Play assessment in the differential diagnosis of autism and other causes of severe language disorder.

The autistic child's problems with language may be an impairment in symbolic functioning that affects all forms of communication, including representational thought and the ability to play creatively. The hypothesis that autistic children specifically do not project symbolic meaning onto toys (which is not associated with other conditions causing severe language disorder) was tested in a group of 15 severely language-impaired children. Data were obtained from a parent interview/questionnaire and analysis of a video-taped play session. The findings suggest that language-disordered children who meet DSM III criteria for autism most consistently show absence of symbolic play, and those who do have symbolic play fall into a wide range of diagnostic categories excluding autism. The report presents valuable observational and interpretational clinical factors, useful in the assessment and differential diagnosis of a language-impaired child.