Table 1.
Main characteristics of the studies analyzed in the scoping review.
| Study | Object | Sample | Study Variables | Main Results |
|---|---|---|---|---|
| Riguet et al. (1981) [61] |
To assess the ability of children with ASD for symbolic play in modelled situations and in free play |
n = 30: 10 ASD, 10 DS, 10 TD. MCA (years): ASD (10.0), DS (9.5), TD (2.9). VMA 2.5 years |
Free and modeled symbolic play. | The symbolic fluidity and content of symbolic play of children with ASD are poor compared to other children with a similar mental age. Symbolic play is less frequent in children with ASD. Modeling provides a higher level of play in children with ASD, but lower than in other children. |
| Sigman & Ungerer (1984) [22] |
To compare sensorimotor skills and play behaviors among children with TD, ID, and ASD. |
n = 48: 16 TD, 16 ID, 16 ASD CA (months): TD (16–25), ID (32–80), ASD (39–74). Developmental age (months): ID (17–38), ASD (18–38) |
Free functional and symbolic play. Symbolic play after receiving an order. Sensorimotor abilities. |
There are no differences in sensorimotor abilities between groups. The group of children with ASD presents less diversity in functional play and less free symbolic play, after receiving indications. There is a relationship between receptive language and functional and symbolic play in the three groups. |
| Baron-Cohen (1987) [20] |
To evaluate the simulation play of children with ASD, comparing it with that of children with SD and with TD. |
n = 30: 10 ASD, 10 DS, 10 TD. MCA (years): ASD (8.0), DS (7.5), TD (4.1). VMA: ASD/DS (2.5 years). N-VMA: ASD (4.9 years), DS (3.8 years) |
Free simulation play. | The group of children with ASD present less spontaneous simulation play. Children with ASD who present symbolic play differ significantly in terms of the verbal and nonverbal mental age of those children with ASD who did not present symbolic play. |
| Stone et al. (1990) [62] |
To determine whether play and motor imitation skills are different among children with ASD, children with ID, and children with communication disorders |
n = 91: 22 ASD, 15 HI, 19 LI, 15 ID, 20 TD MCA: ASD (4.6), HI (4.2), LI (4.5), ID (5.2) NH (4.3). IQ: ASD (54.1), HI (109.8), LI (97.6), ID (56.9), NH (100). Verbal communication: ASD (3.6), HI (2.6), LI (2.2), ID (1.9) NH (1.2) |
Free play. Imitation play. Game type (simple, relational, functional, symbolic). Number of game acts. Play time. |
The group of children with ASD uses fewer toys than the LI, HI, and NH children’s groups, and has less playtime and appropriate playtime. Children with ASD present less functional play, with no differences concerning manipulative, relational and symbolic play. The number of children with functional and symbolic play is lower in the group of children with ASD. They have fewer imitation skills. |
| Libby et al. (1997) [63] |
To determine the existence of differences between children with ASD, DS and TD in the imitation of simulation games of a single action and different actions. |
n = 30: 10 ASD, 10 DS, 10 TD. MCA (months): ASD (120), DS (55), TD (28). Equalized in comprehension and expression from 30 to 32 months. |
Simulation play. Task type: simple or multi-scheme (follow guidelines). Attitudes. |
The group of children with ASD presents greater imitation responses in simple tasks than the TD group. In multischeme tasks there are no significant differences between the three groups, presenting the group of children with ASD with worse scores. In imitation tasks, the DSA group presents a more participatory attitude than children with TD and DS. |
| Libby et al. (1998) [64] |
To determine the existence of differences in spontaneous play between children with ASD, Down syndrome and typical development with a verbal age of approximately 2 years. |
n = 27: 9 ASD, 9 DS, 9 TD. MCA (years): ASD (10.03), DS (4.04), TD (2.01) Equalized in comprehension and expression from 26 to 29 months |
Object search, play with objects and simulation play. | There are no differences in exploration time. The group of children with ASD presents more sensorimotor play and less relational play. There are no differences in functional play with conventional objects between groups. The group of children with ASD presents less symbolic play than the other groups. There are no differences between the groups in symbolic play where an object is substituted for another, but there are differences in symbolic play concerning the absence of an object or attributing a false feature to the object. |
| Rutherford & Rogers (2003) [50] |
To compare the simulation play between children with ASD, DD and TD using the cognitive fundamentals of the simulation play (ToM and EF). |
n = 78: 28 ASD, 24 DD, 26 TD. MCA (months): ASD (33.93), DD (34.83), TD (19.46). VMA (months): ASD (13.36), DD (21.42), TD (23.92). N-VMA (months): ASD (24.88), DD (23.41), TD (22.52) |
Simulation play Predictive variables: ToM and EF. |
Both spontaneous and induced simulation play in children with ASD are lower than in children with other disorders and with typical development. A relationship between ToM and the symbolic play of children with ASD is established, but not with executive functions. There is no significant correlation between verbal mental age and simulation play in children with ASD. |
| Warreyn (2005) [52] |
To compare spontaneous symbolic play, imitation of symbolic play, declarative joint care and social reference between children with ASD and the control group. |
n = 40: 20 ASD, 20 Control group. MCA (months): ASD (58.70), Control (62.25). IQ: ASD (68.80), Control (70.70) Language age (months): ASD (38.17), Control (47.17) |
Symbolic play, social referencing, joint attention and symbolic imitation. | The group of children with ASD gets less symbolic and nonfunctional play and less joint care with their mothers. However, there are no differences in social reference and symbolic play by imitation, compared to the control group. |
| Dominguez et al. (2006) [65] |
To compare the characteristics of spontaneous play among children with ASD and TD matched in chronological age. |
n = 58: 24 ASD, 34 TD. MCA (months): ASD (36.96) TD (56.32). |
Symbolic play. Playing time. Preference for toys |
There are no differences in symbolic and functional play between children with ASD and TD. There are differences in sensorimotor and relational play. Children with ASD have greater play. |
| Rutherford et al. (2007) [66] |
To examine simulation play problems among children with ASD, DD and TD by comparing sensorimotor development using a longitudinal design |
n = 63: 28 ASD, 18 DD, 27 TD. MCA (months) Moment 1: ASD (33.9), DD (34.8), TD (19.5). Moment 2: ASD (57.6) DD (59), TD (30.1). VMA (months) Moment 1: ASD (16.50), DD (20.36), TD (23.83). Moment 2: ASD (29.21), DD (34.36), TD (39.5). N-VMA (months) Moment 1: ASD (23.7), DD (23.41), TD (23.41). Moment 2: ASD (38.21), DD (36.36), TD (35.9) |
Spontaneous simulation play and modeling. Predictive variables: Imitation, Executive Performance, Joint Attention, Cognitive maturity. | There are significant differences in simulation play between children with ASD and the rest of the groups, both in spontaneous and modeled conditions, at the first and second times. Specifically, the group of children with ASD shows fewer examples of symbolic play than the rest of the groups. It is observed that, while children with ASD present difficulties both in the play of sensorimotor and in the play of imitation at the first moment, at the second, these difficulties only occur in the imitation play. Joint attention predicts equally symbolic play at the first and the second moment in the three groups. |
| Naber et al. (2008) [49] |
To determine the existence of differences in manipulative, functional and symbolic play in children under 36 months with and without ASD |
n = 41: 23 ASD, 18 DD y LD. MCA (months): ASD (29.04), DD (27.06) Mean development level (months): ASD (60.83), DD (67.78). |
Game type (manipulative, functional, symbolic). Game level. Playing time. Types of toys. Attachment | There are no differences between children with and without ASD in the time spent playing or in the type and level of play. Children with ASD spend less time reading a book or playing with daily utensils or puzzles. The type of attachment has an effect on the kind, level, and time of play in children with ASD. |
| Bigham (2008) [33] |
To determine the level of understanding of functional and simulation play in children with ASD, TD and LD. |
n = 128: 36 ASD, 37 LD, 55 TD. MCA (months): ASD (92.56); LD (116.57); TD (92.56). VMA: ASD (57.33); LD (60.03); TD (58.56) |
Functional play. Level of decontextualization of the object. Body parts as objects and gestures to represent the imaginary object. | There are no differences in functional play between ASD and TD groups. Children with ASD present more difficulties in simulation plays (substitution of an object) and simulation gestures of the object. They have more difficulty in simulation when the substitute used in the simulation is less related to the referent regarding its shape and function. |
| Hobson et al. (2009) [67] |
To compare the symbolic play of children with ASD and children with DD by assessing self-awareness, the potential for flexibility in play and investing in symbolic meanings and creativity |
n = 32: 16 ASD, 16 DD. MCA: ASD (9.6 years), DD/LD (10.4 years). VMA (years): ASD (5.3), DD/LD (5.0) |
Symbolic play. Self-awareness, investment in symbolic meanings, creativity and fun. | Children with ASD show less symbolic play than other groups. This correlates with the lack of the qualities of symbolic play presented by children with ASD. It is observed that the modeled symbolic play benefits children with ASD. |
| Pierce (2009) [68] |
To examine group differences in symbolic play behaviors among children with ASD, DD, and TD. |
n = 121: 48 ASD, 25 DD, 48 TD. CA from 18 to 24 months |
Symbolic, exploratory and functional play. Communicative and Symbolic Behavior Scale (CSBS). | The group of children with ASD shows less symbolic and functional play behaviors than the TD group. In contrast, concerning to exploratory play, children with ASD have a greater number of behaviors related to exploratory play than children with TD. |
| Lam & Yeung (2012) [51] |
To compare symbolic play between children with ASD and TD. To examine which variables correlate with the symbolic play. |
n = 24: 12 ASD, 12 TD. MCA (years): ASD (6.11), TD (5.64). VMA (months): ASD (70.17) and TD (77.91). N-VMA (months): ASD (22.83), TD (24.08) |
Symbolic play. ToM: Executive operation. | The group involving children with ASD shows significant deficiencies in symbolic play concerning to the TD group. These deficiencies correlate significantly with the ToM, but not with the EF. |
| Thiemann –Bourque et al. (2012) [18] |
To examine the differences or similarities of symbolic play between children with ASD and DD. To analyze the relationship between symbolic play and language. |
n = 73: 35 ASD, 38 DD. MCA (months): ASD (49.2), DD (49.7). |
Symbolic play: expressive communication and listening comprehension. | Similarities are obtained in the symbolic play, in terms of appearance and interest in toys, between the two groups. The diversity of symbolic play of children with ASD is similar to that of children with other DD. Significant correlations are obtained between symbolic play, language, and cognitive abilities. |
| Hobson et al. (2013) [69] |
To examine the differences in symbolic play between children with ASD and DD. To explore the correlation of symbolic play with language, communication and social interaction. |
n = 57: 41 ASD, 16 DD. CA 5 years. VMA: 2.9 years |
Simulation play. Communication and social interaction. | Children with ASD get lower scores in symbolic play than children with other DD, even though they are matched in verbal ability. Deficiencies in communication and social interaction correlate significantly with symbolic play in children with ASD. |
| Strid et al. (2013) [17] |
To examine how children with ASD differ from children with TD in symbolic play, deferred imitation, and type of parent comments (synchronized/nonsynchronized) during play. |
n = 43: 20 ASD, 23 TD. MCA (months): ASD (66.8), TD (35). The group involving children with ASD was separated into two groups: mental verbal age (38.3) and non-verbal mental age (13.6). |
Symbolic play, deferred imitation and parental feedback. | Both symbolic play and deferred imitation are lower in children with ASD than in children with TD. However, symbolic play is still lower in children with nonspeaking ASD. Deferred imitation and simulation play do not correlate in any of the groups. |
| Hobson et al. (2015) [70] |
To explore the relationship between simulation play and communicative engagement in children with ASD, DD and TD. |
n = 130: 41 ASD, 17 DD, 72 TD. MCA (years): ASD (5.7), DD (5.5), TD (3.9). VMA: ASD (2.8 years), DD (2.9 years) |
Symbolic play. Communicative commitment. | Children with ASD spend less time in symbolic play states. Children with DD spend half their time in symbolic play states. Children with ASD get a lower rate of symbolic change of meaning per minute than those from the DD group, getting this rate very similar to that of children with TD. |
| Bentenuto et al. (2016) [42] |
To analyze the characteristics of symbolic and exploratory play in children with ASD, SD and TD, through the collaborative play of mothers and children. |
n = 75 Children and mothers: 25 ASD, 25 DS, 25 TD. MCA (months): ASD (43.33), DS (36.68), TD (20.01). Mental age (months): ASD (24.21), DS (21.12), TD (20.01) |
Symbolic play, exploratory play, collaborative play of mothers with children. | There are no differences in symbolic play between the three groups, with children with ASD showing the same ability as children with DS and TD. However, children with ASD participate more in exploratory play than the other two groups. |
| Lee et al. (2016) [28] |
To explore the relationship between simulation play and the inner experience of children’s playfulness with ASD, DD and TD. |
n = 60: 20 ASD, 20 DS, 20 TD MCA (months): ASD (67.3), DD (71.2), TD (58.9) |
Symbolic play. Playfulness. | Children with ASD show elaborate simulation plays. There is a significant relationship between simulation play and playfulness in children with ASD, so the more elaborate the play, the more joyful the experiences. Children with ASD have more difficulty generating symbolic play ideas, but not imitating them. |
| Thiemann -Bourque (2019) [15] |
To compare symbolic and functional play skills between children with ASD and TD. |
n = 38: 19 ASD, 19: TD MCA (months): ASD (74) and TD (34) |
Symbolic play. Expressive communication and listening comprehension | Children with ASD have fewer symbolic play actions than children with TD. There are no differences between groups in functional play. |
ASD = autism spectrum disorder; CA = chronological age; DD = other developmental disorders; DS = Down syndrome; EF = executive functions; HI = hearing impaired; ID = intellectual disability; LD = specific learning disorder; LI = language impaired; MCA = mean chronological age; N-VMA = non-verbal mental age; TD = typical development; ToM = theory of mind; VMA = verbal mental age.