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SYMBOLIC PLAY IN CHILDREN WITH AUTISM SPECTRUM DISORDER
Rashid Jabbarov1
Aydan Nazarova2
Abstract: Children with Autism Spectrum Disorder (ASD) exhibit persistent decits in social
communication and interaction, restricted and repetitive behaviors, and stereotyped behaviors. Studies
have been conducted on the dierential development of children with ASD in activities that require
imagination and creativity. Studies comparing children with ASD with typically developing children
or children with other developmental disabilities, particularly in terms of imaginative symbolic
play, are important for understanding both the development of symbolic play in ASD and cognitive
development. This review discusses the various ideas that encompass empirical studies investigating
the development of symbolic play in children with ASD and the meaning of such play, and attempt to
explain the limitations observed with ASD. The studies reviewed show that children with ASD dier
from control groups in the development of spontaneous symbolic play (e.g., spending less time on this
play, constructing less complex games), and the sources of the observed dierences may be related to
both ability and performance.
Keywords: autism spectrum disorder, symbolic play, imagination, mental representation, spontaneous
symbolic play
1 Doctor of Psychology, teacher, Baku State Universty, Odlar Yurdu University, https://orcid.
org/0000-0002-0623-2772
2 Master’s student at the Department of Political Science, Psychology and Social Work, Western
Caspian University, Baku, https://orcid.org/0009-0005-6092-5712
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Introduction
Autism Spectrum Disorder (ASD) is a complex neurodevelopmental disorder that manifests
itself from an early age. The two main features that stand out in the diagnosis of ASD are persistent
decits in social communication and interaction, and repetitive/restricted behaviors or interests.
Along with these limitations, the dierential development of children with ASD in activities that
require imagination and creativity is also discussed by researchers and experts working in this eld.
One of the topics that is often discussed in this context is the development of imaginary symbolic play
in children with ASD. [Baron-Cohen et, al, 1985, p. 146].
Studies conducted with typically developing children show that symbolic play begins to be
observed between 18 and 24 months, and increases rapidly during the preschool period. This type of
play is closely related to children’s social (e.g., social skills) and cognitive (e.g., language) development.
Studies with children with ASD have shown that symbolic play develops late or is restricted in their
development [González-Sala et al, 2021; Aghajani et al, 2014].
This article will examine the development of symbolic play in children with ASD, including
studies that compare this group with dierent control groups (e.g., typically developing or with peers
with various developmental disorders) in terms of understanding and constructing symbolic play. The
aim of the article is to learn more about the mental development of children with ASD by examining
the development of imaginative play, which is thought to support social and cognitive development
in typically developing children with ASD. The study of symbolic play in ASD is also important
for theories about the development of this type of play. In addition, it is expected that this compiled
information will contribute to practices targeting children with ASD (e.g., special education programs)
[Lillard et al, 2013].
Many studies have shown that children with ASD experience diculties in imaginative
symbolic play compared to their typically developing peers and groups with other developmental
delays. Recent studies have also shown a relationship between the severity of symptoms observed in
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children with ASD and their symbolic play behaviors. Delays or decits in symbolic play observed in
infancy are a strong predictor of a diagnosis of ASD later in life [Campbell et al, 2016].
Although studies in the literature that show dierences in symbolic play behaviors between
children with ASD and typically developing children are widely accepted, there are also studies that
do not nd dierences between groups. While one reason for the dierences in study results may be
the characteristics of the participants (e.g., children with ASD are at dierent levels on the spectrum,
who the control groups are composed of and how they are formed), another important reason may
be dierences in the tests and methodologies used in the studies. While some studies have observed
children constructing play using unstructured/free play tasks, some studies have used structured play
techniques, and some studies have focused on understanding symbolic play rather than constructing
play [Bigham, 2008, p. 265-280].
The factors inuencing the development of symbolic play in children with ASD have been
explained in dierent ways by dierent researchers, as well as by the measurement methods used.
Some studies suggest that the source of the dierences between groups with and without ASD is
skill-related problems (lack of cognitive features necessary for symbolic play, such as problems in
creating mental representations), while other researchers explain the observed dierences in terms
of performance decits (such as a child’s lack of motivation to play this type of game or diculty
generating ideas for the game). This study will examine the development of this type of play in
ASD by presenting the results of studies that assessed the production and understanding of symbolic
play in children with ASD using various tests. Discussion of the results of studies on the dierent
perspectives that explain the performance of children with ASD in imaginative activities will help
to understand the mental development of both typically developing children and children with ASD
[Jarrold and Smith, 1996].
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The Formation of Symbolic Play in Autism Spectrum Disorder
Most studies of children with ASD point to limitations in the formation of symbolic play.
Although there are studies that show that children with ASD do not dier from typically developing
control groups in symbolic play, many studies focus on dierences in this area [Dominguez et al,
2006].
Studies have examined both the symbolic play that children spontaneously and spontaneously
construct, and the symbolic play that they can construct when directed or commanded.
Only a few studies have examined the symbolic play of children with ASD found that
groups performed similarly to controls in spontaneous symbolic play. For example, Christensen et
al. (2010) studied the play behaviors of 18-month-old infants who were later diagnosed with ASD (a
high-risk group for ASD) and who were later diagnosed with other developmental delays and who
were typically developing. When the duration and order of play with toys were coded, infants who
were later diagnosed with ASD did not dier from typically developing controls in their symbolic
play behaviors (e.g., putting a plate on their head while pretending to be a hat). However, Christensen
et al. (2010) suggested caution in interpreting these results, as the observed baseline eect may not be
due to the fact that 18-month-old infants are too young to engage in symbolic play behavior. There is
more research showing that children with ASD have problems with spontaneous symbolic play. These
studies used dierent age groups (diagnosed preschool and school-aged children or young children
at risk), dierent control groups (typically developing or diagnosed with a variety of developmental
delays), dierent play partners (alone or with a parent or researcher), dierent durations (5 minutes or
more), dierent toys, and dierent testing environments (home or clinic/treatment room). A common
feature across studies is that children with ASD engage in less symbolic play than typically developing
groups and children with a variety of developmental disorders, and display more stereotyped and
repetitive behaviors in this play [Hobson et al, 2012].
A study examining the symbolic play behavior of children with ASD in an unstructured/free
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play environment compared to children with moderate learning disabilities found dierent results. In
interpreting the dierences in results, it has been argued that the reason why children with ASD did
not dier from controls in unstructured symbolic play may be methodological.
Another activity that may be an example of spontaneous symbolic play is having an
imaginary friend. Imaginary friends are invisible beings or personalized objects. Studies show that
approximately 30-50% of typically developing children have imaginary friends at some point in
their lives [Motoshima et al, 2014].In a study comparing typically developing and ASP groups, it
was observed that the rate of having an imaginary friend was much lower in the ASP group (16%)
and that there were dierences in the characteristics of the imaginary friends. For example, while
the imaginary friends of typically developing children were more invisible, the imaginary friends
reported in the ASP group were found to be more personalized objects [Davis, 2018].
In a study conducted with children with ASP and developmental delay, children’s play
behaviors were examined inve play sets, one unstructured (toys were presented and no instructions
were given) and four structured (the experimenter briey explained the symbolic play he wanted
the children to do). Although symbolic play was the least preferred play by children, the ASP and
developmental delay groups did not dier signicantly in symbolic play behavior [Thiemann-Bourque
et al, 2012].
The studies reviewed here show that children with ASP, while exhibiting some limitations
in unstructured, spontaneous symbolic (pretend) play, can exhibit symbolic play-like behaviors in
structured settings. Although play in these structured settings was found to be simpler and more varied
than in control groups, the fact that children with ASP pretended to play in these settings may indicate
that they have skills and abilities in this area but are unable to demonstrate them spontaneously.
This may be due to children’s lack of motivation or relationship problems rather than psychological
deciencies [Jabbarov et al, 2020; Vakil, 2020; Ramiz and Vakil, 2020]. This may also be a result of
adaptation problems, value distortions, and the inability to properly establish feedback with them
[Vakil, 2020; Ramiz and Vakil, 2020].
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Understanding Symbolic Play in Autism Spectrum Disorder
The results of studies using play-based tests (e.g., children with ASD producing fewer and
simpler symbolic games compared to controls) are insucient to distinguish whether the dierences
observed in children with ASD are due to dierent mental development (e.g., problems with mental
representation skills) or purely performance-related problems. For this reason, various studies
have used children’s understanding of this type of play to measure their competence and mental
representation skills. have investigated. In this way, it has been argued that competence problems that
may be overshadowed by performance problems in studies using play-based tests can be more clearly
tested [Thiemann-Bourque et al, 2012, p. 433-455].
Most studies investigating the comprehension/understanding of symbolic play in children
with ASD show that children have no problems understanding symbolic play. In these studies, the
researcher shows children a series of behaviors and asks them to indicate the consequences of the
behavior. For example, the researcher pretends to pour tea on a toy duck and then asks the child: “What
does the duck look like now?” The children choose one of three pictures shown to them (a picture
corresponding to the change in the claim – a duck soaked in tea, a picture indicating an insignicant
change – a duck with red triangles on it, and a picture indicating the current state of the toy – a dry
duck). The researchers found that children with ASD performed above chance in understanding such
pretentious behaviors: Children had no diculty nding the picture that matched the researcher’s
pretext change [Kavanaugh and Harris, 1994].
Based on these studies, the researchers claim that children with ASD can understand symbolic
play (create mental representations) and have no problems in this area. The studies mentioned above
show that children understand the behavior of attributing “non-existent” properties to an object (making
a duck look dirty when it is actually clean). However, these studies, which do not measure children’s
behavior of substituting one object for another (using a banana as a telephone) or of interacting with an
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imaginary object (acting as if drinking water from an imaginary glass), are not sucient to claim that
children with ASD do not have problems understanding mental representations and creating mental
representations in various forms of play.
In their study, the researchers examined whether children understood the behavior of
using one object in place of another and interacting with an imaginary object. Children with ASD
and moderate learning disabilities participated in the study, and their performance was compared
to typically developing children in a previous study. The children were expected to understand the
behavior of substituting one object for another shown by the researcher. This behavior was studied
at dierent levels. Children’s ability to understand symbolic behaviors was measured by breaking
down the form and function of the objects used in each action. This behavior is thought to be easier
to “use objects with similar forms and functions as if they were the same object” than to pretend
objects with dierent forms and functions. However, in line with the study’s hypotheses, children
with ASD failed to understand pretend behaviors at dierent levels than control groups. In summary,
according to research on the understanding of symbolic play, children with ASD may understand the
attribution of “nonexistent” properties to objects. However, they have been observed to have diculty
understanding symbolic play, such as substituting one object for another, making imaginary objects.
In interpreting the dierences between the ndings, it has been suggested that children with ASP do
not have diculty with the materials used in previous studies (imaginary tea is poured from a teacup
associated with tea), because in such conditions there is no need to create a mental image due to the
similarity in function and form. However, it has been argued that in order to claim that the concept
of symbolic play is inviolable, it is necessary to understand the change of form and function, which
has been shown to be lacking in ASP, and it has been concluded that the dierence in symbolic
play behaviors observed in these children is related to “competence” (mental representation skills)
[Bigham, 2010, p.38].
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Problems in mental representation
The meta-representational skills/mental representation skills that emerge in typical
development at around age 2 form the basis of the later (around age 4) theory of mind skills
(understanding the impact of our own and others’ mental states on behavior), and symbolic play and
theory of mind skills operate by the same mechanism. There are also studies that show that children
with ASD do not develop theory of mind compared to children with Down syndrome and typically
developing children. However, the dierences in symbolic play observed in children with ASD are
also thought to be specic to this group. When constructed symbolic play is compared, children with
ASD display less symbolic play than children with Down syndrome who are matched for language
and intelligence development. Based on these results, it has been claimed that children with ASD
are unable to engage in simple symbolic play behavior and do not have a theory of mind, and the
dierences in symbolic play observed in ASD have been explained by problems in these children’s
mental representation skills. Accordingly, children with ASP are unable to form second, distinct
representations of objects, and because of this lack of this ability, which underlies symbolic play and
theory of mind, children show decits in both of these skills [Baron-Cohen et, al, 1985, pp. 37-46].
In a study of ASP, mentally retarded, and typically developing children, children’s mental
representational abilities were measured using a false belief theory of mind test (e.g., understanding
that a child may have a false belief about something that no one else has seen). When symbolic play
comprehension was measured using tasks that measured children’s ability to understand symbolic
play and functional play performed by others, a relationship was found between children with ASP’s
performance on mental representation tasks and their understanding of symbolic play.
The fact that children with ASP rarely display symbolic play behaviors in unstructured play
and have diculty understanding some types of symbolic play supports the idea that dierences in
this group may be related to problems in mental representational abilities. Their lack of dierences in
understanding structured play and simple symbolic play from controls makes it dicult to explain the
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dierences in children’s symbolic play skills by problems. However, if the main problem in producing
symbolic play is a lack of mental representation skills, then children with ASD might be expected to
perform similarly to their peers in a variety of games that do not require mental representation. While
many studies have provided research in this direction, other studies argue that there are dierences in
the play behaviors of children with ASD in general and that this may not be specic to symbolic play.
Problems with executive functions
Executive functions are a general term that describes metacognitive skills that are thought
to be associated with the frontal lobe of the brain and involve goal-directed behavior and thinking.
Three main skills have emerged as executive functions in research: working memory (holding and
manipulating information in memory), inhibitory control (suppressing dominant thoughts or behaviors),
and mental exibility (the ability to change thoughts and behaviors in response to changing rules or
situations). It is thought that dierences in executive function observed in ASPD may explain the
variation in symbolic play seen in these children[. Zelazo et al, 1997].
Inhibitory control. A literature review by Hill (2004) found that individuals with ASPD have
diculty inhibiting dominant stimuli, which manifests itself in a variety of behaviors (e.g., repetitive
stereotyped behaviors, problems with impulse control). When researchers examined the relationship
between inhibitory control and symbolic play behavior, they suggested that the lack of symbolic play
behavior produced by children in unstructured settings may be due to impaired inhibitory control,
and that children must suppress the real world during symbolic play and the creation of mental
representations, and therefore children with inhibition problems may not be able to display symbolic
play behavior [Harris, 1993].
Mental agility. Another diculty for people with ASPD is generating original thoughts and
behaviors. The poor performance in symbolic play behavior seen in children with ASPD is due to a
decit in mental exibility, or in this context, generative function. [Turner,1997].
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However, studies have shown that children with ASPD have diculty not only in creating
symbolic play but also in understanding symbolic play, undermining the idea that the observed
dierences in play are related to limitations in productivity. Children with ASPD are able to engage
in both structured and unstructured play. have diculty in producing symbolic play behavior during
unstructured free play. Furthermore, although there is a signicant relationship between productivity
and symbolic play in an unstructured environment, productivity performance in the ASP group is not
inferior to that of typically developing controls, making it dicult to explain the dierences observed
in ASP solely in terms of productivity problems.
This section examines two subcomponents of executive function that explain the decits
in symbolic play seen in children with ASP. Dysfunctions in executive function have been shown to
be associated with many symptoms of autism and have been suggested to be related to dierences
in symbolic play behavior. Studies using structured play tasks support the claim that children with
ASP have the ability to produce symbolic play behavior, but that dysfunctions in executive function,
particularly inhibitory control and agility/eciency, cause children to have diculty performing
symbolic play. However, recent studies have shown that the decit in symbolic play seen in children
with ASD cannot be explained solely by performance decits based on dierences in executive
function, and that inadequacy of mental representation skills may also play a role [Hill, 2004, p. 189-
233]
Lack of motivation
It is thought that the decit/dierence in symbolic play behavior seen in children with ASD
may be explained by a lack of motivation in addition to problems with mental representation and
executive function decits. Children with ASD may perform similarly to typically developing peers
in situations where motivation is not reduced or unmotivated. From this perspective, the diculties
children with ASD experience in creating symbolic play may be explained by their lack of interest in
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this play. Children with ASP may exhibit mechanical aspects of symbolic play behavior (e.g., using
objects instead of other objects and using toys for their own purposes), and it has been suggested that
children with ASP have decits in the motivational and emotional domains that make symbolic play
creative and enjoyable, which may explain the diculties children experience in this play in dierent
settings. However, there is no literature that empirically examines the relationship between lack of
motivation and symbolic play behavior [Hobson et al, 2013].
Conclusion
Symbolic play behavior, which is an important part of early childhood and development and
typically emerges in children by the age of two, is associated with a variety of social and cognitive
skills [Aghajani et al, 2014; Jabbarov et al, 2023].Therefore, understanding the progression of this type
of play in both typically developing and dierent developmental groups will be useful not only for
parents, but also for researchers studying child development and for counselors and teachers working
in this eld. This review examines studies conducted with ASP participants, a group in which symbolic
play, a type of imaginative play, ASP, develops dierently, and discusses dierent perspectives that
explain this development. The results of the studies reviewed and the implications of these results for
explaining dierences in ASP are quite diverse. Taking all of these studies into account, it can be
concluded that children with ASP have problems in spontaneously constructing symbolic play, mainly
in unstructured settings. These ndings may be related to problems with mental representation, but they
can also be explained by problems with productivity, inability to inhibit reality, or lack of motivation.
The limitations that children with ASP demonstrate in understanding some types of symbolic play
and the relationship between children’s performance on theory of mind tests and their symbolic play
performance suggest problems in mental representation skills in children with ASP. However, the lack
of understanding of some symbolic play behaviors performed by children with ASP in others and the
dierences in rental representation skills observed in ASP make it dicult to explain the dierences
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observed in ASP. Although children are intellectually competent, their executive function problems
(e.g., inhibitory control problems) and low motivation for this type of play may be important factors
in explaining the dierences in symbolic play observed in children with ASD.
In short, the factors that may explain the symbolic play performance of children with ASD
and the dierences in this performance are important and require further research.
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