Research on autism continues to ask which activities best support positive social relationships for children with autism. Children have benefited from therapy sessions that provide ongoing activities to build their ability to engage in healthy social interactions. However, less is known about how K–12 schools might offer similar programs, or whether school programs would help in the end. There is a gap, then, in understanding whether such programs could be implemented in schools to support the social, and therefore mental, health of children with autism.
Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47(6), 611–620. https://doi.org/10.1111/j.1469-7610.2005.01567.x
Kasari et al. report a randomized controlled study of 58 children with autism, aged 3 to 4, who attended applied behavior analysis (ABA) classrooms. The children were assigned to a joint attention intervention, a symbolic play intervention or a control group that received neither. Sessions lasted 30 minutes, ran five days a week for five to six weeks, and combined discrete-trial teaching with more child-directed interaction. Children in each intervention group improved the skill they were taught, and they carried these gains into interactions with their caregivers without being taught to do so. The control group showed no improvement in either skill.
Random assignment and a control group make this stronger evidence than the case studies in this list, and the transfer to caregivers suggests the gains were not limited to the therapy room. However, the study cannot show which component caused the improvement: the discrete-trial teaching, the child-directed play or the two together. It also does not show whether better play and joint attention lead to wider social gains, and the participants were young children in ABA classrooms, so the findings may not apply to older children or other settings.
This study offers the strongest controlled evidence in the list that play skills can be taught within a classroom-based program, which supports the case for school provision. Because it focuses on children aged 3 to 4, it should be read alongside research on school-age children.
Kenny, M. C., Dinehart, L. H., & Winick, C. B. (2016). Child-centered play therapy for children with autism spectrum disorder. In A. A. Drewes & C. E. Schaefer (Eds.), Play therapy in middle childhood (pp. 103–147). American Psychological Association. https://doi.org/10.1037/14776-014
In this chapter, Kenny et al. present a case study of a 10-year-old boy diagnosed with autism spectrum disorder (ASD). They describe the rationale and theory behind child-centered play therapy (CCPT): children with ASD often have social and behavioral problems that can improve when they have a safe therapy space in which to express themselves emotionally through play. The authors outline the progress the boy made with the social and communication difficulties associated with ASD, and they explain the role parents can play in carrying out CCPT. Their findings come from qualitative data gathered by observing the boy across multiple therapy sessions.
CCPT builds on earlier work by theorists who identified the role of play in supporting cognition and relationships. The case study shows how CCPT can be used successfully in a therapeutic setting to improve a child's communication and socialization skills, but it describes a single case, so its results cannot be generalized. The authors also acknowledge that CCPT is likely to be unsuitable for children who are not high functioning or who are more severely emotionally underdeveloped.
The chapter is useful for professionals working with children with ASD, and for parents, because it explains how parents can help carry out the treatment. However, more information is needed to decide whether CCPT would suit a K–12 school program for children with ASD.
Kossyvaki, L., & Papoudi, D. (2016). A review of play interventions for children with autism at school. International Journal of Disability, Development and Education, 63(1). https://doi.org/10.1080/1034912X.2015.1111303
Kossyvaki and Papoudi reviewed 14 studies, found by searching PsycINFO and ERIC for work published between 2000 and 2014, that used interventions to develop the play skills of autistic children at school. They aimed to identify these studies and to examine which play skills they targeted. The studies covered a wide range of skills, including pretend play, social play, joint engagement and initiating play with peers, and they used behavioral, developmental and mixed approaches. The authors call for more research in schools and for closer links between academic research and everyday school practice.
As a review of school-based studies, it speaks directly to the gap described in the introduction. However, many of the studies it includes used very small samples, and generalization beyond the intervention was assessed in only some of them. The search ended in 2014, so more recent studies are not covered, and the review is descriptive rather than a statistical synthesis.
This review is the most direct support for the claim that school-based play interventions exist but need more research. It is a useful starting point for locating individual school studies and for seeing which play skills have been targeted.
O'Keeffe, C., & McNally, S. (2023). A systematic review of play-based interventions targeting the social communication skills of children with autism spectrum disorder in educational contexts. Review Journal of Autism and Developmental Disorders, 10(1), 51–81. https://doi.org/10.1007/s40489-021-00286-3
O'Keeffe and McNally systematically reviewed play-based interventions that target the social communication skills of children with ASD in educational settings. Following PRISMA guidelines, they searched for studies published between 2000 and 2020 and synthesized the nine in which play was the main intervention. These studies included 107 children who received an intervention and 43 in wait-list control groups, aged roughly 3 to 13. Common features were adult-guided play, activities matched to each child's developmental level and interests, and the involvement of peers. Three studies reported positive results across all outcomes, and the rest were mixed.
The review was pre-registered and used a recognized quality appraisal framework, which strengthens confidence in its process. However, it used narrative synthesis rather than meta-analysis, so effect sizes could not be compared, and most of the included studies were rated weak in quality. The authors conclude that play-based intervention is promising but that the evidence is limited, particularly in naturalistic classroom settings.
This is the most recent and most school-focused source here, and it directly addresses whether play-based programs could work in education. Its finding that the evidence is promising but limited supports the introduction's point that the gap remains.
Stagnitti, K. (2016). Play therapy for school-age children with high-functioning autism. In A. A. Drewes & C. E. Schaefer (Eds.), Play therapy in middle childhood (pp. 237–255). American Psychological Association. https://doi.org/10.1037/14776-013
Stagnitti describes the Learn to Play program, which supports the social and personal development of children with high-functioning autism through a series of play sessions. The therapist begins the play, helps the child focus on it, and gradually encourages the child to move beyond the therapist's story by adding new, logical steps. The program is intended for children aged 1 to 8 who already communicate with others both verbally and nonverbally. Its rationale is that more complex imaginary play is linked to better emotional well-being and social skills, and Stagnitti reports that children gained personal and social skills by several incremental levels in a short time.
Stagnitti provides evidence that the program works but acknowledges that more research is needed to understand its long-term benefits. The discussion focuses on children identified as high functioning, so it is unclear whether the program works for other children. Stagnitti also notes that the program is already used in some schools but does not discuss whether results there differ from results in therapy settings.
The overview helps in judging whether the program could supplement K–12 school provision. However, more research is needed on how it would be implemented and on its benefits and drawbacks, and without that information it would be difficult for a researcher to base changes to other programs on this work. It does offer useful context and ideas for developing further research.
Wimpory, D. C., & Nash, S. (1999). Musical interaction therapy—Therapeutic play for children with autism. Child Language Teaching and Therapy, 15(1), 17–28. https://doi.org/10.1177/026565909901500103
Wimpory and Nash present a case study of musical interaction therapy used as part of play therapy to build communication skills in infants with ASD. They based their argument on films of play-based therapy sessions that included musical interaction, and they filmed follow-up play between the parent and child to assess its success. Twenty months after music play was introduced, the child showed prolonged playful interaction with both the psychologist and the parent, began pretend play spontaneously and started to develop appropriate language skills.
Because the case study was published in 1999, its results are dated, and research in the field has probably moved on since. The technique is useful, but the evidence rests on one case, and the article was written for psychologists and researchers working with infants with ASD, so other readers may find the findings less applicable.
This research gives background on using music in play-based therapy for infants with ASD. It presents a basis for the technique and outlines its initial development, so it is most useful when paired with more recent research in further trials.