Cultivating the imagination: Caregiver input during pretend play with toddlers at elevated likelihood for autism

Toddlers with autism spectrum disorder (ASD) may exhibit less pretend play than their neurotypical counterparts. Previous research suggests that caregivers' input during play influences children's play behavior, and children's behavior may in turn prompt caregivers of differently developing children to talk about play in different ways. Caregiver input about pretend play during toy play at home was examined at 18- and 36-months in toddlers with an older sibling with ASD, who are at elevated likelihood (EL) for ASD (n = 40), and toddlers with typical likelihood (TL) for ASD (n = 12). EL toddlers were classified into three outcome groups: EL-ASD (n = 10), EL-no diagnosis (EL-ND; n = 14), or EL-language delays (EL-LD, n = 16). Caregiver utterances were categorized according to the types of pretend and non-pretend play suggested (e.g., pretending with inanimate objects vs. using objects for their intended function). Pretend utterances were further categorized as related or unrelated to the child's own actions. All caregivers produced proportionately more utterances about complex types of pretend play over time. At 36 months, caregivers of autistic toddlers produced proportionately fewer pretend play utterances, and proportionately fewer pretend play utterances were related to EL-ASD toddlers' actions compared to their neurotypical peers. These findings highlight bidirectional effects between caregivers and toddlers during play. While EL-ASD toddlers may provide less frequent opportunities for caregivers to talk about complex types of pretend play, the current study highlights caregivers' high levels of attunement to their toddlers' play skills. The current study investigated how caregivers of toddlers with and without autism may differ in the ways they talk about pretend play with their children. Our findings demonstrate that caregivers of autistic toddlers spoke about play related to their toddlers' play actions less frequently, and spoke less frequently about pretend play than caregivers of neurotypical toddlers. However, caregivers of toddlers across groups talked about a variety of types of play. Findings highlight that caregivers are highly attuned to their toddlers' play skills regardless of developmental outcome. This may be especially important in informing early interventions using playtime with a caregiver as context for supporting social and language development for children with autism.