What if non-#autistic “pretend play” is pathological?

board game with pieces
I’ve been thinking a fair amount about so-called “theory of mind” (ToM), lately, and I keep coming across references to it. Take, for example, the recent paper “Theory of Mind Deficit Is Associated with Pretend Play Performance, but Not Playfulness, in Children with Autism Spectrum Disorder” They talk about how “pretend play” is impaired in autistic kids (oh, sorry – “children with Autism Spectrum Disorder”), and how “ToM significantly predicted pretend play variables”.

Well, okay. They ran the tests, they did the analysis, they made their findings. The paper says:

The results showed that children’s ToM was significantly associated with their pretend play in initiating play actions, object substitutions, property attribution, and pretending an imaginary object were present. However, the correlation coefficients failed to show a significant relationship between children’s ToM and their playfulness.

So, kids who did poorly on ToM didn’t “perform” pretend play very well.

From the paper (bold emphasis is mine, and I’ve taken out the citations):

Play, the main occupation of children, both reflects and improves the development of their physical, cognitive, and social skills. Play is the dynamic interaction between the individual child and the child’s immediate environment, and it is influenced by sociocultural factors. The two essential manifestations of play are external performance and internal experience. The former is observable performance, which unfolds in play activities; the latter is playfulness, which is the key to determining whether an activity belongs to play or not. Therefore, it is important to view play as a whole construct involving both external performance and internal experience.

Issues with this paper begin right from the start. First off, the idea that play is “the main occupation of children” seems flawed to me. And it seems to completely misunderstand the purpose of “play”. Kids aren’t just horsing around. They’re developing their inner systems, their senses, their reflexes, their relationship with the world. In my opinion, learning and development is the main occupation of children, and if it comes across as play, then great. But learning/development is not secondary to play, as the authors seem to believe. Quite the contrary — play is secondary to learning and development.

The paragraph then takes a turn for the better (sigh of relief) when the authors talk about how play has a dual nature — external and internal. It’s not just about how it looks to outsiders; it’s also about how you experience it yourself (the level of playfulness). And yeah, we need to consider both the internal and external sides of play, in order to assess it fully.

Pretend play is a form of external performance and is defined as play composed of both conventional imaginative play and symbolic play. Conventional imaginative play is preliminary pretend play. It refers to perceiving objects (or conventional toys) as real or small copies of things, and using them in a functionally proper way outside of the typical context. Examples are pretending to feed a doll using a toy spoon, using an empty cup to pretend to drink, or rolling a toy car on the floor and making engine noises. Symbolic play is sophisticated pretend play. It refers to using objects (or unstructured toys) as something else, attributing properties, or pretending an absent object is present. Examples are using a banana as a telephone, pretending a piece of cloth is wet, or making an imagined cup with the hands and pretending to drink. Therefore, pretend play provides an opportunity for children to practice events occurring in their daily lives or social worlds. Through engagement in pretend play, children learn the differences between reality and imagination. Moreover, pretend play reflects and facilitates the development of emotions, language, cognition, social skills, social awareness, and perspective-taking ability.

I’m sure there’s plenty of research substantiating the above, but I think there are a lot of conceptual leaps that hew to a typical line. And those leaps may be blinding the researchers to additional considerations.

Why is it so essential that children turn something into something it’s not, to show sophistication? Why is it assumed that children who substitute one thing for another are developing normally? Seems odd to me. Why wouldn’t they wonder if something was amiss with those kids, if they clearly can’t tell that what they’re holding is in fact not a telephone, but they keep trying to use it as one? And how is it heart-warming, for a child to not understand that their doll is inanimate, that it’s incapable of eating and drinking, so it’s pointless to try to feed it or give it a bottle? Maybe that’s standard-issue non-autistic childhood behavior, but it’s not the only kind of human behavior that bears fruit.

The bias becomes quickly clear. Pretend play appears to be the one and only precursor to normal development. So, one could say that if it’s absent, it’s logical to expect that “emotions, language, cognition, social skills, social awareness, and perspective-taking ability” would all be ultimately impaired. Ugh.

Pretend play deficit appears to be a clinical feature of children with ASD and has long been a focus of the study of child development. Previous studies have found that children with ASD are unable to understand the pretend actions in play. Wing, Gould, Yeates, and Brierly (1977) conducted the first research that directly examined pretend play in children with ASD and children with intellectual disability and found that the majority of children with no observable pretend play or those with stereotyped, copying pretend play behaviours were children with autistic disorder. Several studies have also found that pretend play is apparently less frequent in children with ASD, and that their play behaviours lack symbolism, creativity, and complexity. Rutherford et al. conducted a longitudinal study that measured children’s pretend play in a free play condition and a structured condition with external instructions. Their results showed that children with ASD found it significantly more difficult than typically developing children to perform pretend play in both conditions and that spontaneous pretend play was more impaired. Furthermore, in addition to difficulties in performing pretend play, children with ASD have impaired comprehension of pretend play as well. In summary, research has shown that children with ASD are unable to understand the pretend actions in play. Children with ASD have decreased frequency and complexity when performing pretend play, and the difficulties can present spontaneously or appear with external facilitations.

Oh, my. That’s chock full of bias, pathologizing, and outright cluelessness about what’s really going on beneath the surface of autistic play. It’s so full of … “incomplete understanding”… I’m not sure where to start.

There’s the deficit model approach. Talking about our differences as impairments. Citing research from 1977 (for heaven’s sake!), and not apparently asking any #ActuallyAutistic folks about why we played they way we did, when we were younger. Trust me, a lot of us remember. And we could shed a truckload of light and insight on this question of “Why do autistic kids play the way they do?”

I take issue with their assumption that autistic kids don’t understand pretend actions in play. What if — just what if — we actually did understand, but categorically rejected it, because we needed to play in a very different way? What if we’re just more interested in learning how the real world actually works, rather than fooling around with playthings that aren’t the real thing? There seems to be an assumption that children aren’t capable of that kind of reasoning, when we’re quite young.

But I remember clearly, so many times when I was young, being offered dolls and toys and other objects that were supposed to be played with a certain way, but consciously choosing not to interact with them the way I was expected. Because I wanted to find out how they worked. I wanted to see how they were put together. I didn’t play with the pretend vacuum cleaner my aunt gave me one Christmas. I took it apart and played with the different pieces, to see how they operated, how they felt, how they took up space. I had no interest in any dolls other than one that looked exactly like a real baby and had a body made of fleshlike foam. I didn’t think of that doll as my child, though. I thought of it as a friend. Because clearly, I couldn’t have a child of my own. I was too young. I was closer in “age” to that baby, than I was to my mother. So, you do the math. It made no logical sense for me to pretend I was that “baby’s” mother.

So, when all these adults are sitting on the floor, trying to get autistic kids to do pretend play like the “normal” kids, they might ask themselves if it makes any logical sense for those kids to do what they’re asking them to do. And it might also help if they tossed in a bit of reality along with the pretend. I just don’t get why children are expected to concoct their own version of what’s real and what’s not, when the real, physical, tangible world is right there in front of them, just waiting to teach them about all the laws of physics.

What the paper clearly misses, is the possibility that rather than being a sign of impairment, autistic kids’ modes of play are simply a sign of difference. Where non-autistic kids may pretend more, say, using a banana as a telephone or pretending that a doll is a real baby or imagining that a toy car is a real vehicle that makes real sounds, autistic kids might — just might — have more of an interest in non-pretend (or real) play.

What if autistic kids (who were shown in the study to be playful just like the non-autistic kids) simply have a different mode of play which emphasizes reality, which interacts with things as they are, rather than turning them into something else?

And what if that ability to actually play with the real properties of objects were essential to our development in learning to navigate the world around us and interact with our environments?

Looking even deeper, what if the researchers factored in sensory processing issues and rather than pathologizing their play styles, they realized that they actually served a purpose. To whit:

In this study, it was observed that children with ASD who had poor adaptation to change and more unique use of objects would exhibit play behaviours that were less changeable and lacked narrative. For example, the children might keep rolling the toy truck to watch the rotation of the wheels without any play purpose, and the children would also show resistance when asked to play with other objects or when the tester modelled the play actions.

Play, as many of us autistic folks know, can be “less changeable” for a whole host of reasons.

First, the situation might be overwhelming for the kid, which prompts them to stim, or find some repetitive motion that soothes their jangled nerves. Also, certain kinds of play might lead to a “flow state” which is blissfully consistent. Or the kid rolling the truck might be observing the rotation, seeing how it changes, based on the surface, sensing the vibrations of it, basically absorbing massive amounts of data about that seemingly simple scenario — all of which is invisible to the adult. What’s more, that adult might have had a childhood rich with pretend play, which got them in the habit of making stuff up in their mind that seemed to correlate with reality, but which was just the product of their undirected, uninformed imagination.

And if an adult comes along and interrupts your flow state, disrupts your experiment, insisting that you do something different that isn’t contextually appropriate, how is that supposed to affect an autistic kid? It’s annoying. It can be  hurtful. Why should we accommodate their non-contextual request to change what we’re perfectly fine with?

However, the results showed that ToM was not a significant predictor of children’s playfulness, possibly because of the small sample size. In addition, the results showed that autistic behaviour was the most significant predictor of children’s playfulness. It suggested that children with more autistic behaviours would look less joyful during play. As autistic behaviour encompasses the characteristics of ASD, the results are congruent with those of previous studies demonstrating that children’s playfulness is related to individual characteristics, such as age, sex, and other personality attributes.

So, stop with the pathologizing, already. And never mind the ToM stuff, period. I find it very telling that the researchers felt the need to say autistic kids “look less joyful during play”. How would they know what joyful looks like? Trust me, I can be ecstatic on the inside, and people around me think I’m pissed off. Seems the impairments of social detection aren’t only autistic.

After reading through this paper, I have to wonder, what if so-called pretend play were actually a sign of pathology, indicating that non-autistic children are prone to make up things  in their minds which simply aren’t true… and if left unchecked, that can ultimately develop into full-blown inability to deal with reality as it is. What if children who were skilled at pretend play eventually grow into adults who surround themselves with invented falsehoods which confirm their biases and are never challenged, because they’re seen as “normal” behavior? Given the amount of autism research like this paper, it would appear that too many pretend-play experts have been allowed to persist in their childhood habits of making sh*t up, and it’s now affecting their adult work.

Hmmmm… I think someone should do some research on that. Now that would be a paper I’d like to read.

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7 thoughts on “What if non-#autistic “pretend play” is pathological?

  1. This is really insightful. I think that you would love the book “Children’s Minds” by Margaret Donaldson, in which she describes her work demonstrating that Piaget completely under-estimated the abilities of children. My son has down syndrome and his behavior was always viewed through a lens of disability, when he was at school. For example, I was told that his tendency to love the reading corner was because he found the classroom “too overwhelming ” rather than being seen for what it was -a love of books! The army of teaching and therapeutic staff were fully informed on the “stages” that all kids are supposed to go through but had completely missed the research showing that children with down syndrome can become good early readers, which helps with their development and especially, their speech and language abilities. The limitations of the staff then led to his removal from the classroom for remediation , such as “speech therapy”, with the inevitable result that he missed out on the education that his peers were receiving, as well as the social benefits and, the feeling that he really belonged. Which led to a few minor behavioral issues, which led to the involvement of yet another “expert” professional, the behavioral psychologist. The way you describe your way of playing makes perfect sense to me and rather than being pathological, could be seen as actually quite advanced. This is the kind of activity that could lead one to becoming good at science and engineering in the future, is it not?!

    Liked by 2 people

    1. VisualVox

      Thank you for writing. I’m sorry to hear about your son’s marginalization. It’s a loss for everyone.

      I absolutely believe that our way of work-playing (which is much more obviously “work” than the “play” of non-autistic kids) is a great preparation for science and engineering, but also any discipline that requires intense focus. In a way, our mode of playing is setting us up for success in the most grueling and demanding disciplines, and when I hear adults saying children should be encouraged to only do things that will apply to later work, it makes me cringe. Because what in the world is better training for the world of hyperfocused, intense work (be that science, engineering, the arts, inventing, or really any detail-oriented work), than the autistic mode of play?

      Well, we all have a long way to go to figure things out. I just wish people would think for themselves and deal with what-is, rather than looking to experts of yesteryear who knew some things, but not all things.

      It’s always an adventure. Fortunately, we’re resilient creatures, we human beings. 🙂

      Like

  2. Something I first noticed while still a child myself (in the early to mid-1980s) was that many “normal” children were only imitating whatever they saw on television when playing with their plastic robots or G.I. Joe dolls or whatever. They’d recreate the previous week’s episodes of the cartoons that went with the toys. Nothing original or inventive was permitted; any straying from the actual events seen in the show was considered “doing it wrong.” To me, that seemed weird. I preferred make up my own stories, even if I was pretending those toys were the television characters they looked like (which wasn’t usually the case).

    Liked by 1 person

  3. You wrote “what if so-called pretend play were actually a sign of pathology, indicating that non-autistic children are prone to make up things in their minds which simply aren’t true… and if left unchecked, that can ultimately develop into full-blown inability to deal with reality as it is”. I must say I completely disagree with this. I did a lot of pretend play when I was a child. I had dolls and pretended they were my children. Yes, I knew I wasn’t old enough to actually have children, but of course I pretended to be an adult. I wasn’t completely stupid! I also did a lot of what the paper calls “symbolic play”. I’ve seen the same in my niece, when she uses wooden building blocks as the walls of the hair salon, the hair dryer, the shampoo bottle and the hair dye. I went even further and had a whole load of invisible horses and dogs. I think this is a world away from “making sh*t up” and being ignorant of reality. Actually, I remember that it was the more “normal” kids who had difficulty using a building block as a hair dryer. Unless they had a realistic looking toy hair dryer, they just couldn’t imagine it, and I always felt that their inner lives were the poorer for it. As for wanting to play only with actual real things as a child – you might have to wait a long time for that before the adults let you! (And I noticed that I’ve made myself sound kind of offended and angry, which I’m not, so please don’t take it that way!)
    You also wrote “What the paper clearly misses, is the possibility that rather than being a sign of impairment, autistic kids’ modes of play are simply a sign of difference.” I completely agree with you there.

    Liked by 2 people

    1. VisualVox

      Yeah, after I wrote this, it occurred to me that I should probably qualify all of it by saying that I was constantly engaged in pretend play, when I was a kid. My sister and I created elaborate alternate worlds, And when I was by myself, I was usually involved in some sort of pretending. It was all hugely beneficial, and I used it to practice for interacting with the real world. I guess I was in a contrary and frame of mind when I wrote the piece, but it doesn’t reflect the full spectrum of my thoughts and feelings about the subject. Thanks for bringing this up, additional clarification is definitely in order.

      Liked by 1 person

      1. I think it’s the contrariness I picked up on and reacted to, although there’s nothing wrong with being contrary now and then! I totally agree with the main thrust of your piece, namely that there is no right or wrong (“pathological”) way to play.

        Liked by 1 person

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