Examining the Contribution of Children’s Play and Engagement to Language Development in Preschoolers with Autism Spectrum Disorder

Background: Individuals with autism spectrum disorder (ASD) display significant heterogeneity in symptom and skill presentation across the lifespan (e.g., Georgiades et al., 2013; Howlin & Magiati, 2017). In addition, some of these individual difference factors (e.g., cognitive function, expressive language skills) present at treatment outset have been linked to treatment outcomes (Howlin & Magiati, 2017) giving rise to an interest in factors that may impact the child’s participation in the learning environment. In an effort to improve outcomes, such as language development, skills such as joint attention and symbolic play are often direct targets of early intervention for children with ASD (e.g., Kasari et al., 2008) yet trajectories of language development in these children are not fully understood and further research is needed.

Objectives: The present study aimed to examine the contribution of children’s engagement and symbolic play skills on later expressive language functioning. Although these data were drawn from a larger ASD preschool intervention study, the present study investigates individual differences in participating children for the sample as a whole.

Methods: The sample for this study consists of 134 preschool children (85% male, M = 4.2 years, SD = .62) diagnosed with ASD who were enrolled in one of 78 participating classrooms in the study and present for all relevant assessments. The classrooms were located in North Carolina, Florida, Minnesota, and Oregon. Children participated in an assessment battery at the beginning of the year that included measures of general developmental level (MSEL), symbolic play (SPA), joint engagement (ICER-R) and autism symptoms (ADOS-2). At the end of the school year, expressive language was also assessed (PLS-5).

A three-level hierarchical regression was conducted with expressive language (EC standard score) as the dependent variable, child age and developmental level (MSEL Composite Standard Score) entered as predictors on the first step, joint engagement (duration of coordinated or supported joint engagement with people and objects during ICER-R) on the second step, and symbolic play (duration during the SPA) entered on the third step.

Results: The full model predicted 47.8% of the variance in expressive language scores, F(5,128) = 25.38, p < .001. The models adding joint engagement (β = .148, p < .05, F change (1,129) = 5.28, p < .05) and symbolic play (β = 2.82, p < .01, F change (1,128) = 4.76, p < .05) each explained an additional 2% of the variance beyond the lower level predictors.

Conclusions: These results show that children with higher levels of joint engagement and symbolic play at the beginning of the year demonstrate more expressive language skill at the end of the year. This suggests the importance of continuing targeted interventions and monitoring related to complex play, classroom engagement, and early language predictors in children diagnosed with and at-risk for ASD. This sample included preschool children with notable language impairment, a group for whom the sequelae of these early deficits may be particularly problematic if not adequately addressed.