Children with Prader–Willi syndrome (PWS) are at risk for autism spectrum disorder (ASD), including pervasive social deficits. While play impairments in ASD are well documented, play abilities in PWS have not been evaluated. Fourteen children with PWS and ten children with ASD were administered the Autism Diagnostic Observation Schedule (ADOS) (Lord et al. in Autism Diagnostic Observation Schedule manual. Western Psychological Services, Los Angeles, 2006) as part of a larger project. A modified Affect in Play Scale (APS; Russ in Play in child development and psychotherapy: toward empirically supported practice. Lawrence Erlbaum Associates Publishers, Mahwah, 2004; Pretend play in childhood: foundation of adult creativity. APA Books, Washington, 2014) was used to score ADOS play activities. Results indicate both groups scored below normative data on measures of imagination, organization, and affective expression during individual play. In addition, the inclusion of a play partner in both groups increased all scaled scores on the APS. These findings suggest children with PWS show impaired pretend play abilities similar to ASD. Further research is warranted and should focus on constructing and validating programs aimed at improving symbolic and functional play abilities within these populations.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price includes VAT (USA)
Tax calculation will be finalised during checkout.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Baron-Cohen, S. (1987). Autism and symbolic play. British Journal of Developmental Psychology, 5(2), 139–148.
Bass, J. D., & Mulick, J. A. (2007). Social play skill enhancement of children with autism using peers and siblings as therapists. Psychology in the Schools, 44(7), 727–735.
Beeghly, M., Weiss Perry, B., & Cicchetti, D. (1989). Structural and affective dimensions of play development in young children with Down syndrome. International Journal of Behavioral Development, 12(2), 257–277.
Constantino, J. N., & Gruber, C. P. (2005). Social responsiveness scale. Los Angeles: Western Psychological Services.
Descheemaeker, M.-J., Govers, V., Vermeulen, P., & Fryns, J.-P. (2006). Pervasive developmental disorders in Prader–Willi syndrome: The Leuven experience in 59 subjects and controls. American Journal of Medical Genetics Part A, 140A(11), 1136–1142.
Dimitropoulos, A., Ho, A., & Feldman, B. (2012). Social responsiveness and competence in Prader–Willi syndrome: Direct comparison to autism spectrum disorder. Journal of Autism and Developmental Disorders, 43(1), 103–113.
Dykens, E. M., & Cassidy, S. B. (1999). Prader–Willi syndrome. In S. Goldstein & C. R. Reynolds (Eds.), Handbook of neurodevelopmental and genetic disorders in children (pp. 525–554). New York, NY: Guilford Press.
Dykens, E. M., Lee, E., & Roof, E. (2011). Prader–Willi syndrome and autism spectrum disorders: An evolving story. Journal of Neurodevelopmental Disorders, 3(3), 225–237.
Evans, D. W., Leckman, J. F., Carter, A., Reznick, J. S., Henshaw, D., King, R. A., et al. (1997). Ritual, habit and perfectionism: The prevalence and development of compulsive-like behavior in normal young children. Child Development, 68(1), 58–68.
Fehr, K. K., & Russ, S. W. (2013). Aggression in pretend play and aggressive behavior in the classroom. Early Education and Development, 24(3), 332–345.
Fein, G. G. (1987). Pretend play: Creativity and consciousness. In D. Gorlitz, & J. F. Wohlwill (Eds.), Curiosity, imagination, and play: On the development of spontaneous cognitive motivational processes (pp. 281–304). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Greaves, N., Prince, E., Evans, D. W., & Charman, T. (2006). Repetitive and ritualistic behaviour in children with Prader–Willi syndrome and children with autism. Journal of Intellectual Disability Research, 50(2), 92–100.
Hoffmann, J., & Russ, S. (2012). Pretend play, creativity, and emotion regulation in children. Psychology of Aesthetics, Creativity, and the Arts, 6(2), 175–184.
Hogart, A., Wu, D., LaSalle, J. M., & Schanen, N. C. (2010). The comorbidity of autism with the genomic disorders of chromosome 15q11.2–q13. Neurobiology of Disease, 38(2), 181–191.
Jones, A., & Glenn, S. M. (1991). Gender differences in pretend play in a primary school group. Early Child Development and Care, 72, 61–67.
Jordan, R. (2003). Social play and autism spectrum disorders: A perspective on theory, implications, and educational approaches. Autism, 7(4), 347–360.
Kasari, C., Freeman, S., & Paparella, T. (2006). Joint attention and symbolic play in young children with autism: A randomized controlled intervention study. Journal of Child Psychology and Psychiatry, 47(6), 611–620.
Kasari, C., Gulsrud, A., Freeman, S., Paparella, T., & Hellemann, G. (2012). Longitudinal follow up of children with autism receiving targeted interventions on joint attention and play RH = targeted interventions on joint attention and play. Journal of the American Academy of Child and Adolescent Psychiatry, 51(5), 487–495.
Kaugars, A. (2001). Emotional processes in four-year-old children prenatally exposed to cocaine. Unpublished doctoral dissertation, Case Western Reserve University, Cleveland OH.
Kaugers, A. S., & Russ, S. W. (2009). Assessing preschool children’s pretend play: Preliminary validation of the affect in play scale-preschool version. Early Education and Development, 20(5), 733–755.
Krasnor, L. R., & Pepler, D. J. (1980). The study of children’s play: Some suggested future directions. New Directions for Child and Adolescent Development, 1980(9), 85–95.
Leslie, A. M. (1987). Pretense and representation: The origins of “theory of mind”. Psychological Review, 94(4), 412–426.
Lewis, V., & Boucher, J. (1997). The test of pretend play. London: Harcourt Brace.
Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (2006). Autism Diagnostic Observation Schedule manual (4th ed.). Los Angeles, CA: Western Psychological Services.
Malone, M. (2009). Patterns of home- and classroom-based toy play of preschoolers with and without intellectual disabilities. International Journal of Disability, Development and Education, 56(4), 333–347.
Manning, M. M., & Wainwright, L. D. (2010). The role of high level play as a predictor social functioning in autism. Journal of Autism and Developmental Disorders, 40(5), 523–533.
Milner, K. M., Craig, E. E., Thompson, R. J., Veltman, M. W. M., Thomas, N. S., Roberts, S., et al. (2005). Prader–Willi syndrome: Intellectual abilities and behavioural features by genetic subtype. Journal of Child Psychology and Psychiatry, 46(10), 1089–1096.
Moore, M., & Russ, S. W. (2008). Follow-up of a pretend play intervention: Effects on play, creativity, and emotional processes in children. Creativity Research Journal, 20(4), 427–436.
Power, T. J., & Radcliffe, J. (1989). The relationship of play behavior to cognitive ability in developmentally disabled preschoolers. Journal of Autism and Developmental Disorders, 19, 97–107.
Riguet, C. B., Taylor, N. D., Benaroya, S., & Klein, L. S. (1981). Symbolic play in autistic, down’s, and normal children of equivalent mental age. Journal of Autism and Developmental Disorders, 11, 439–448.
Russ, S. W. (1993). Affect and creativity: The role of affect and play in the creative process. Hillsdale, NJ: L. Erlbaum Associates.
Russ, S. W. (2004). Play in child development and psychotherapy: Toward empirically supported practice (Vol. xi). Mahwah, NJ: Lawrence Erlbaum Associates Publishers.
Russ, S. W. (2014). Pretend play in childhood: Foundation of adult creativity. Washington, DC: APA Books.
Russ, S. W., & Grossman-Mckee, A. (1990). Affective expression in children’s fantasy play, primary process thinking on the Rorschach, and divergent thinking. Journal of Personality Assessment, 54(3–4), 756–771.
Russ, S. W., Robins, A. L., & Christiano, B. A. (1999). Pretend play: Longitudinal prediction of creativity and affect in fantasy in children. Creativity Research Journal, 12(2), 129–139.
Rutter, M., LeCouteur, A., & Lord, C. (2003). Autism diagnostic interview-revised (ADI-R) manual. Los Angeles, CA: Western Psychological Services.
Rydell, A. M., Hagekull, B., & Bohlin, G. (1997). Measurement of two social competence aspects in middle childhood. Developmental Psychology, 33(5), 824–833.
Seja, A. L., & Russ, S. W. (1999). Children’s fantasy play and emotional understanding. Journal of Clinical Child Psychology, 28, 269–277.
Semel, E., Wiig, E. H., & Secord, W. A. (2003). Clinical evaluation of language fundamentals, fourth edition (CELF-4). Toronto: The Psychological Corporation/A Harcourt Assessment Company.
Sigman, M., & Mundy, P. (1987). Symbolic processes in young autistic children. New Directions for Child and Adolescent Development, 36, 31–46.
Stanley, G. C., & Konstantareas, M. M. (2007). Symbolic play in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(7), 1215–1223.
Uren, N., & Stagnitti, K. (2009). Pretend play, social competence and involvement in children aged 5–7 years: The concurrent validity of the child-initiated pretend play assessment. Australian Occupational Therapy Journal, 56(1), 33–40.
Van Berckelaer-Onnes, I. A. (2003). Promoting early play. Autism, 7(4), 415–423.
Veltman, M. W. M., Thompson, R. J., Roberts, S. E., Thomas, N. S., Whittington, J., & Bolton, P. F. (2004). Prader–Willi syndrome: A study comparing deletion and uniparental disomy cases with reference to autism spectrum disorders. European Child and Adolescent Psychiatry, 13(1), 42–50.
Vieillevoye, S., & Nader-Grosbois, N. (2008). Self-regulation during pretend play in children with intellectual disability and in normally developing children. Research in Developmental Disabilities, 29, 256–272.
Wechsler, D. (2003). Wechsler intelligence scale for children (4th ed.). San Antonio, TX: Harcourt Assessment.
Williams, E., Reddy, V., & Costall, A. (2001). Taking a closer look at functional play in children with autism. Journal of Autism and Developmental Disorders, 31(1), 67–77.
We would like to thank all of our research participants for their time and support of this project. Thank you also to the members of the Neurodevelopmental Research Lab for assistance with this research, especially Tovah Weinrib for dedicating her time to conduct reliability coding for the study. This work was supported by a Grant from the Prader–Willi syndrome association (USA).
About this article
Cite this article
Zyga, O., Russ, S., Ievers-Landis, C.E. et al. Assessment of Pretend Play in Prader–Willi Syndrome: A Direct Comparison to Autism Spectrum Disorder. J Autism Dev Disord 45, 975–987 (2015). https://doi.org/10.1007/s10803-014-2252-1
- Autism spectrum disorder
- Prader–Willi syndrome
- Pretend play
- Social skills