Functional play with pretense
Functional play with pretense represents 1 category of pretend play. Functional play with pretense behaviors were measured in 33 of the 37 pretend play studies. This category represents the pretend play behaviors that might not be symbolic in nature. Functional play with pretense is the use of actual or miniature objects in the manner in which they were intended, but without the reality-based outcome (eg, placing a miniature cake pan in a miniature oven does not result in an actual cake). Functional play with pretense (a) involves the functional use of objects; (b) is nonliteral, thus involves pretend play; and (c) might not be symbolic. Functional plays with pretense and substitution behaviors are similar in their nonliteral nature. Functional play with pretense involves the nonliteral use of actual or miniature objects in the manner in which they were intended, whereas substitution involves the substitution of actual objects for other objects, absent objects for actual objects, or absent attributes for actual attributes. Functional play with pretense also is different from functional play. Generally, functional play is defined as using an object as its function designates with an intended, reality-based outcome (eg, coloring with crayons, putting a peg in a hole, placing a lid on a play tea pot, spinning the wheels on a truck, and turning the pages of a book; Libby, Powell, Messer, & Jordan, 1997; Sigman & Ungerer, 1984; Williams et al., 2001). Functional play and functional play with pretense (ie, using a spoon to feed a stuffed animal, putting a pan on a miniature oven and stirring with a spoon, or putting a bottle up to a doll's mouth) can be clearly distinguished from each other because only the latter involves nonliteral behaviors without the intended, reality-based outcome (eg, putting a bottle up to the doll's mouth does not result in feeding the doll). Functional play with pretense behaviors often included feeding (ie, self, a doll, or figure), grooming, or daily routines.
Measuring functional play with pretense
Across this literature, functional play with pretense was either included in the definition of pretend play (eg, Lifter, Ellis, Cannon, & Anderson, 2005), as the definition of pretend play (eg, DiCarlo & Reid, 2004), or excluded from the definition of pretend play (eg, Sigman & Ungerer, 1984). In fact, 4 of the 37 studies did not measure functional play with pretense behaviors at all, whereas 7 studies excluded functional play with pretense behaviors from the definition of pretend play and categorized them as functional, nonpretend play behaviors. Twenty-six of the 37 studies included functional play with pretense in the definition of pretend play. For 7 of these 26 studies, functional play with pretense was the definition of pretend play. In these 7 studies, the definition of pretend play did not include substitution behaviors. However, even when functional play with pretense was included in a broader definition of pretend play, the definitions were inconsistent or ambiguous. For example, Taylor and Iacono (2003) defined pretend play as including “activities not carried out to their usual outcome (eg, dressing up without going out)” (p. 71). Their definition of functional play included “the appropriate use of an object or the conventional association of two or more objects...” (p. 71). Ingersoll and Schreibman (2006) included performing distinct actions with miniature objects in the definition of pretend play. DiCarlo and Reid (2004) defined pretend play ambiguously (ie, actions that appeared to imitate a real-life situation involving objects that corresponded to the toys used in the action) and did not indicate which behaviors were not included as pretend play. Thus, even within the intervention studies, pretend play was inconsistently defined and ambiguously operationalized. Consistent, clear definitions of functional and pretend play are imperative for synthesizing across studies and conducting meta-analyses to inform evidence-based practices.
The second category in the pretend play taxonomy is substitution. This category encompasses 3 types of pretend play: (1) object substitution, (2) imagining absent objects, and (3) assigning absent attributes. This category is represented as symbolic play across many, but not all, play taxonomies. Thirty of the 37 studies included at least 1 type of substitution behavior in the operationalization of pretend play (ie, object substitution, imagining absent objects, or attribution assignment). Sixteen studies measured all 3 substitution behaviors (eg, Jarrold et al., 1996; Sherrat, 2002; Stahmer, 1995). The definitions included the following: (a) the use of an object as if it was another object, (b) imagining absent objects, or (c) assigning absent attributes to self or objects (eg, Blanc, Adrien, Roux, & Barthelemy, 2005; Stahmer, 1995; Ungerer & Sigman, 1981). Object substitution behaviors include using a block as if it was a car or truck or using a cloth for a cape. Object substitution behaviors can vary in sophistication. For example, toddlers and younger children might use objects of a similar shape or size to stand for something else (eg, a rectangle block as a car or a phone). As children develop more sophisticated play skills, they may use objects with different shapes or sizes to stand for something else (eg, a block as a helicopter or ball as a cup). Imagining absent objects includes holding your hand to your ear and pretending to talk on the phone or putting your hand on your head pretending to wear a hat. These behaviors also vary in sophistication. For example, children might pretend to talk on the phone without a phone or hold a steering wheel and drive a car while playing. Older children might play ball with each other without the ball or act out various routines in play with other children (eg, brushing teeth without a toothbrush and getting dressed without clothes). Assigning absent attributes includes pretending a doll is crying and rocking her or saying miniature, plastic food is hot and blowing on it. As children develop more sophisticated play skills, they might begin to take on roles (eg, “I'll be the veterinarian and fix my animals” with stuffed animals) or engage in fantasy games with their peers (eg, children might act out scenes from movies or books). Across this literature, substitution behaviors were inconsistently included and operationalized in the definition of pretend play.
Object substitution was twice as likely to be included in the definition of pretend play in the nonintervention studies, which suggests that intervention studies are not defining pretend play the same as descriptive studies. Yet, object substitution was not included in all definitions of pretend play in the descriptive studies. Twenty-seven studies measured object substitution behaviors. Two studies combined object substitution and imagining absent objects as “make-believe transformations” (ie, if the child substituted ambiguous or nonexistent objects for real objects; Stahmer, 1995; Thorp, Stahmer, & Schreibman, 1995). Three measured only object substitution as pretend play, not assigning absent attributes or imagining absent objects (Blanc et al., 2005; Charman & Baron-Cohen, 1997; Toth et al., 2006). This is an important distinction because object substitution might be a pivotal skill and an important intervention target due to its symbolic nature. Furthermore, the materials used to measure object substitution varied across studies. Junk toys were often used to measure and teach object substitution behaviors; however, the degree to which junk objects resembled actual objects varied across the studies. In some studies, junk toys were the same shape and size as the toys they were meant to represent (ie, using a block as a car or a rod as a bottle). For instance, Riguet, Taylor, Benaroya, and Klein (1981) measured object substitution with a washcloth for a blanket to cover a doll and a pill container for a cup. Other studies required the use of objects that were different in size and form from the objects they represent. For instance, Charman and Baron-Cohen (1997) measured object substitution with a rod as a bottle and a square block as a cup. Rutherford and Rogers (2003) measured object substitution with a piece of paper as a blanket to cover a doll and a peg as a spoon to feed a doll. Thus, object substitution was inconsistently defined and measured in this literature.
Assigning absent attributes
Assigning absent attributes also was differentially measured across the studies. Twenty-six studies measured assigning attributes. Five of these studies measured assigning attributes separately from object substitution (eg, Jarrold et al., 1996; Sherrat, 2002; Venuti, de Falco, Esposito, & Bornstein, 2009). For 3 of these studies assigning absent attributes was the definition of pretend play (eg, Colozzi, Ward, & Crotty, 2008; MacDonald, Clark, Garrigan, & Vangala, 2005). Assigning absent attributes frequently included assigning attributes to a doll (ie, having a doll drive a truck [Lifter, Sulzer-Azaroff, Anderson, & Cowdery, 1993] or having a doll jump or run [Jarrold et al., 1996]). However, assigning absent attributes was inconsistently included in the definition of pretend play.
Imagining absent objects
Seventeen studies included imagining absent objects in the definition of pretend play. Imaging absent objects included making pouring sounds with a tea pot over a cup as if pouring tea into a cup (Ungerer & Sigman, 1981), or moving hands around a bowl as if stirring with a spoon in the spoon's absence (ie, using nonexistent items; Stahmer, 1995). Imagining absent objects was inconsistently included in the definition of pretend play across this literature.
Characteristics of pretend play
Each of the 4 types of pretend play may occur in sequences and be accompanied by vocalizations (see Table 3). In fact, for most children, pretend play includes sequences and vocalizations (Fein, 1981). Thus, sequences and vocalizations are included as characteristics of pretend play in the taxonomy because they are important to consider when measuring and teaching pretend play. Sequences of pretend play are 2 or more related and consecutive functional play with pretense or substitution behaviors. The simplest sequences involve more than 1 action based on the same theme (eg, duplicating a routine or expressing a narrative). A sequence of pretend play includes the following: feeding a doll with a spoon, burping the doll, and putting the doll to bed. It is important to note that these sequences may include different types or categories of pretend play. For example, a child might stir a spoon around a small pot (functional play with pretense), bring the spoon to his mouth (functional play with pretense), and say, “This pudding is yummy!” (assigning absent attributes). Vocalizations related to pretend play might (a) identify a specific role the child is acting out (eg, Goldstein & Cisar, 1992); (b) assign attributes to themselves (eg, Taylor & Iacono, 2003; Thorp et al., 1995); (c) plan, map, or confirm pretend play behaviors (Charman & Baron-Cohen, 1997; Jarrold et al., 1996); or (d) simply describe the toys or actions. Both sequences and vocalizations related to pretend play were inconsistently measured across the studies.
Sequences were inconsistently defined across the studies. The simplest sequences involved more than 1 action duplicating a routine, expressing a narrative, or based on the same theme. Twelve of the 37 studies measured sequences of pretend play behaviors. Two of these 12 studies required a sequence of more than 2 behaviors (ie, Stahmer, 1995; Thorp et al., 1995). Several studies measured sequences of behaviors as part of specific routines (eg, Lieber & Beckman, 1991). For example, Lieber and Beckman measured sequences of more than 1 object substitution or functional play with pretense behavior around cooking or bedtime routines, respectively.
Across several studies, sequences were used as the measure of play complexity. For example, play complexity was defined as the same action toward 2 or more objects, different or related actions performed in succession (eg, Ungerer & Sigman, 1981), or variety in play themes based on novel behaviors, and length of play episode (eg, Lieber & Beckman, 1991). Lewis and Boucher (1995) measured play complexity as proportion of original ideas within a play sequence with a car or a doll. This proportion was the number of original actions produced with a specific toy divided by the total number of original and repeated actions. Stahmer (1995) measured play complexity as a sequence of 3 actions related to the same theme. Thorp et al. (1995) measured play complexity as persistence of play or carrying out a sequence of 4 related play actions. Ungerer and Sigman (1981) and Sigman and Ungerer (1984) measured play integration as the number of sequences of related play acts, and play complexity as the number of different acts in these sequences. This inconsistency in the definition of sequences and play complexity makes analyses across studies difficult.
Vocalizations were inconsistently included as characteristics of pretend play across these studies. Nineteen studies measured or included vocalizations related to pretend play. Three studies required confirmatory vocalizations for inferring pretense (Bishop, Hobson, & Lee, 2005; Charman & Baron-Cohen, 1997; Jarrold et al., 1996). Charman and Baron-Cohen required a confirmatory vocalization when measuring novel object substitution actions. The confirmatory vocalizations could be naming the action or making appropriate noises (eg, “I am feeding the baby” or a drinking noise). Jarrold et al. (1996) operationalized substitution behaviors as the child verbalizing their planned action and then acting it out without props (eg, “I am going to kick a ball” and the child kicks his leg out in the absence of an actual ball). Taylor and Iacono (2003) included, but did not require, confirmatory verbalizations in their measure of pretend play, as signals of the nonliteral nature of the behavior (eg, the child uses a different voice or mannerism to play a role). Ingersoll and Schreibman (2006) measured vocalizations during play, but they did not have to be related to the pretend play behaviors. Kim, Lombardino, Rothman, and Vinson (1989) defined and measured mean length of utterance during each play session; however, they did not report the results. In summary, vocalizations were not mentioned, included as secondary behaviors, or required in the measurement of pretend play in this literature; thus, analysis across studies is limited.
Adequacy of measuring pretend play
The purpose of this article was to describe a taxonomy of pretend play for children with disabilities based on a systematic review of the literature to characterize pretend play across this literature. The systematic review revealed that it is difficult to synthesize the pretend play literature due to the differences in the measurement and definitions of pretend play. The taxonomy provided more refined, precise definitions of pretend play, which allowed for comparisons across studies. This examination of the pretend play literature with children with disabilities highlights the need for future research in several areas.
Children with autism
Twenty-seven of the 37 studies included children with autism. This suggests that pretend play is an important topic for children with autism. Research consistently confirms that children with autism do not engage in the same levels of spontaneous pretend play as children without disabilities even when matched for mental age and receptive and expressive language abilities (eg, Charman & Baron-Cohen, 1997; Jarrold et al., 1996; Libby et al., 1997). However, the measurement and characterization of pretend play in children with autism were inconsistent across the studies. Future studies should examine the types and characteristics of pretense behaviors proposed in this taxonomy in children with autism.
Pretend play behaviors are often considered sequential in their emergence over time. Some pretense behaviors seem to logically precede others (ie, functional play with pretense proceeds object substitution) and involve a greater cognitive capacity. For example, Lifter et al. (1993) demonstrated developmentally appropriate pretense behaviors (eg, teaching simple pretend play behaviors before more complex behaviors) were more likely to be acquired than age-appropriate pretense behaviors (eg, teaching more complex pretend play behaviors appropriate for their age level) in children with autism. However, across the literature, there were inconsistencies in the characterization of the emergence of pretend play in children with disabilities. Using the proposed taxonomy in future research (eg, replications of the Lifter et al. study) may elucidate the emergence of pretend play, which is important for planning and teaching developmentally appropriate goals for children with disabilities.
Inference of pretense
The application of this taxonomy indicated that clear guidelines for inferring pretense are not widely accepted. Confirmatory vocalizations might provide added evidence for inferring pretense in children but were not measured consistently across studies. For example, Jarrold et al. (1996) separately measured intermediate pretend play as “behaviors which appeared imaginary, but could not be definitely placed in the [pretend play] category because of ambiguity in the child's actions, or through a lack of vocalization of intention” (p. 279). Venuti et al. (2009) separately measured transitional play as “approximated pretend play but without the confirmatory evidence” (p. 278). These definitions suggest that verbalizations were used to confirm the inference of pretend play. Future research using this taxonomy to operationalize the inference of pretend play may indicate the need to refine the definitions or expand the categories and types of pretend play.
Children with typical development
The purpose of this article was to develop and apply a taxonomy of pretend play to studies of children with disabilities. However, this taxonomy could also be applied to studies of children with typical development. Given that one primary rationale for teaching pretend play to children with disabilities is to occasion social interactions with peers, it is important to have a consistent, validated framework for characterizing and measuring play across all children. Future research might examine the application of this taxonomy to published studies of pretend play in children with typical development. Also, future pretend play intervention research with children with typical development might use taxonomy to operationalize the dependent variables or provide a framework for characterizing pretend play.
There are several limitations to this study worth noting. First, it is important to note that the categories and types of pretend play presented in the proposed taxonomy are not exhaustive or mutually exclusive of the overall play behaviors of children with disabilities. For example, the proposed taxonomy does not describe sensorimotor or relational play behaviors, which are often observed in infants and toddlers (Sherrat & Peter, 2002). Also, this taxonomy does not describe the social aspects of play (eg, parallel play [play near peers with the same toys in the same manner] and cooperative play [play with peers with the same toys and same goals]; Parten, 1932). Researchers should recognize the limited scope of this taxonomy when testing the proposed taxonomy.
Also, the proposed taxonomy was developed post hoc from published, peer-reviewed articles. Several studies measured pretend play in structured, segregated school settings or clinics, which may limit the types of pretend play observed. Ideally, the taxonomy would be the result of hours of observing children with disabilities across settings. Furthermore, the taxonomy has not demonstrated utility in research or intervention settings. Again, future research using the proposed taxonomy is warranted, which may reveal the need to further refine the taxonomy.
Application for practice
The taxonomy presented in this study can be used to create a direct observation system for gathering information on the pretend play repertoires of children with disabilities. Educational teams might use the operationalized definitions of pretend play in the taxonomy to provide consistency and reliability in measuring pretend play. Furthermore, practitioners can use the taxonomy with caregivers to discuss and gather information about the pretend play repertoires of children at home and at school. Practitioners can make recommendations to families using the types of pretend play within the taxonomy. For example, practitioners might encourage a family with a child with autism to have stuffed animals, bottles, small cups, spoons, and blocks accessible at all times to promote functional play with pretense and object substitution. Also, practitioners can use the taxonomy when talking with families about promoting pretend play at home based on the child's preferences and current level of functioning (eg, if the child has a favorite stuffed bear, the caregivers might model feeding the bear with a spoon or cup to promote functional play with pretense).
In summary, although the definitions used to define pretend play were reliable within each study, meta-analyses and replications are near impossible for the pretend play literature, because of the inconsistencies across studies. This taxonomy can be used to move the field forward, toward a consistent, replicable definition of pretend play for use in both descriptive and intervention studies. This will help identify and establish evidence-based practices for teaching pretend play to children with disabilities, which is clearly an important, functional skill.
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