Play-based interventions to support social and communication development in autistic children aged 2–8 years: A scoping review

Abstract

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.

A robot or a dumper truck? Facilitating play-based social learning across neurotypes

“…In other words, they got the opportunity to acquire complex social experiences on their own terms. Even though research into the effects of play-based interventions exists (Gibson et al, 2021), we suggest that further research into the inner workings of play-based social learning is needed. In particular, we see potential in (1) the intrinsically motivating qualities of play, (2) the broadening of communicative strategies that follows from using play objects and narratives, and…”

“…A large number of social interventions targeting autistic people exist (Gibson et al, 2021;Kasari & Patterson, 2012). Many of these interventions take their point of departure in the clinical model by looking at the diagnostic indicators and designing highly structured methods to train autistic people in neurotypical social behavior, e.g.…”

Responding to Autism in Low and Middle Income Countries (Lmic): What to Do and What Not to Do

“…A point has been reached when it is possible to match certain interventions to the children’s particular needs. Moreover, persons who are familiar with the child—such as parents and teachers—can be taught the techniques so that they can be used in the natural environments of the home and classroom [ 15 ].…”

Impact of parental involvement on the communication skills of children with autism

“…Hence, the family members are also significant in helping the child with autism cope with his difficulties. Parents are expected to implement the programs that will develop the child's skills with ASD, whether in the child's daily living skills or in communicating with the other family members [8], [9].…”