Play is often considered by practitioners to be a natural and enjoyable context for providing intervention and support to autistic children. However, the literature on play-based interventions is large and heterogeneous.This means it is challenging for families and practitioners to navigate the evidence base and make choices about differing play-based approaches. This review aims to provide a comprehensive map of the research on this topic and to develop a conceptual framework to inform decision-making.We used a scoping review methodology to find peer reviewed intervention studies of play-based approaches totargeting language, social and communication outcomes for autistic children aged 2-8 years. We then summarised the literature using narrative synthesis and Evidence Gap Maps (EGMs).We identified 388 studies, covering many intervention types, for inclusion. Just over 50% had <10 participants. Girls and minority background groups were under-represented. In our summary we suggest important dimensions for appraisal of play-based interventions, including considering the role of play in an intervention and the extent to which approaches are child-led.

Background and aims Play is used by practitioners from across disciplinary backgrounds as a natural and enjoyable context for providing intervention and support in early childhood. In the case of autism interventions, many therapies are based on the association between social play and the development of social skills, language development, and communication skills, as these are often particular areas of challenge for autistic children. However, play is a wide-ranging concept and the extant literature on play-based interventions is large and heterogeneous. This means it is challenging for practitioners and families to navigate the evidence base and make choices about differing intervention strategies. This review aims to provide a comprehensive map of the research on this topic and to develop a conceptual framework to inform clinical decision-making. Methods An initial stakeholder consultation confirmed the relevance of the topic to practitioners and autistic people. A scoping review methodology (preregistered) was used to identify relevant literature. We systematically searched seven databases to find peer-reviewed primary intervention studies of play-based approaches targeting language, social and communication outcomes for autistic children aged 2-8 years. We then summarised the literature using narrative synthesis and Evidence Gap Maps (EGMs). The literature was summarised according to a range of characteristics, including study design, population characteristics, agent of intervention and outcomes measured, among others. These summaries were then used to develop a framework for some key considerations for practitioners appraising play-based approaches. Results 388 studies met inclusion criteria. Approximately 21% of studies were RCTs, and over 50% had ≤10 participants. Over 45% of studies reported multiple relevant outcomes, with social play skills being the most common single intervention target. Girls and minority background groups are under-represented. A range of intervention types were identified, and some high-level categorisations are proposed. Main contribution: On the basis of the evidence synthesis we suggest important dimensions for appraisal of play-based interventions, including the role of play within an intervention (as a context, a key developmental mechanism, or a component of a larger approach), the underpinning philosophy (e.g. behaviourist or developmental), and the role of the practitioner (providing parent feedback, 1:1 intervention, group facilitation). Conclusions The wide range of approaches uncovered by this review is a testament to the wonderful diversity inherent to both play and autism. However, research could usefully focus on consolidating the evidence base for existing approaches, rather than aiming for further diversification. Implications: The conceptual framework proposed in this review can help practitioners appraise the literature and aid their advice to families when making shared intervention decisions.

BackgroundPlay is important for mental health and wellbeing. Descriptions of autistic play have typically focused on ‘deficits’ and are based on comparisons to neurotypical ‘norms’. According to the neurodiversity paradigm, it is important that autistic voices are highlighted, and that difficulties, differences and strengths are explored. With this in mind, we designed the present study to focus on the experiences and perspectives of autistic people concerning the topic of autistic play.MethodsWe conducted a consultation with autistic stakeholders, as well as with parents and teachers of autistic individuals to help us design the study and interview questions. We used semi-structured interviews with 22 autistic adults aged 18-57 (clinically confirmed diagnosis, n = 21; self-diagnosed, n = 1) who live in the UK. We analysed the data using interpretative phenomenological analysis to identify themes. Results We found important commonalities and differences in the ways that socialisation in play, imaginary play and flow (a state involving intense focus on the play) are experienced. Autistic adults discussed the importance of both solitary and social play, with solitary play having an important recuperative function. They also reported preferences for parallel play and playing with similar autistic people. They also discussed imaginary play experiences including social role play and grounded-in-reality play, and the dual nature of flow experiences during play.ConclusionsThe findings of this study contrast with deficit-focused understandings of autistic play and build on neurodiversity-informed studies. We highlight, for example, the importance of considering the different circumstances under which solitary or social play are preferred, as well as the importance of taking an individual approach to play. We encourage wider understanding and acceptance of these play preferences and experiences, to support autistic people’s wellbeing.

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