Tool Tuesday: Summer Study Series Part 2— “Ideas on Scaffolding Play through Narratives”

Continuing 2024’s Summer Study Series, this month we will look at a study using play contexts to build narrative language. It’s notable that since the publication of this 2020 study (Boston University), “Believing in Make‐Believe: Efficacy of a Pretend Play Intervention for School‐Aged Children with High‐Functioning Autism Spectrum Disorder,” there have been some significant shifts in our field’s focus towards neurodiversity-affirming language and approaches. For example, we should avoid stigmatizing labels such as “high-functioning”—go with “low support.” Although providing opportunities for complex language development—including narrative structure—is one of my goals in using play contexts with my students, I will suggest some adaptations to the language used, in order to be less directive in play. Play, after all, is supposed to be fun and validating! 

So, for details on this study (Doernberg, Russ, Dimitropoulos, 2020):

• The authors begin by detailing differences among autistic people in terms of pretend play and emotional understanding. A key point for me was the discussion of imagination: “Notably, the use of imagination and role-playing in pretend play may allow for a child to cognitively take on the perspectives of others, which may be further related to understanding the emotional experiences of others.” Let’s take that a step further—connecting with others through imagination is: a) FUN, and b) socially beneficial and facilitative of peer connections. This is a shift in my presentation of activities to my students—rather than “you need to do this,” “what you are doing is great and I dig it, AND this other thing may also benefit you.”
• The study implemented a play-based intervention with 25 students diagnosed with ASD (INV group), compared to a “waiting list control group” (WC). Measures such as an “Affect in Play” scale using puppets served as pre- and post-treatment measures, followed by a relatively small intervention period with a dosage of (5) 20-minute sessions.
• The intervention was based on an existing protocol from Russ and Moore and focused on “facilitating improvements in imagination in storytelling, organization of the story, and frequency and variety of emotion expressed in play, all via prompted play techniques…modeling, scaffolding, praising, reflecting emotions, and following the child’s lead.” I could not find the full protocol, as the author (also an author on this study) indicated it had been submitted for publication, but apparently not yet published.
• Intervention sessions involved “unstructured” toys such as blocks, Legos, toy cars, small dolls, etc., used with an introduction (more on this below, script the researchers used) and prompts such as “What is happening? What will happen first? What happens next?” “Show me. Use this to be pretend/make-up. Make up a different ending.”
• Loosely describing the results, the study found significant improvements in the INV group in “imaginative” moves in play and, notably for narrative language, organization markers such as sequencing and cause-effect. The study did not find a significant increase in “the frequency and range of affect expressed in play,” referencing emotional processing.

For practical applications of this study, I see it pointing to the power of narrative scaffolding in play. I particularly like to introduce students to the Story Grammar Marker^® icons and then have the uber-portable and flexible magnets from the Universal Magnet Set available, as they seem to fit right in with any set of toys. In addition, they can be used in any order, or in isolation to refer to and reinforce a specific story element.

While naturally directive and standardized because this was a study, let’s take a look at the script the researchers used:

“I have some toys for you to play with. I want you to make up stories about different things. So, you can make up a story and play it out with the toys. I will tell you when we are going to switch stories! Have the dolls and animals talk out loud so that I can hear. I will play with you. I want you to make up a story with a beginning, middle, and end. Think about what will happen next in the story. Use your imagination and make up new things.”

With a couple of tweaks, this can work for a more neurodiversity-affirming intervention:

“We are going to play with _______.  We can make up stories about different things! Here, I am using my imagination and will go first!”

This can be followed by omitting all that extra language and demands and modeling a story with the toys provided, using the magnets or other SGM visual support, to indicate some of the elements of the story acted out. It should be noted that we can also use story/expository icons to reinforce more repetitive elements of autistic play, for example, lining up cars to represent a LIST of cars.

In addition to your flexible toys, I often recommend the wonderful Toca Life: World app, which can be used to play out stories with simple to more complex structures.