The Effects of Symbolic Play Training on Communication Skills in Children with High-Functioning Autism: A Single-Subject Study

Autism Spectrum Disorder (ASD) is the most serious and unknown childhood condition. A significant deficit in ASD is impairment in communication skills, which causes language and speech problems. Play–Based interventions are among the most common approaches for these children. A critical skill of play, i.e., associated with the acquisition of language and verbal skills, is symbolic play. The deficit in symbolic play is also a characteristic of children with ASD. Considering the importance of symbolic play in development and deficiency in symbolic play in children with ASD, a curriculum can be designed for these children. However, play–centered interventions for children with ASD have rarely focused on symbolic play. The present study aimed to determine the effects of Symbolic Play Training (SPT) on communication skills in children aged 4–6 with high–functioning ASDs.

This experimental study applied a single experimental design, i.e., performed using the A–B method. The study's statistical population included children with ASD in Sabzevar City, Iran, in 2018. Three children with high–functioning ASDs were selected using the purposive sampling method (Center of Roshd). The study's inclusion criteria included obtaining a score of 85 or higher on the Gilliam Autism Rating Scale (GARS; Gilliam, 1995), the age range 4 to 6 years, parental consent to participate in the study, and no physical disabilities and audiovisual impairments. The study participants were evaluated and intervened at the Autism Education and Rehabilitation Center for 4 months. The first participant was 5.4 years old, which according to the results of the GARS, the autism rate equaled 71, suggesting the odds of mild ASD. The second participant was 5 years old. The total scores of the subscales of the GARS equaled 70; thus, the probability of ASD was low. The third participant was 6 years old. For this participant, the sum of the subscales of the GARS was 79, reflecting the probability of mild ASD. The study subjects were three 4––6–year–olds. Educational sessions were arranged in 36 weekly sessions, 4 days for 1.5 hours. The GARS was used to assess the severity of ASD. To measure communication skills before and after implementing the intervention program, the Autism Treatment Evaluation Scale (ATEC; Rimland & Edelson, 2000) was performed. For data analysis, visual analysis of graphs and trend line, Reliable Change Index (RCI), recovery percentage index, the Percentage of Nonoverlapping Data (PND), and the Percentage of Overlapping Data (POD) were used. The collected data were analyzed using SPSS at the significance level of 0.05.

Based on the visual analysis of the data, the interventional program effectively improved communication skills in all study participants. The RCI for the first, second, and third subjects was measured as 15.03, 7.22, and 9.37, in sequence, i.e., more significant than the criterion value of 1.96 for all research participants. The percentage of recovery achieved by the first participant was 66%, indicating treatment success. The percentage of recovery achieved in the second participant was 51%, reflecting improvement. The percentage of recovery achieved in the third participant was 67%, suggesting appropriate recovery.

Based on the present study findings, SPT played an effective role in reducing communication problems among children with high–functioning ASDs. Thus, SPT can be applied as an effective intervention for improving linguistic and communication skills in pre–schoolers with high–functioning ASDs.