Psychology

O R I G I N A L P A P E R

Play and Joint Attention of Children with Autism in the Preschool Special Education Classroom

Connie Wong • Connie Kasari

Published online: 17 February 2012

� Springer Science+Business Media, LLC 2012

Abstract The purpose of this study was to examine play

and joint attention in children with autism (n=27) as

compared to children with other developmental delays

(n=28) in public preschool special education classrooms.

The participants were observed in their classroom envi-

ronment for 2 h over 3 separate days. Results show that

children with autism spent more of their time unengaged

and less time engaged in symbolic play and joint attention

behaviors as compared to children with other develop-

mental delays. Additionally, teachers seldom focused

directly on symbolic play and joint attention in their

teaching. These findings suggest the importance of edu-

cating teachers to target play and joint attention skills in

their preschool special education classes, specifically for

children with autism.

Keywords Autism � Play � Joint attention � Engagement � Preschool special education

Introduction

Young children with autism have significant social-com-

munication delays in symbolic play and joint attention.

Specific deficits in these areas distinguish children with

autism from typically developing children as well as from

children with intellectual disabilities (Mundy et al. 1986).

Furthermore, both symbolic play and joint attention are

significantly associated with later social (Sigman and Ru-

skin 1999), cognitive (Mundy et al. 2010; Stanley and

Konstantareas 2007) and communication development

(Charman et al. 2003; Kasari et al. 2008; Loveland and

Landry 1986; Mundy and Markus 1997; Mundy et al. 1986,

1990; Sigman and Ruskin 1999).

In symbolic play, children progress developmentally

from playing with toys functionally, such as in constructive

and manipulative play, to playing with toys symbolically

(Lifter et al. 1993). However, in comparison to typically

developing children, children with autism at the same

mental ages have significant delays in the development of

symbolic play (Jarrold et al. 1993; Baron-Cohen 1987).

Children with autism tend to manipulate toys or objects in a

rigid or stereotyped manner (Atlas 1990) and less often

spontaneously initiate creative symbolic play activities

(Jarrold et al. 1993; Libby et al. 1998). Beyond these

delays in play skills, children with autism are often object

focused with less frequent engagement of others into their

play activities (Kasari et al. 2010).

Joint attention, the ability to shift attention between

another person and an object or event, has a communica-

tive function in that these skills are used for the purpose of

sharing attention or interest with another person (Hobson

1989). Compared to MA-matched children with and with-

out intellectual disabilities, children with autism have

specific deficits in initiating and responding to joint

C. Wong (&) Frank Porter Graham Child Development Institute, CB8040,

University of North Carolina at Chapel Hill, Chapel Hill, NC

27510, USA

e-mail: [email protected]

C. Wong

Psychological Studies in Education, University of California,

Los Angeles, CA, USA

C. Kasari

Semel Institute for Neuroscience and Human Behavior,

University of California, Los Angeles, CA, USA

123

J Autism Dev Disord (2012) 42:2152–2161

DOI 10.1007/s10803-012-1467-2

attention (Mundy et al. 1986). They are more likely to use

pointing and attention skills to regulate others’ behaviors

rather than to share interest (Mundy et al.).

The observed differences in play and joint attention

skills for children with autism are well documented, and

recent efforts to teach these skills have yielded positive

results (Jones et al. 2006; Lang et al. 2009; Martins and

Harris 2006; Stahmer 1995; Whalen and Schreibman

2003). There are few randomized controlled trials (RCTs)

in which joint attention and play skills have been examined

as outcomes of the intervention although the intervention

may have focused on these core areas of development

(Dawson et al. 2010; Green et al. 2010; Landa et al. 2011).

However, Kasari et al. (2006) showed that not only were

children with autism able to spontaneously generate sym-

bolic play activities and initiate joint attention with others

as a result of their focused RCT intervention, they also had

better language outcomes 1 year later (Kasari et al. 2008).

Obtaining change is critical on these areas of core deficit

for young children with autism since improvement is

linked to better developmental outcomes. However,

research studies have most often been conducted in labo-

ratory settings using skilled therapists to teach children.

While some recent studies demonstrate that parents can be

effective in improving play and joint attention outcomes

(Kasari et al. 2010; Rocha et al. 2007; Schertz and Odom

2007), children spend considerable time in preschool set-

tings with teachers.

It is not clear the extent to which teachers focus on these

core impairments for children with autism, even in class-

rooms that are autism-specific. For example, Sigman and

Ruskin (1999) reported that children with autism initiated

and participated in fewer social interactions with peers than

children with Down syndrome and children with other

developmental disabilities and tended to play in isolation.

Holmes and Willoughby (2005) also observed mostly sol-

itary or parallel functional play behaviors in seventeen 4- to

8-year old children with autism in the classroom. Addi-

tionally, Keen et al. (2002) reported that in their study of

eight children with autism, the children mostly requested

objects or protested; there were few instances of com-

menting. Further, teachers infrequently acknowledged

children’s communicative attempts (Keen et al. 2005).

The lack of focus given to symbolic play and joint

attention may be due to teachers’ lack of knowledge

regarding the importance of these skills. Although recent

reports identifying evidence-based practices for children

with autism include research support for the use of inter-

ventions that focus on play and joint attention (National

Research Council 2001; National Standards Project 2009;

Stansberry-Brusnahan and Collet-Klingenberg 2010),

teachers often have limited time and support to access

research findings (Closs and Lewin 1998). Furthermore,

there is limited research on classroom-based methods

(Brunner and Seung 2009). While Stahmer and Aarons

(2009) found that autism early intervention providers

generally reported favorable attitudes towards using evi-

dence-based practices, little is known regarding their actual

use of those strategies in practice. Finally, there is a lack of

emphasis on developing symbolic play and joint attention

in early childhood curricula. In a content analysis of

commonly adopted curricula for young children with aut-

ism, few contained symbolic play skills in an appropriate

developmental sequence and fewer curriculum guides

provided instruction for teaching joint attention skills.

When joint attention skills were mentioned, they were

often in the context of other goals such as pointing to show

receptive understanding rather than for sharing interest

(Wong and Kasari 2003).

Given the limited research in classrooms and with

teachers, the objective of this study was to build upon the

existing research focused on play and joint attention in

children with autism by examining those behaviors in the

preschool classroom setting as well as focusing on teach-

ers’ facilitation of play and joint attention. Specifically, we

asked (1) To what extent do children with autism initiate

play and joint attention across different types of settings in

the natural classroom environment? (2) What opportunities

do teachers provide for encouraging and/or developing

symbolic play and joint attention behaviors? (3) How do

teachers respond to children’s initiations of symbolic play

and joint attention in the classroom?

Methods

Participants

Recruited from a public early childhood learning center in

a suburban school district, participants included 55 pre-

schoolers analyzed in two groups: children with autism

(n = 27) and a mixed group of children with other dis-

abilities (n = 28). Children with autism all had a clinical

diagnosis of autism from a licensed psychologist or neu-

rologist. Though the majority of children in the mixed

group of other disabilities had speech/language delays,

other diagnoses included Down syndrome, cerebral palsy,

ADHD, and emotional/behavioral disorder.

Participating children ranged in age from 3 to 5 years

old with mental-age scores between 18.5 and 59 months as

calculated from the Mullen Scales of Early Learning

(Mullen 1995). The preschoolers were primarily boys, with

the proportion of males to females being higher in the

autism group, reflective of the gender ratio in autism.

Table 1 shows further demographic information. There

were no significant differences between the two groups.

J Autism Dev Disord (2012) 42:2152–2161 2153

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The eleven participating classrooms had between six

and fourteen children taught by a certificated teacher and

two to four instructional assistants. All eleven teachers

were female and had between one and 32 years of expe-

rience teaching preschool special education. Table 2 pro-

vides further detailed background information. Nine of the

participating classrooms were self-contained non-categor-

ical classrooms and two were autism-specific; however, not

all children in the autism-specific classrooms had a diag-

nosis of autism. Regardless of class designation and child

diagnoses, the teachers all reported that classroom practices

were guided primarily by the school-designed curriculum

which was based off of state preschool standards and

supplemented by the Carolina Curriculum for Preschoolers

with Special Needs (Johnson Martin et al. 2004).

Measures

Classroom Observation

Children were observed in their classroom on three sepa-

rate mornings within a two-week period. Researchers blind

to children’s diagnosis continuously recorded the presence

of specific child behaviors and teacher behaviors towards

the target child in 5-min intervals for a total of approxi-

mately 2 h (M = 123.57, SD = 13.77 min) observation

time per child. Data was collected on a Palm V using Elan

2.0.1 (Sanders 2002), a shareware application designed for

behavioral data collection in educational settings. It is a

date and time-stamp recording application in which

templates can be created to record specific variables of

interest as well as anecdotal notes. When observed, all

participants had been in their classrooms for at least

3 months.

Table 3 describes the different play and joint attention

behaviors that were coded. In order to maintain higher

levels of interrater reliability, initiating joint attention

required the child to go beyond a coordinated joint look

(shifting gaze back and forth between an object/event and

another person) to also display a clear gesture of sharing

interest such as a show or a point. Thus, only higher level

joint attention skills were coded (Van Hecke et al. 2007).

Teacher behaviors were coded when they directly provided

any instruction in or prompts for play and joint attention as

well as if they responded to those behaviors. Researchers

recorded anecdotal notes to provide examples of the

behaviors. The average intraclass correlation coefficient

established between two independent coders was .86, with

a range of .81–.92 for the child and teacher play and joint

attention behaviors. Researchers also tracked children’s

engagement states (Adamson et al. 2004; Bakeman and

Adamson 1984) to calculate the percentage of time chil-

dren spent in each state. Intraclass correlation coefficients

for percent time in the different engagement states ranged

from .86 to .95.

Finally, the child’s activities in the classroom were

recorded as unstructured (e.g., free play, recess), structured

(e.g., circle, centers), or caregiving (e.g., toileting, snack).

Overall, children spent 56% of the time in structured

activities (M = 68.82, SD = 19.50 min), 32% in

Table 1 Child demographics

Autism (n = 27)

M (SD)/frequency (%)

Mixed disability (n = 28)

M (SD)/frequency (%)

V2/F

Chronological age (months) 51.70 (6.74) 49.76 (5.89) F(1,53) = .06, p = .80

Gender

Male 22 (82%) 18 (64%) V2(1) = 2.05, p = .15

Female 5 (18%) 10 (36%)

Ethnicity

Caucasian 13 (48%) 13(46%) V2(3) = .33, p = .95

Hispanic 3 (11%) 4 (14%)

Asian American 8 (30%) 7 (25%)

Other 3 (11%) 4 (14%)

Mullen scales of early learning

Mental age (months) 42.14 (9.19) 39.24 (9.42) F(1,52) = .16, p = .70

Receptive language age (months) 41.81 (9.77) 38.20 (10.42) F(1,52) = .27, p = .61

Expressive language age (months) 37.67 (10.70) 35.09 (9.26) F(1,52) = .12, p = .74

Mother’s highest level of education

High School 1 (4%) 1 (4%) V2(2) = .67, p = .72

Some College/Vocational Training 2 (7%) 4 (14%)

College/Professional/Graduate 24 (89%) 23 (82%)

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unstructured activities (M = 39.45, SD = 11.91 min), and

12% in caregiving activities (M = 14.78, SD = 9.07 min).

For ease of interpretation, data was transformed so that the

variables of interest were divided by the total time in the

activity. There were no significant differences in activity

times between the two groups of children.

Structured Play Assessment (SPA; Ungerer and Sigman

1981)

The frequency, type, and level of spontaneous play

behaviors were coded from this videotaped 15-min inter-

action to determine highest play level mastery. While the

child and tester sat facing each other at a table, the tester

presented four groups of related toys including a tea set,

baby bottle, dolls, telephone, brush, mirror, doll furniture,

tissue, blocks, dump truck, and a garage.

To master a play level, the child had to spontaneously

initiate three play acts at a specific level of three different

types. For example, to reach mastery at the substitution

level, the child displayed a substitution with three different

objects (e.g., block as a cookie, paper as a blanket, and toy

bed as an airplane). Thus, for each child, we determined the

highest mastered level of play they demonstrated on the

assessment (not just the highest level of play shown).

Early Social-Communication Scales

(ESCS; Mundy et al. 1986)

The child’s nonverbal initiations and responses to joint

attention were scored from this videotaped 15-min semi-

structured assessment. The child and tester sat across from

each other with a set of toys to the side that were visible but

beyond reaching distance of the child. The tester, who was

Table 2 Teacher/classroom demographics

Teachers/classrooms

(N = 11)

M (SD)/frequency (%)

Teacher age (years) 49.89 (6.33)

Teacher ethnicity

Caucasian 9 (82%)

Hispanic 1 (9%)

Asian American 1 (9%)

Years of teaching

In current position 8.20 (7.94)

Total in similar position 16.30 (12.13)

Class age designation

3- to 4-year olds 5 (46%)

4- to 5-year olds 6 (54%)

Class type

Non-categorical self-contained class 9 (82%)

Autism specific self-contained class 2 (18%)

Class size

# of child study participants in the class 5.00 (2.45)

Total # of children in the class 10.27 (2.32)

Total # of adults assigned to the class 3.45 (.69)

Ratio of children to instructors 3.06 (.84)

Table 3 Behaviors coded in the classroom observation

Behavior Definition

Engagement

states

(adapted from Adamson et al. 2004)

Unengaged The child appears uninvolved with any specific person or object

Person-engaged The child is engaged in an interaction with another person

Object-engaged The child is solely focused on an object. The child is not communicating with another person in any way

Supported joint The child and another person are actively involved in the same object or toy, but the joint engagement is actively maintained

by the other person.

Coordinated joint The child initiates or is actively involved with and coordinates attention to both another person and the object to share

attention

Play (adapted from Lifter et al. 1993; Ungerer and Sigman 1981)

Child functional

play

The child creates combinations of objects and/or may extend familiar actions with objects in a pretend quality to self, others,

or to doll figures

Child symbolic

play

The child extends familiar actions to two or more figures or moves the figures as if they are capable of action. The child may

use one object to stand in place for another or pretends to use something that is not there. The child may adopt various

familiar or fantasy roles in a play theme

Joint attention (adapted from Mundy et al. 1986)

Child RJA The child responds (attentional or behavioral) to another’s bid (show or point to an object) for joint attention

Child IJA The child initiates (show or point) a bid for joint attention towards another person for sharing purposes

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trained to elicit different responses, presented the different

toys one at a time.

From the assessment, the child’s mastery of responding

to and initiating joint attention was determined. To reach

mastery criteria of a specific skill, the child must have

demonstrated an act with at least two different objects on

the ESCS. In determining skill mastery for joint attention

initiations, only acts associated with eye contact were

considered intentional. We used these criteria to determine

what the child could demonstrate in joint attention at a

minimum ‘‘mastered’’ level across the assessment.

Mullen Scales of Early Learning (MSEL; Mullen 1995)

The MSEL assesses language, motor, and perceptual abil-

ities for children birth to about 5 years old. The visual

reception, fine motor, expressive language, and receptive

language subscales were used to calculate mental age.

Furthermore, the language subscales were used to report

receptive and expressive language age scores.

Demographic Information

The parents/guardians completed a demographic form to

obtain the child’s chronological age, gender, ethnicity, and

the parents’ highest level of education.

Teacher Survey

Teachers completed a questionnaire to collect teachers’

demographic information (age, gender, ethnicity, highest

level of education, and years of related teaching experi-

ence) as well as general classroom information (number of

students in the classroom and the number of adults in the

classroom).

Procedure

After obtaining informed parental consent to participate, all

assessments and observations were collected within

1 month for each child. Demographic forms and teacher

surveys were distributed, completed, and collected within

this same time frame.

Results

Primary analyses were conducted using ANCOVAs to

compare dependent variables of engagement, play, and

joint attention behaviors of children and teachers between

the autism and mixed disability groups and to explore if

there were differences across activities. Since Wong et al.

(2007) found that children with autism who had higher

mental age scores had higher rates of learning symbolic

play and joint attention skills when taught those skills, the

model included mental age as a covariate. Table 4 shows

the means and standard deviations of those behaviors in the

two groups and across activities.

Multilevel analyses were run using HLM 6.02 (Rau-

denbush et al. 2005) for dependent variables of play and

joint attention. While classroom differences were found,

the variance was primarily explained by individual child-

level variables rather than by classroom or teacher char-

acteristics; therefore, the following analyses were con-

ducted at the child level.

Engagement States

Children with autism spent more time in an unengaged

state than children in the mixed disability group

(F = 23.81, p \ .001), with significantly more time spent unengaged during caregiving activities than in any of the

other activities (F = 6.01, p \ .05). Children with autism were observed to be mostly eating/drinking or waiting in a

passive manner while children in the mixed disability

group were more likely to engage themselves by watching,

playing with something, or engaging another person.

Compared to children with other disabilities, children

with autism spent a higher percentage of time being object-

engaged in structured than in unstructured activities

(F = 5.31, p \ .05). Regardless of activity, children with autism spent a significantly lower percentage of time in

person engagement than children in the mixed disability

group (F = 14.32, p \ .001). The percentage of time spent in each of the engagement

states was further examined for its relation to each of the

main play and joint attention variables of interest. Table 5

shows a summary of the regression analyses.

Play

Most functional play occurred during unstructured activi-

ties (F = 19.68, p \ .001). However, compared to children in the mixed disability group, while children with autism

initiated fewer functional play acts in unstructured settings,

they displayed more functional play in structured activities

(F = 8.64, p \ .01). For symbolic play, no significant differences were found

between children with autism and children with other dis-

abilities. Although symbolic play acts were observed more

frequently in unstructured settings (F = 14.51, p \ .001), those behaviors were present at relatively low levels

overall. During structured activities, play was not the pri-

mary objective. In fact, anecdotal notes reflected that cre-

ativity was often stifled in favor of adhering to the goals of

the activity. For example, one of the teachers redirected a

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child to finish completing her puzzle when she started

moving the animal puzzle pieces as if they were walking

and making corresponding animal sounds.

Overall, children displayed more functional than sym-

bolic play acts in the classroom (t = 12.80, p \ .001). Of the total play acts displayed in the classroom, approxi-

mately 94% were at the functional play level while only

about 6% were at the symbolic level. Furthermore, while

only 28 of the children displayed one or more play initia-

tions at the symbolic or dramatic level during the class-

room observations, 45 of the participants demonstrated

mastery criteria for playing at those levels during the

Structured Play Assessment.

Teachers did target more functional than symbolic play

skills with the children (t = 2.36, p \ .05). In examining teachers’ teaching of functional play skills, a main effect of

activity type was found (F = 9.62, p \ .01) but no main effect was found for the disability group. These results are

qualified by a significant interaction of group and activity

(F = 8.08, p \ .01). For children in the mixed disability

group, teachers targeted functional play more in unstruc-

tured activities than in structured activities. The pattern for

children with autism was the opposite, with more teacher

focus on functional play in structured settings and almost

none in unstructured activities. No significant effects were

found in teaching symbolic play.

An analysis on teachers’ responses to children’s play acts,

functional and symbolic, revealed that teachers responded at

higher proportions during structured activities than in any

unstructured and caregiving activities (F = 5.17, p \ .05).

Joint Attention

Although there were no significant differences in the fre-

quency of bids for joint attention between the two groups in

the classroom, children with autism responded to fewer

bids than children in the mixed disability group

(F = 17.40, p \ .001). While children with autism only responded to 58.31% of opportunities, children in the

mixed disability group responded 74.94% of the time.

Table 4 Means and standard deviations of classroom behaviors across activities

Structured Unstructured Caregiving

Autism

M (SD)

Mixed

disability

M (SD)

Autism

M (SD)

Mixed

disability

M (SD)

Autism

M (SD)

Mixed

disability

M (SD)

Engagement states

% Unengagement 33.13 (13.58) 20.96 (10.92) 37.82 (21.05) 23.66 (13.44) 51.66 (22.52) 33.41 (20.77)

% Person engagement 6.99 (5.42) 11.74 (5.85) 6.93 (5.55) 12.25 (8.92) 2.92 (4.68) 7.01 (10.78)

% Object engagement 20.09 (8.76) 14.44 (7.65) 36.62 (12.79) 40.51 (14.64) 20.34 (17.63) 25.14 (17.72)

% Supported joint engagement 14.67 (5.69) 20.54 (11.96) 6.54 (5.24) 6.88 (4.50) 10.16 (7.88) 12.00 (18.92)

% Coordinated joint engagement 3.29 (3.78) 5.90 (6.25) 5.51 (7.52) 8.48 (10.07) 5.29 (6.53) 9.70 (13.92)

Play

Frequency of functional play acts 21.27 (17.75) 11.64 (14.84) 47.64 (52.94) 58.24 (44.95) 0 1.29 (5.81)

Frequency of symbolic play acts .96 (1.98) .56 (1.79) 3.33 (4.77) 5.47 (8.97) .22 (1.15) .27 (1.39)

Frequency of teacher prompts

for functional play

1.31 (3.00) .76 (2.24) .09 (.36) 2.00 (3.34) 0 0

Frequency of teacher prompts

for symbolic play

.29 (.63) .40 (1.12) .09 (.36) 1.02 (3.41) 0 0

% of teacher responses to child’s play acts .21 (.56) .27 (1.00) .10 (.48) .25 (1.01) – –

Responses to joint attention (RJA)

Frequency of teacher bids for JA 72.13 (36.61) 71.38 (25.19) 15.53 (13.21) 14.78 (8.84) 22.87 (29.13) 16.84 (12.67)

% of child RJA to bids for JA 62.82 (15.65) 75.22 (12.05) 59.60 (28.52) 69.92 (21.31) 44.55 (34.25) 77.73 (18.92)

Frequency of teacher prompts for RJA .58 (1.15) .44 (.81) .04 (.23) 0 0 0

% of teacher responses to child’s RJA 0 .60 (2.13) 0 0 0 0

Initiations of joint attention (IJA)

Frequency of IJA 17.44 (13.17) 31.02 (20.56) 18.98 (19.34) 31.38 (27.34) 19.40 (22.95) 39.56 (54.90)

Frequency of teacher prompts for IJA .73 (1.48) .87 (2.57) .38 (.94) 0 .11 (.58) 0

% of teacher responses to child’s IJA 49.89 (17.39) 43.45 (13.89) 41.38 (24.46) 35.18 (18.94) 41.97 (36.03) 48.71 (26.87)

Frequencies have been calculated as acts per second, * p \ .05, ** p \ .01, *** p \ .001

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Teachers did initiate more joint attention acts towards

children during structured activities than in the other

activities (F = 5.50, p \ .05). However, the occurrence of teachers instructing children to respond to their bids for joint

attention was very low. When teachers did teach children to

respond, they were mostly telling children to ‘‘look’’ when

they showed or pointed to something. Moreover, teachers

seldom responded to or praised children for attending to their

requests for joint attention.

Consistent with results from the ESCS, children with

autism initiated fewer joint attention skills than children in

the mixed disability group (F = 10.92, p \ .01) across all activity types in the classroom. Furthermore, teachers

taught children to initiate joint attention acts at low fre-

quencies. Anecdotal notes suggest that when teachers did

teach children to initiate joint attention acts, it was usually

in the context of teaching other academic or language

skills. For instance, teachers would physically help shape a

child’s hand into a point for them to identify the correct

answer to their question. In such a case, the correct answer

would usually be an object or picture and the goal was

often to test comprehension (e.g., labeling, color/shape/

letter identification). No significant differences were found

between the teachers’ treatment of children with autism

and children in the mixed disability group.

In an examination of teachers’ responses to children’s

initiations of joint attention, no significant effects were

found. However, while teachers would respond by looking

towards what the child wanted to share, they rarely rec-

ognized and reinforced shows and points as joint attention

behaviors.

Discussion

The results of this study confirm that children with autism

showed fewer play and joint attention behaviors than

children with other disabilities in their classrooms as would

be predicted by previous assessment studies (e.g., Mundy

et al. 1986). Teachers in the classroom provided minimal

teaching of play and joint attention and responded to those

behaviors at low levels in the classroom setting. Of particular

note is that teachers did not adjust their teaching to address

these developmental domains and teacher and classroom

variables were not associated with teacher performance.

Engagement

Most striking, the results indicated that children with aut-

ism spent 37% of the observed time in an unengaged state,

where, by definition, they were not purposefully attending

to or interacting with objects or other people. Indeed, the

results of this study show that the greater percentage of

time spent in an unengaged state, the less likely children

displayed play and joint attention skills. Children with

autism likely have more difficulty sustaining attention to

some of the activities in the classroom than children with

other developmental delays, and probably require adult

facilitation.

Furthermore, children with autism also have increased

difficulty in initiating engagement with other people.

Although all children spent fairly equivalent amounts of

time engaged with objects, children with other disabilities

were more likely to initiate engagement with other people,

either teachers or other peers in the classroom. Conversely,

children with autism were more likely to slip from object-

engaged states to states of unengagement. Thus, children

with autism need greater environmental arrangements to

successfully engage with others in the classroom.

Play

Although capable of playing at symbolic levels, chil-

dren primarily played at functional levels of play.

Table 5 Summary of hierarchical regression analyses for unengaged, supported joint, and coordinated joint engagement states (N = 55)

Variable Unengaged b Object b Person b Supported joint b Coordinated joint b

Step 1 R 2

= .35* R 2

= .03 R 2

= .24** R 2

= .14* R 2

= .29***

Autism diagnosis .51*** .16 -.48*** -.31* -.31*

Mental age -.39** -.11 -.08 .26* .49***

Step 2 R 2

= .66* R 2

= .72*** R 2

= .61** R 2

= .50*** R 2

= .75***

Autism diagnosis .27** .02 -.30* -.10 .001

Mental age -.18 .18 -.25 .03 .17

Functional play -.24** .72*** -.16 .13 -.02

Symbolic play -.05 -.05 .13 -.26* .20*

Response to JA -.11 -.17 -.16 -.13 .04

Initiations of JA -.51*** -.29* .32* .68*** .69***

* p \ .05, ** p \ .01, *** p \ .001

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Developmentally, it may be simpler for children to engage

in functional play than putting forth the effort to create more

complex, symbolic play. Additionally, some of the func-

tional play toys may be more attractive as battery-powered

sound effects and lights increasingly accompany them. Due

to the lack of symbolic play displayed during the classroom

observations, there was not enough power to detect differ-

ences in symbolic play between the two groups of children.

Teachers rarely facilitated the play of children in the

classroom. When they did, the focus was on functional play

despite the child’s mastered play level. However, it was

difficult to determine whether teachers’ responses to chil-

dren’s play had any effect because they responded at such

low levels. During unstructured times, teachers allowed

children to engage in play activities independently with

minimal feedback. In structured settings, when teachers did

respond, it was often negative because play at that time

usually meant that the children were not completing their

assigned task. Teachers often discouraged playing crea-

tively for the sake of maintaining classroom order and

completing the objectives of the activity. Regardless, in

general, teachers did not recognize or support children’s

play during structured or unstructured periods.

Joint Attention

Consistent with the literature, children with autism respon-

ded to and initiated fewer bids for joint attention in both the

classroom and assessment setting when compared to chil-

dren with other disabilities (Mundy et al. 1986). The finding

remained significant even when considering the children’s

developmental levels and their classroom environments.

Teachers presented more opportunities for children, with

or without autism, to respond to their joint attention acts in

structured rather than unstructured activities. As expected,

in circle or at centers, teachers would use more showing

and pointing to teach children than in unstructured and

caregiving settings. Although teachers provided opportu-

nities for children to respond, they generally did not pro-

vide specific instruction about responding and initiating to

increase their joint attention abilities.

While teachers did respond naturally to children’s ini-

tiation of joint attention skills, they rarely responded to

them with the intent of reinforcing those behaviors. Nor

were teachers attempting to specifically teach nonverbal or

verbal joint attention skills.

Implications

The findings from this study highlight several factors that

need to be considered in translating research on play and

joint attention to practice for children with autism. First,

children with autism are spending a significant amount of

time unengaged in the classroom. Without decreasing the

percentage of unengagement, it would be difficult to

intervene on and increase children’s symbolic play and

joint attention behaviors.

Second, as teachers were not recognizing symbolic play

and joint attention acts, it may be that these skills should be

treated as separate skill domains to be specifically taught

and reinforced, especially for children with autism. One of

the issues for teachers is the lack of available resources on

play and joint attention (Wong and Kasari 2003). Early

childhood curriculum guides need to be more explicit in

describing these domain areas.

Another issue for teachers is that in typical preschools,

the goal is to foster independence and thus, teachers take

the role of a facilitator by setting up stimulating environ-

ments and providing functional assistance like obtaining

materials and problem solving (Fleming et al. 1991).

However, children with autism may need more social

assistance, requiring additional guidance and structure to

engage with others. While children with other disabilities

may naturally engage and interact with other people,

children with autism may have too much independence in

that they are not seeking out others in the classroom.

Therefore, teachers may need greater support in learning

about evidence-based practices targeting play and joint

attention for young children with autism in the classroom.

These data are among the first to examine play and joint

attention skills in a classroom setting for children with aut-

ism. However, a limitation of this research was that these data

were gathered from one school district in a fairly homoge-

neous area with respect to ethnicity and socioeconomic sta-

tus. Data collected in a more diverse area with teachers using

different curricular models may be useful in determining if

these results can be generalized to other children and class-

rooms. Regardless, teacher training and future research

practice should focus more on symbolic play and joint

attention in the school setting because of the importance of

these skills on later language and social development.

Acknowledgments The authors thank the children, families, and teachers who participated in this study and the research assistants who

helped gather and code these data: Eric Ishijima, Kimberly Ochs, and

Alisha Patel. This article is based on a doctoral dissertation submitted

by the first author, under supervision of the second author, at the

University of California, Los Angeles. This research was supported in

part by a training grant from the National Institutes of Health, NIMH

grant MH064927(Connie Kasari), and Autism Speaks grant 2373

(Connie Wong).

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