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Teaching to Play or Playing to Teach: An examination of play targets and generalization in two interventions for children with autism


Play is universally found and is an important aspect of childhood development. Difficulty with imaginative, or symbolic play, is a core deficit of children with an autism spectrum disorder (ASD) (DSM-5; APA, 2013). This study represents the first attempt to compare play targets between two interventions. Sixty-five pre-school aged, minimally verbal children with ASD and their parents participated in this study. Both Discrete Trial Training (DTT) and Joint Attention, Symbolic Play, Engagement & Regulation (JASPER) interventions directly target play skills as a primary area for improvement, but have varying methodological approaches. A randomized controlled trial found that symbolic play types increased across both interventions when targeted, but children receiving the JASPER intervention demonstrated greater gains compared to children receiving DTT. Additionally, only children in the JASPER condition were able to maintain these gains six months later at follow-up. Improvements in symbolic play types were associated with higher scores on cognitive and languages outcomes for both treatments. JASPER interventionists were more likely to choose play targets that were matched with the child’s developmental play level compared to DTT, but this did not result in different outcomes between groups. Improvements made with therapists in both treatments did not generalize to parent child interactions at home. These findings suggest further adaptations must be made to improve generalization from school to home, and across partners.

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