavily, as a crucial
vehicle for social learning. Therefore, we use a
measure of imitation as a marker of social learning in
this age group.
General Cognitive Maturity as a Predictor
of Pretend Play
Finally, it is possible that pretend play develops in an
individual as that individual matures cognitively. This
view is widely encouraged, sometimes explicitly,
sometimes implicitly. Developmentalists tend to think
of play as developing through cognitive maturation.
Therefore, we include a measure of mental age (MA)
as a predictor variable.
Using Longitudinal Studies to Test Developmental
Theories
Each of the above theories suggests a different set of
foundational skills as necessary for the development
of pretend play in early childhood, and a longitudinal
design could help to test these different models.
Longitudinal studies of typical development have
consistently found a relationships between pretend
play and language development (Haight & Miller,
1992; McCune-Nicolich, 1981; Russ, Robins, &
Christiano, 1999). Longitudinal studies have also
documented relationships between play patterns of
social partners and development of pretend play in
typical children (McCune, Dipane, Fireoved, &
Fleck, 1994), providing possible support for a social
learning view of pretend play.
There has been very little longitudinal work examining
pretend play in autism. Marian Sigman and Ruskin
(Sigman, 1998; Sigman & Ruskin, 1999) published a large
and comprehensive study of 70 children with autism, 93
with Downs, 59 with other developmental delays, and 108
typical children. These children were initially tested be-
tween 1 and 5 years of age and tested again 8–12 years
later. Although she used pretend play measures as early
predictors, she did not report follow-up measures of
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pretend play. Rather, she was interested in how early
pretend play measures related to later verbal and social
capacities, and found that an early measure of pretend
play was a significant predictor of later language.
While several models may explain the pretend play
deficit in autism, only a few papers have attempted to
test these models. Morgan et al (2003) tested the
explanatory power of the central coherence hypothesis
to account for pretend play deficits and found that
pretend play was completely independent of central
coherence measures in both children with autism and
those with other delays. In an earlier paper, we began
to test these theoretical models (Rutherford & Rogers,
2003). We examined the relationships between pretend
play performance, general developmental maturity, JA
as a marker of intersubjectivity, and two executive
functions: generativity and inhibition. For the entire
group of children, both executive function tasks were
strongly associated with pretend play, but not with
sensorimotor play. In the present study, we use a lon-
gitudinal design to test these theoretical accounts of
the pretend play deficit in autism.
The Current Study
The present study was designed to test these seven
hypotheses:
1. Pretend play in autism is dependent upon general
cognitive maturity (MA) and general symbolic
capacity. Early developmental rates measured as
MA will predict pretend play maturity at time 2.
2. Pretend play is dependent upon executive perfor-
mance. Early measures of generativity and cognitive
flexibility will predict maturity of pretend play at
time 2.
3. Pretend play depends on understanding others’
mental representations. Given that pretend play
emerges during the first two years of life, JA
behaviors are the best measure of developing
awareness of other’s ‘‘mental’’ processes.
4. Pretend play is dependent upon social learning
experiences as well as cognitive maturity. Ability
to imitate others is the main vehicle for social
learning and should moderate development of
pretend play skills in autism.
5. Children with autism will demonstrate a qualita-
tively different pattern of pretend play development
compared to typically developing children or those
with general developmental delays—demonstrating
a deviant pattern of development rather than simply
a delay.
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6. Children with autism will demonstrate more
impairment in spontaneous performance of pre-
tend play than in scaffolded situations, supporting
the competence/performance hypotheses of pre-
tend play in autism.
7. Pretend play is uniquely affected in autism. Sen-
sorimotor play is unaffected by autism and reflects
developmental maturity.
Methods
Participants
The participants were 28 children with autistic disorder
(AD), 18 children with other developmental disorders
(DD), and 27 typically developing children all matched
on overall MA at both time periods. Children in the two
clinical groups were seen twice over a 24-month period.
In order to maintain developmental matching of all
groups, the typically developing children were seen
twice within a 12-month period. The average chrono-
logical ages (CA) of these children at time 1 were
33.9 months for the children with autism, 34.8 months
for the children with other developmental disorders,
and 19.5 for the typically developing children. The
average CA at time 2 were 57.6 months, 59.0 months,
and 30.1 months respectively (see Table 1).
The children with autism and other developmental
disorders were recruited from various health and early
education agencies. The typically developing children
were recruited from pediatrician’s offices and through
a large university developmental subject pool. The
children with autism were free from any other medical
condition, had no visual or hearing impairment, had
been diagnosed with autism by an outside agency,
received current clinical diagnoses of autism, and met
criteria for autism on at least two of three diagnostic
systems: DSM-IV, ADI-R and ADOS-G.
The children in the DD group all had normal vision
and hearing or vision corrected to within the normal
range, had unimpaired hand use, and were mobile.
None was considered by any clinician, past or present,
to have symptoms of autism. No one in the DD group
met criteria for autism on the DSM-IV, one met
criteria for autism on the ADOS-G, and one met cri-
teria for autism on the ADI-R. These children were
kept in the sample because clinical assessment did not
suggest autism, and because any bias introduced would
be conservative. The diagnoses for these 18 children
included 7 children with Down Syndrome and 11
children with mixed etiology developmental disorders.
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J Autism Dev Disord (2007) 37:1024–1039
There were 27 typically developing children who
continued to time 2 testing. None of these children met
ADOS-G, ADI-R or DSM-IV criteria for autism or
PDD. None of them had other psychiatric or devel-
opmental diagnoses.
Measures
Autism Diagnostic Interview—Revised (Lord et al.,
1994)
The ADI-R is a structured, standardized parent inter-
view developed to assess the presence and severity of
symptoms of autism in early childhood across the three
main symptom areas in autism. Raters in this project
were reliable to 85% or better item agreement on three
consecutive administrations using the full range of
scores (0–3) rather than the truncated scoring usually
used (0–2). Reliability was checked on 20% of partic-
ipants and was at or above 85%.
Autism Diagnostic Observation Schedule—Generic
(Lord et al., 2000)
The ADOS-G is a semi-structured standardized inter-
view using developmentally appropriate social and toy-
based interactions in a 30- to 45-min interview to elicit
symptoms of autism in four main areas: social inter-
action, communication, play, and repetitive, restrictive
behaviors. Dr. Lord trained two of the raters in the
present study to reliability on the ADOS-G; the other
raters in the lab were trained to reliability of 85% or
better item agreement on three consecutive adminis-
trations using the full range of scores (0–3). This was
measured on 20% of participants.
Mullen Scales of Early Learning—(Mullen, 1989)
The MSEL is a standardized developmental test for
children ages 3 months to 60 months consisting of five
subscales: gross motor, fine motor, visual reception,
expressive language, and receptive language. The
MSEL was administered to all subjects according to
standard instructions by raters with advanced degrees
trained in assessing young children with autism and
other developmental disorders. Reinforcers were used
at times to reward cooperation and attention.
Abridged Early Social Communication Scales (ESCS;
Mundy, Hogan, & Doehring, 1996)
The ESCS involves a 20-min semi-structured toy-based
interaction between examiner and young child that is
J Autism Dev Disord (2007) 37:1024–1039 1029

Table 1 Chronological age

CA (months) VMA (months) NVMA (months) Overall MA (months)
and Mullens overall MA
Time 1
Autistic disorder: n = 28
Mean 33.65 16.50 23.7 20.35
SD 3.67 6.8 6.17 6.35
Range 26–41 5–33 12.5–43.5 11.5–41.75
Developmental disabilities: n = 18
Mean 35 20.36 23.41 21.75
SD 7.21 6.5 6.58 6.2
Range 24–47 11–31 16–35 14.25–33
Typically developing: n = 27
Mean 19.67 23.83 23.41 21.26
SD 4.77 7.13 6.58 4.56
Range 12–35 11.5–42.5 16–35 14–28.5
Time 2
Autistic disorder: n = 28
Mean 57.6 29.21 38.21 37.2
SD 3.89 13.70 13.28 12.5
Range 48–65 8–51.5 14–62.5 12.25–56.25
Developmental disabilities: n = 18
Mean 59.0 34.36 36.36 35.64
SD 7.6 11.93 10.61 10.98
Range 47–71 10.5–62 16.5–51.5 13.5–56.75
Typically developing: n = 27
Mean 30.1 39.5 35.9 38.0
SD 4.1 6.68 5.0 5.2
Range 25–38 24.5–54.5 25.5–46.5 25–45.5

designed to elicit a sample of a child’s non-verbal
communicative behaviors across several communica-
tive functions. Inter-rater reliability was initially
established at 85% and then maintained throughout
the project by having two raters code 20% of all tapes.
All JA measures in this study were taken from the
ESCS. We calculated overall JA scores by converting
both Initiating Joint Attention (IJA) and Responding
To Joint Attention (RJA) scores to Z-scores, and then
taking the average of these two measures for each
subject, yielding a normalized JA score for each
subject. Before this transformation, IJA and RJA were
significantly correlated (r = .30, P = .01). We used this
overall JA score as our index of awareness of others’
mental processes.
Pretend Play Frequency Counts
and Developmental Measures
There is a theoretically important difference between
competence and performance of pretend play, but to
date most work in this area has focused on perfor-
mance rather than competence. In most of the studies
on pretend play in autism, data have involved
frequency counts from videotape, a good index of
performance, but not suitable as a measure of com-
petence. The particular frequency variables that are
gathered and analyzed have significance for the inter-
pretation of group differences. As the studies from
Sigman’s lab have illustrated, examining total number
of play acts in a category can give quite a different
picture than examining number of novel play acts, or
maturity of play acts. Qualitative differences may be
missed when more fine-grained aspects of the play are
not considered. There are some methodological
options for assessing competence, or maturity of play
(Fewell & Rich, 1987) and this approach was used in
this study.
The Fewell Play Scale, 5th edition (Fewell & Rich,
1987) was administered to all subjects by trained raters.
This scale involves a semi-structured play interview
designed to assess play maturity in children
5–30 months of age. A set of toys is placed on the table
and the experimenter says ‘‘What can you do with
these toys?’’ or ‘‘Here are some things that you can
play with.’’ If the child does not play spontaneously,
the experimenter prompts the child by either modeling
the play behavior, or giving specific instructions. The
exact verbal prompt or model action is specified for
each item. Items are ordered from easiest (targeted to
2- to 4-month-olds) to hardest (targeted to 27- to
30-month-olds), and the test is terminated once both
the basal level (three consecutive passes) and the
ceiling (three consecutive failures) are found.

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The Fewell measure gives a child full credit for
performing a pretend play act even once because it
demonstrates that the child has that ability. Our
measure provided an opportunity for both spontaneous
and scaffolded play, further lending each child an
opportunity to demonstrate his or her competence. If
the child did not produce a specific play act sponta-
neously, the adult prompted it first by a verbal prompt,
then by modeling, then finally with the verbal prompt
and modeling combined. This use of controlled task
difficulty and carefully specified and graded prompts
gave each child every opportunity to exhibit his or her
level of competence, and to largely bypass confounds
such as motivation and generativity deficits seen in
studies that focus on frequency counts. The order in
which our subjects passed the items was highly corre-
lated with the canonical order of the Fewell Play Scale,
supporting the developmental ordering of the scale.
For the purposes of this project, the total scores were
divided into pretend play scores and sensorimotor play
scores. The pretend play scores included all items
involving acts with a doll as agent, and all items involving
the use of a prop as if it were another object (Rutherford
& Rogers, 2003). In calculating scaffolded pretend play
scores, a child was awarded 4 points for completing the
item spontaneously, three points for completing it with a
verbal prompt, two points for completing it after it was
modeled, one point for completing it after both a verbal
prompt and modeling, and no points if the item was not
completed. Reliability was high; Cronbach’s a was .79
calculated on 100% of subjects.
Twenty-one of the items from the original play scale
made up in the sensorimotor play scale. Scores were
calculated in the same way as for the pretend play scale.
Reliability on this scale was also high; Cronbach’s a was
.80 in this study calculated from 100% of subjects.
Executive Function Measure: Spatial Reversal Task
This task was designed to assess the child’s ability to
change search strategy when the spatial location of a
reward had changed, based on a paradigm developed
by Kaufman and colleagues (Kaufman, Leckman, &
Ort, 1989). In the first trial, two opaque cups were
inverted on a table behind a screen, and out of view of
the child. A reward (a snack or toy) was placed under
each cup. The screen was removed and the child was
allowed to search for the reward by looking under only
one cup. In the next trial, the reward was placed only
under the cup that the child looked under in the first
trial. Once the child has achieved four consecutive
correct searches, the reward was hidden under the
other cup. The location of the toy was reversed
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J Autism Dev Disord (2007) 37:1024–1039
following every fourth consecutive successful trial for
23 total trials.
The number of correct searches was recorded
(excluding the first trial) as were the number of
perseverative responses. A perseverative response was
a search that repeats an immediately preceding incor-
rect search. The scores analyzed in this study were the
number of correct searches minus the number of
perseverative responses.
Imitation. The imitation battery was developed by
one of the authors (S.R.). The initial battery consisted
of 16 tasks. Seven items were eliminated prior to
analyses due to violations of assumptions of normality;
so nine items were used (three manual acts, three non-
conventional actions on objects, and three oral-facial
movements). (See Rogers et al, 2003 for imitation
items.) The test battery was split in half and adminis-
tered on two separate days using a counterbalanced,
randomized order of items. Items were administered at
a table, with the child facing the adult. A specific
administration procedure was employed throughout
imitation trials based on (Meltzoff and Moore, 1977).
With the child looking directly at the adult, the exam-
iner said ‘‘(Name), do this’’ and repeated the action
three times rapidly in a burst of three actions each (thus
demonstrating nine rapid repetitions of the action).
The child was rewarded for any attempt with social,
and sometimes tangible, rewards. The first spontaneous
imitation and the best imitation were scored and all
coding was done from videotape. Examination of first
and best performance scores revealed no significant
differences; therefore, first scores were used through-
out the analyses. Scoring criteria for accuracy of each
item were established based on the number of errors
involved in the child’s performance, with 0 reflecting no
action at all, 1 reflecting a movement that appeared
unrelated to the target movement, and higher scores
reflecting fewer errors in the production. Errors con-
sisted of inaccuracies like bimanual-unimanual substi-
tutions, location of contact point on the body, and
inaccurate limb positions. For the analysis, the scores of
1’s were converted to 0’s, so that only imitative re-
sponses received scores. Inter-rater reliability was
established prior to scoring and maintained throughout
the study by having two coders independently rate 20%
of the tapes. Inter-rater reliability assessed via weigh-
ted kappas ranged from .86 to .88.
Results
The dependent measures were first analyzed for vio-
lations of assumptions of the statistical procedures, and
J Autism Dev Disord (2007) 37:1024–1039
it was found that skewness and kurtosis were less than
an absolute value of 1 and thus did not need to be
corrected (Fidell & Tabachnick, 2003). Variance was
assessed by examining Levene’s test for homogeneity
of variance. For variables where Levene’s test was
significant, Fmax ratios were calculated. None of the
Fmax ratios were greater than 4 and thus the data was
considered to have met statistical assumptions (Fidell
& Tabachnick, 2003). We also assessed deviations from
linearity by examining the predictor by residual plots,
which exhibited random scatter.
General Analysis Strategy
For each play variable, both at time 1 and at time 2,
the analysis strategy used was designed to examine
three basic questions: (a) Are there group differences
in play?; (b) What other developmental variables best
predict individual differences in play?; and (c) Do
predictive relationships differ as a function of group?
Multiple regression was used to address each of these
questions in successive steps: first we examined the
main effect for diagnosis using dummy codes to
represent specific contrasts (i.e., autism vs. DD, and
DD vs. Typical); second we used a stepwise entry
procedure with the group of predictor variables (imi-
tation, JA, executive functioning, MA) to explore
which variable(s) best predicted play after accounting
for group differences; third, following any significant
effects for predictor variables, we examined any group
by predictor variable interactions using centered
product vectors to explore whether such predictive
relationships found on the second step differed as a
function of group. We first report the results of such
analyses for the play variables at time 1, followed by
the same analyses for play variables at time 2. Note
that for time 2, however, all play variables were com-
puted as absolute change from time 1 scores in order to
effectively partial out time 1 from time 2 play scores.1
We tested whether the three groups had significant
differences in our demographic measures: CA, overall
MA, verbal mental age (VMA) and non-verbal mental
age (NVMA) at time 2. Table 1 shows these means for
each group. A single multivariate analysis was per-
formed with each of our demographic measures as a
dependent variable and group as the fixed factor. The
overall MA for the groups was not significantly
different (F(2, 40) = .146, P = .86), which was expected
1
The same analyses done using play scores at time 1 as a true
covariate (i.e., entered into the model even before group diag-
nosis) yielded the same results, albeit with the expected drop in
power when using additional variables).
1031
since they had been matched on overall MA. There
was no significant difference in VMA (F(2, 40) = 1.90,
P = .16), or NVMA for the groups (F(2, 41) = .20,
P = .82). As expected, the difference between the
three groups on CA was significant, (F(2, 40) = 94.88,
P < 0.001). Socio-economic status did not differ
significantly between groups.
Before presenting results from the regression mod-
els, we will first look at correlations between the four
time 1-predictor variables. As can be seen in Table 2,
there were significant relationships between overall
MA and each of the other three variables; in contrast,
there were no significant correlations between any of
the three domains of JA, imitation, and spatial reversal
As such, these latter three time 1-predictor variables
are assumed to measure relatively independent
domains, whereas overall MA is a measure of general
developmental level (and thus its ubiquitous relation-
ship with most other measures).2 Next, we will briefly
address the issue of matching here by reporting group
demographic comparisons at time 2 along with the
same analyses at time 1.
Analyses of Time 1 Variables
Group Differences in Development of Play at Time 1
As shown in Tables 3–6, the first step of each three-step
multiple regression analysis reveals that there are
significant group differences for all measures: both
spontaneous and scaffolded pretend play and sponta-
neous and scaffolded sensorimotor play at time 1.
Group contrasts, as represented by dummy codes,
show that the autism group exhibited less pretend play
at time 1 than the DD group in spontaneous and
scaffolded conditions. Similarly, the autism group
showed less sensorimotor play than the DD group in
both spontaneous and scaffolded conditions. The
difference between the typical group and the DD
group in play was not significant, for any condition.
Thus, children with autism demonstrated a develop-
mental delay in all play measures at time 1 even
though all were matched on developmental maturity.
In contrast, the DD and typical groups did not differ.
Group Demographic Comparison at Time 2
Next, we tested whether the three groups had significant
differences in our demographic measures: CA, overall
2
It should be noted however, that for the AD group, when
analyzed separately, there was a significant relationship between
JA and Imitation (r = .44, P = .03).
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1032 J Autism Dev Disord (2007) 37:1024–1039

Table 2 Correlations of time 1 predictor variables or NVMA for the groups (F(2, 41) = .20, P = .82). As
Overall MA Spatial reversal Imitation expected, the difference between the three groups on
CA was significant, (F(2, 40) = 94.88, P < 0.001).
JA r = .37 r = .15 r = .14
P = .004 P = .32 n.s.
Imitation r = .51 r = .18 What T1 Measures Predict Pretend Play Development
P < .001 P = .22 at Time 1?
Spatial reversal r = .51
P < .001
The second block of the regression analyses examined
the relationship between each of the predictor vari-
ables of interest: JA, imitation, spatial reversal, and
Table 3 Summary of hierarchical regression analysis for overall MA.
variables predicting time 1 spontaneous pretend play scores Spontaneous Pretend Play. As shown on Table 3
Step Variable B SE(B) ß DR2 F for DR2 diagnosis by itself accounted for 23% of the variance
(F(2, 35) = 5.18, P < .05) in pretend play at time 1.
1 Diagnosis 1 –1.59 .51 –.53* .23 5.18* Once the variance associated with diagnosis was
(autism vs. DD)
Diagnosis 2 –.52 .62 –.14
removed, no other predictor variable was a significant
(DD vs. typical) predictor of development of spontaneous pretend play.
Scaffolded Pretend Play. As shown in Table 4,
Note. 37 participants were included in the analysis
diagnosis again accounted for a significant amount of
*P < .05; **P < .01; ***P < .001
the variance in scaffolded pretend play: 28%. Once the
variance associated with diagnosis was removed,
MA, VMA and NVMA at time 2. Table 1 shows these overall MA was a significant predictor of scaffolded
means for each group. A single multivariate analysis was pretend play at time 1. Furthermore, the third step of
performed with each of our demographic measures as a the analysis shows that this relationship differs as a
dependent variable and group as the fixed factor. The function of group, F(5, 32) = 8.24, P < .001. Specifi-
overall MA for the groups was not significantly different cally, the interaction terms revealed that MA is a
(F(2, 40) = .146, P = .86), which was expected since stronger predictor of scaffolded pretend play in the
they had been matched on overall MA. There was no DD group (r = .31) than in the AD group (r = .13); in
significant difference in VMA (F(2, 40) = 1.90, P = .16), contrast, the relationship between scaffolded play and

Table 4 Summary of
Step Variable B SE(B) ß DR2 for step F for DR2
hierarchical regression
analysis for variables 1 Diagnosis (autism vs. DD) –5.72 1.86 –.45** .28 7.19**
predicting time 1 scaffolded Diagnosis (typical vs. DD) .78 1.98 .06
pretend play scores 2 Diagnosis (autism vs. DD) –5.10 1.67 –.40** .09 10.46***
Diagnosis (typical vs. DD) .45 1.76 –.40
MA (time 1) .44 .12 .42**
3 Diagnosis (autism vs. DD) –5.2 1.56 –.41** .08 8.24***
Note. 38 participants were Diagnosis (typical vs. DD) .54 1.71 .04
included in the analysis MA (time 1) .76 .18 .73***

MA · Diagnosis (autism vs. DD) –3.84 1.48 –.40*
P = .05; *P < .05; MA · Diagnosis (typical vs. DD) –2.27 2.20 –.13
**P < .01; ***P < .001

Table 5 Summary of
Step Variable B SE(B) ß DR2 for step F for DR2
hierarchical regression
analysis for variables 1 Diagnosis (autism vs. DD) –4.40 1.24 –.55** .34 9.31**
predicting time 1 spontaneous Diagnosis (typical vs. DD) .72 1.54 .07
sensorimotor scores 2 Diagnosis (autism vs. DD) –4.16 1.18 –.51** .10 8.76***
Diagnosis (typical vs. DD) 1.67 1.51 .17
Spatial reversal .167 .07 .31*
3 Diagnosis (autism vs. DD) –3.41 1.19 –.42** .07 6.61***
Diagnosis (typical vs. DD) 2.05 1.49 .20
Note. 38 participants were
Spatial reversal .40 .13 .74**
included in the analysis


SR · Diagnosis (autism vs. DD) –2.79 1.37 –.39

P = .05; *P < .05; SR · Diagnosis (typical vs. DD) –2.66 1.51 –.32
**P < .01; ***P < .001

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J Autism Dev Disord (2007) 37:1024–1039
Table 6 Summary of hierarchical regression analysis for variables predicting time 1 scaffolded sensorimotor scores
Step Variable B SE(B)
1 Diagnosis 1 (autism) –13.6
Diagnosis 2 (typical) 5.04
2 Diagnosis 1 (autism) –12.2
Diagnosis 2 (typical) 8.4
Overall MA (time 1)
Spatial reversal (time 1)
Note. 36 participants were included in the analysis
*P < .05; **P < .01; ***P < .001
MA was statistically equivalent between the DD group
and the typically developing group (r = .62). No other
predictor variable was a significant predictor of devel-
opment of scaffolded pretend play.
Spontaneous Sensorimotor Play. For spontaneous
sensorimotor play, diagnosis accounted for 34% of the
variance (F(2, 35) = 9.31, P < .01). Once the variance
associated with diagnosis was removed, only spatial
reversal (ß = .31, P £ .001) predicted spontaneous
sensorimotor play at time 1. Results showed that
product vectors were significant predictors of sensori-
motor play development since there was a significant
group by spatial reversal interaction (F(5, 32) = 6.61,
P < .001). Examination of individual interaction terms
revealed that spatial reversal was a significantly stron-
ger predictor of spontaneous sensorimotor play for
children with DD (r = .62) than it was for children with
autism (r = .19). In contrast, there was no difference in
this predictive relationship when comparing children
with DD to typically developing children (r = .41).
Scaffolded Sensorimotor Play. For scaffolded sen-
sorimotor play, diagnosis accounted for 31% of the
variance F(2, 35) = 7.54, P < .01). Once the variance
associated with diagnosis was removed, only spatial
reversal (t(36) = 2.22, P = .03) was a significant pre-
dictor of scaffolded sensorimotor play at time 1. No
other predictor variable significantly predicted scaf-
folded sensorimotor play scores at time 1. Results
showed that product vectors were significant predictors
of sensorimotor play development since there was a
significant group by spatial reversal interaction (F(5,
36) = 6.38, P < .001). Examination of individual
interaction terms revealed that spatial reversal was a
significantly stronger predictor of scaffolded sensori-
motor play for children with DD (r = .73) than it was
for children with autism (r = .08). There was also a
significant difference in this predictive relationship
when comparing children with DD to typically devel-
oping children (r = .34).
1033
ß DR2 F for DR2
4.6 –.47** .31 7.54**
5.6 .15
4.4 –.42 .12 7.26**
5.5 .24
.29
.31*
Analyses of Time 2 Variables
Group Differences in Pretend and Sensorimotor Play at
Time 2
Scaffolded and spontaneous pretend and sensorimotor
play scores are shown in Table 7. The difference in
spontaneous pretend play scores at time 2 was signifi-
cantly different between the three groups, (F(2,
43) = 12.2, P < .001), as was the difference in scaf-
folded pretend play (F(2, 51) = 5.45, P = .007); the AD
group showed fewer examples of pretend play than the
two control groups in both cases. More specifically, the
AD group showed significantly lower spontaneous
pretend play scores than the DD group ((t) = 3.50,
P = .001) whereas the DD group and the typical group
did not differ significantly ((t) = .85, n.s.). In addition,
the AD group showed significantly lower scaffolded
pretend play scores than the DD group ((t) = 2.27,
P = .028) whereas the DD group and the typical group
did not differ significantly ((t) = .62, n.s.).
In contrast, there were no group differences in either
spontaneous sensorimotor play or scaffolded sensori-
motor play, though the AD group showed fewer
examples of spontaneous sensorimotor play than the
other two groups.
What T1 Measures Predict Development in Pretend
Play from Time 1 to Time 2?
The second block of the regression analyses examined
the relationship between each of the predictor vari-
ables of interest: JA, imitation, spatial reversal and
overall MA at time 1 and changes in pretend play
scores between time 1 and time 2. Complete results
appear in Tables 8 and 9.
Spontaneous Pretend Play. As shown in Table 8
diagnosis by itself accounted for 14% of the variance
and was a significant predictor of pretend play devel-
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1034 J Autism Dev Disord (2007) 37:1024–1039

Table 7 Group means on play measures at time 2

Scaffolded Scaffolded Spontaneous Spontaneous
pretend play SM play pretend play SM play

Autistic disorder (n = 28) 9.81 35.05 2.7 13.2

SD = 9.25 SD = 19.53 SD = 2.6 SD = 5.9
Developmental 16.5 31.36 5.7 18.6
disorder (n = 18) SD = 9.8 SD = 23.37 SD = 2.0 SD = 3.8
Typical (n = 27) 19.81 46.31 6.6 20.3
SD = 11.05 SD = 34.6 SD = 2.0 SD = .65
F(2, 51) = 5.45 F(2, 51) = .086 F(2, 43) = 12.2 F(2, 51) = 1.41
P = .007 P = .91 P < .001 P = .25

Table 8 Summary of hierarchical regression analysis for variables predicting change in spontaneous pretend play scores
Step Variable B SE(B) ß DR2 for step F for DR2

1 Diagnosis (autism vs. DD) –1.96 .94 –.40* .14 2.5

Diagnosis (typical vs. DD) –.40 1.21 –.06
2 Diagnosis (autism vs. DD) .28 1.37 –.06 .12 4.5*
Diagnosis (typical vs. DD) .95 1.31 .15
JA (time 1) 1.36 .64 .53*
3 Diagnosis (autism vs. DD) –.24 1.54 –.05 .03 .59
Diagnosis (typical vs. DD) 1.08 1.55 .17
JA (time 1) 1.18 1.26 .46
JA · Diagnosis (autism vs. DD) –.33 1.90 –.07
JA · Diagnosis (typical vs. DD) 1.88 2.3 –.18

Note. 47 participants were included in the analysis

*P < .05; **P < .01; ***P < .001

Table 9 Summary of hierarchical regression analysis for
variables predicting change in scaffolded pretend play scores
Step Variable B SE(B) ß DR2 F for DR2
1 Diagnosis 1 (autism) –7.85 3.4 –.39 .17
Diagnosis 2 (typical) .36 3.6 .02
Note. 48 participants were included in the analysis
*P < .05; **P < .01; ***P < .001
opment. Once the variance associated with diagnosis
was removed, only JA at time 1 significantly predicted
spontaneous pretend play development accounting for
another 12% (change in R2 = .12) of the variance.
Once the variance associated with both diagnosis and
JA was removed, no other variable predicted sponta-
neous play development over time.3
In the final step of each regression analysis, we
examined possible interaction effects of JA with diag-
nosis in order to determine whether play development
in the different diagnostic groups may be dependent on
different processes. We examined possible interactions
by creating product variables by multiplying JA
4.2*
Z-scores (calculated across all three groups) by the
diagnostic dummy variables. Results showed that these
product variables were not significant predictors of
pretend play development in any of our four analyses.
In other words, JA affects development of pretend play
similarly across the different diagnostic groups.
Scaffolded Pretend Play. Diagnosis again accounted
for a significant amount of the variance in scaffolded
pretend play: 17%. Once the variance associated with
diagnosis was removed, no other predictor variable was
a significant predictor of development of scaffolded
pretend play.
Sensorimotor Play. Neither diagnosis nor any of the
predictor variables significantly predicted change in
either spontaneous or scaffolded sensorimotor play
scores over time.

How do Performance and Competence Compare?

3
Note that in a hierarchical regression in which MA, imitation
and spatial reversal are forced in before JA, JA still predicts a
One important question driving this longitudinal study
significant amount of variance in spontaneous pretend play
development (P = .002) whereas no other predictor, while forced is the question of play performance versus underlying
in ahead of JA, predicts a significant amount of variance. competence. We used spontaneous play as a marker of

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J Autism Dev Disord (2007) 37:1024–1039
performance, to tell us whether a child is likely to
voluntarily engage in play, and scaffolded play as a
marker of competence, to tell us whether a child can
engage in play, given extensive social support and
modeling. In order to directly compare scaffolded
and spontaneous play scores, we converted each to
Z-scores, so that each participant had one Z-score for
scaffolded pretend play and one Z-score for spontane-
ous pretend play. The average Z-score for each variable
for each group is shown in Fig. 1. We know from the
above group comparison that the AD group has sig-
nificantly lower scores on both scaffolded and sponta-
neous pretend play. We directly compared these
relationships by using the Z-scores in a 2 (spontaneous
vs. scaffolded) by 3 (group) ANOVA, which reveals an
interaction between these two play scores and group
membership (F(2, 42) = 4.4, P = .02). In the post-hoc
analysis, the autism group showed a different relation-
ship between these two measures than either the DD
group (P = .02) or the typical group (P < .001). (There
was no main effect of spontaneous vs. scaffolded, which
is what would be expected since we were comparing
independently derived Z-scores). For the autism group,
spontaneous pretend Z-scores, our measures of per-
formance, are significantly lower than scaffolded pre-
tend Z-scores, our measure of competence. For the
other groups the differences between spontaneous and
scaffolded scores did not reach significance. Thus,
children with autism show much less spontaneous
symbolic play, compared to their scaffolded production,
than do the other groups. Either the group with autism
is much more responsive to social modeling than typical
or delayed children (which seems unlikely), or children
with autism have much more difficulty generating play
Performance and Competence Compared
0.5
0.4
0.3
0.2
0.1
Z-score
0 group did not significantly differ from controls in pre-
DD IA Typ
-0.1
-0.2
-0.3
Spontaneous
-0.4 Scaffolded
-0.5
DD IA Typ
Fig. 1 Spontaneous and scaffolded pretend play performance in
three groups: developmental delay, idiopathic autism, and typical
1035
schemas than other groups (as suggested by Jarrold and
others (Jarrold et al., 1996)).
Discussion
This longitudinal study was designed to contribute to
our understanding of the development of pretend play
in typically developing children, children developing
with autism and children with other developmental
disabilities. One major aim of this study was to test
several theoretical accounts of the nature of pretend
play, both in typical development and in autism.
Accounts tested included cognitive maturation, a
metarepresentational theory of pretend play, an exec-
utive function theory of pretend play, and a social
learning, or imitative theory of pretend play. A second
major aim was to examine the pretend play compe-
tence, as well as performance, in young children with
autism. Past research on pretend play in autism has
often focused only on performance, examining
frequency and novelty of spontaneous pretend play
acts in particular. Since some authors have suggested
that the deficit in autism involves generating the play
ideas (the performance aspect), as opposed to being
capable of representational play (the competence
aspect), we provided a scaffolded condition in which
adults provided increasing support for generating
symbolic play ideas, and compared children’s produc-
tions of both spontaneous and scaffolded play. Finally,
we were interested in the specificity of the play deficit.
Is pretend play the only type of play affected by
autism, or is sensorimotor play also impaired?
The specificity question was addressed by examining
both sensorimotor play and pretend play. At time 1,
when children had an MA of just under 2 years old, the
autism group showed a deficit in all kinds of play:
pretend and sensorimotor, and for both performance
(spontaneous) and competence (scaffolded) measures.
However, by the time of the second visit, when chil-
dren had an MA of around 3 years old, the autistic
deficit in play was specific to pretend play, and not seen
in sensorimotor play. This deficit appears to be an
autism-specific deficit, as the developmentally delayed
tend play.
This contrast bears on the theoretical question
concerning generativity deficits. The executive func-
tion hypothesis involving generativity and set shifting
would predict deficits in spontaneous play compared
to scaffolded play in both pretend and sensorimotor
conditions (though the pretend condition could be
more affected because the play ideas are coming
123
1036
from a repertoire of ideas, where the sensorimotor
play ideas arise from the affordances of the materials
themselves). There was no significant group differ-
ence in spontaneous or scaffolded sensorimotor play
scores, whereas there were significant group differ-
ences in both spontaneous and scaffolded pretend
play scores, for the autism group only (as illustrated
in Fig. 1). Our results agree with past research on
similar groups showing a specific pretend play deficit
in autism that is not restricted to spontaneous pro-
duction. Thus, the play deficit is specific to pretend
play and affects both spontaneous and scaffolded
play. This suggests that, in these groups, pretend play
scores cannot be explained by a failure to generate
novel behaviors. Note, however that for the autism
group, there is still a significantly greater deficit in
spontaneous than scaffolded pretend play, leaving
open the possibility of some, perhaps small, rela-
tionship between generativity and spontaneous
pretend play.
The regression analyses provide the strongest com-
parison of our focal question: which theoretical per-
spective is best able to predict pretend play
development. We used four measures of ability at
time 1: JA, executive function, imitation, and general
cognitive development, as possible predictors. Each
measure is theoretically tied to an account of the
development of pretend play. Only the JA measure
predicted variability in change scores in pretend play
between time 1 and time 2. JA accounts for a signifi-
cant amount of development in spontaneous pretend
play, even after removing all the variance associated
with diagnosis. As further evidence of the special and
unique role of JA behavior, the JA measure was not a
strong or significant predictor of sensorimotor play
development in our participants. This is a dramatic
demonstration of the strong and unique relationship
between JA and the development of spontaneous
pretend play.
What does JA allow for? What is the mechanism
that explains this relationship between JA and pretend
play? JA is a pivotal concept in several different
theories of typical and autistic development. For
example, these results are consistent with the theory of
mind theory, which suggests that early deficits in a
‘‘shared attention mechanism’’ (measured with JA
measures) leads to theory of mind deficits, including a
failure to understand pretend play. According to this
theory, JA is an important developmental building
block, without which typical theory of mind develop-
ment will not take place.
The current findings do not support a model of
symbolic play that develops directly from dyadic, or
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J Autism Dev Disord (2007) 37:1024–1039
gestural imitation. While the children clearly benefited
from adult modeling of toy-directed actions in the
scaffolded condition, the strong predictive relationship
with JA, but not dyadic imitation, emphasizes the
triadic nature of the social learning involved. Children
need to integrate the partner, and the action on the
object. JA reflects a child’s ability to coordinate mind
and attention with that of a social partner, and allows
the child to take in information from other people.
Dyadic engagement may well underlie triadic
engagement, however. The strong role of JA in pretend
play development found here is consistent with social
orienting models of development (see, e.g. Dawson,
Meltzoff, Osterling, Rinaldi, & Brown, 1998; Mundy &
Neal, 2001). According to this model, young typically
developing children spend much more time spontane-
ously orienting to social stimuli, and therefore have
access to much more social and non-social information,
than children with autism. Development of JA may well
be the result of dyadic processes involving mechanisms
underlying emotions or affect sharing (Hobson, 1993).
If affect is not easily or spontaneously shared, reflected
and experienced in young children with autism, the
typical motivation or reinforcement for engaging in
pretend play with another may be reduced. While
dyadic processes may be important foundations for the
development of triadic processes, the present study
clearly demonstrated a unique reliance of pretend play
development on triadic processes involving JA. It is,
however, striking that there is no significant interaction
to indicate that the relationship between JA and
pretend play development is different across different
groups. The cognitive underpinnings of pretend play
development may therefore be similar in the different
groups that we tested.
It is surprising that the other predictor variables
tested here were not significant predictors of pretend
play development. Imitation, as an index of social
learning was tested as a predictor of both kinds of play.
All three groups of children demonstrated enhanced
performance in the scaffolded over the spontaneous
condition, and thus demonstrated enhanced perfor-
mance using immediate imitation. However, a separate
measure of imitative ability in a structured task was not
a strong or significant predictor of either of the pretend
or the sensorimotor play performance. One possible
explanation is the nature of the measure itself. In
contrast to our JA measure, our imitation measure did
not probe spontaneous vs. instructed imitation, delayed
imitation, or multi-step imitation. It is possible that
more extensive measures of imitation would account
for more variance in pretend play, if used in future
studies.
J Autism Dev Disord (2007) 37:1024–1039
Spatial reversal was expected to be a predictor of
pretend play. Set shifting would seem necessary to shift
one’s perspective between the real and imagined
interpretation of a pretend scene. Nonetheless, our
executive function measure did not predict pretend
play development. An even more surprising result is
that overall MA at time 1 was not a significant predictor
of pretend play development. Overall developmental
level did not influence variability in play development
once other sources of variability were controlled.
However, overall developmental ability certainly
shares some variance with JA and other variables being
tested here. Our main variables are not independent of
each other, as has been demonstrated in many previous
studies, and shared variance may be the primary reason
why other variables do not add significantly once both
diagnosis and JA variability are removed.
It is important to mention that our measure of
general cognitive development was overall MA, which
included VMA. Because verbal development is known
to be impaired in children with autism, many research
projects factor out VMA in their analyses. We decided
not to factor out VMA in the results presented here.
We believe that language (as a symbolic system) and
pretend play (often called symbolic play) may rely on
the same underlying symbolic cognitive system.
Therefore, we did not want to factor out the very
cognitive process that we hoped to measure. When we
did run regression analyses factoring out VMA and
found no essential changes in the results; in particular,
JA measured at time 1 remained the strongest and
only significant predictor of pretend play at time 2,
even with the variance attributed to verbal develop-
ment accounted for.
According to our results and others, there are deficits
in both pretend play competence (our scaffolded pre-
tend play measure) and performance, in autism at this
age. This is important, since deficits in competence are
less readily explainable by a lack of motivation, inter-
est, or the propensity to produce novel acts, compared
to deficits in performance. Indeed, the contrast between
scaffolded pretend play and scaffolded sensorimotor
play indicates strong group differences unique to
pretend play.
We hope and expect that our findings will be
extended by future research. We are currently col-
lecting data for this cohort at time 3, and expect that
even stronger conclusions will be drawn from the
extension of this longitudinal study. In addition, a fu-
ture study would be strengthened by adding complexity
to some of the predictor variables. In particular,
executive function is a many faceted cognitive ability,
including generativity initiation of goal directed
1037
behavior, inhibitory control, working memory, and
flexible control of attentional processes. A measure of
executive function that includes more of these factors
may yield different results. In addition, an imitation
measure that measures both spontaneous and scaf-
folded imitation, and immediate and delayed imitation
would provide a more complete measure of imitation,
and could yield different results. Finally, a future study
that included more subjects might allow for clearer
correlational analyses and even regression analyses
within group. However, such a study would have to be
massive, since recruiting and retaining these groups
over time for a longitudinal study, when one is gener-
ally limited to a particular geographic area, is already
quite cumbersome and costly.
Our last important finding concerned the role of JA
in development of pretend play development across our
different groups. There were no group interactions: JA
predicted pretend play development roughly equally in
all groups. The implications of this finding are striking.
This finding speaks to the delayed versus deviant
question. Because the relationship is the same across
groups, it could be that developmental processes are the
same in the different groups (not deviant) but that
pretend play is delayed in autism because JA is delayed
in autism. The delay in JA may be the explanation for
the delay in pretend play development in autism.
This is consistent with the idea that pretend play is
dependent upon children’s ability to share interests and
attention with others. It may be, as theory of mind
theory indicates, that JA behavior is the first marker of
intersubjective awareness and that it marks the coming
on line of the cognitive system that supports meta-
representation, and with it, pretend play. While the
current findings weigh early social knowledge more
heavily than early executive abilities in pretend play
development, there is much more to be learned about
how early dyadic social processes, as well as triadic
processes, affect later symbolic development.
Acknowledgements SJR and SH were partially supported
by National Institute of Child Health and Human Develop-
ment Grant #PO1HD35468. SJR was also supported by
National Institute of Deafness and Communication Disorders
NIDCD Grant #R21 DC05574. The support of the Devel-
opmental Psychobiology Research Group and the Collabo-
rative Programs of Excellence in Autism are gratefully
acknowledged.
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