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This quantitative study uses longitudinal caregiver surveys to explore the relationship between pretend play and development in children with ASD. Caregivers assessed the development of 7069 young children quarterly for three years on five subscales: combinatorial receptive language, expressive language, sociability, sensory awareness, and health. Pretend play was associated with superior developmental trajectories: 1.9-fold greater improvement of combinatorial receptive language ( p  &lt; 0.0001), 1.4-fold greater improvement of expressive language ( p  &lt; 0.0001), and 1.3-fold greater improvement of sensory awareness ( p  = 0.0009). Pretend play did not account for a significant amount of the variability in children’s sociability and health. The strong association of pretend play with combinatorial receptive language remained significant even when controlling for expressive language. Similarly, the strong association of pretend play with expressive language remained significant even when controlling for combinatorial receptive language. The association of pretend play with combinatorial receptive language was stronger than the association of seizures, sleep problems, or high-TV exposure. These findings support earlier studies suggesting that pretend play may be an important stepping stone for language acquisition and highlight a potential for pretend play therapeutic interventions.

Pretend play predicts language development in young children with Autism Spectrum Disorder