Expert: Valerie Herskowitz - 10/4/2011

Question
Hi Valerie,Thankyou once again for your advice regarding my son. Could you please advise on the question of pretend play.My son appears to meet all the diagnostic criteria for a diagnosis of autism, however when I have looked into autism it states that children with autism do not play pretend or use their imaginations, this causes me confusion as my son who is now coming up to three has begun to play pretend, it is on a very basic level and tends to be very repetitive, for example, he sat a figure in a toy train and said sit down and then careful, [which is what we say to him as he climbs on everything], he does not build on this any further and repeats . When he is in the bath he will put a duck in a boat and then say outside and then take the duck out again and then repeat again and again.He does the same thing every bathtime.
He will say bye and go out of a door and then come back and say hello and repeat over and over.
He has also picked up a stick and blew it and said bubbles.
He has also started to make vroom noises when riding his bikes. His pretend play never involves anyone else and is very limited.
Do children who are autistic ever play pretend and if not what is likely to happen regarding my son receiving an autism diagnosis as he seems to fit the criteria in every other way and I cannot think of any other explanation for his dificulties and behaviour. would his pretend play be considered atypical and limited and then is this likely to be disregarded when considering a diagnosis.Please advice. many thanks

Answer
HI Sharon

Actually the diagnosis of autism is made on only 3 criterion: 1. Has to have started before the age of 3  2. Has to demonstrate a speech and language delay or difficulty  3. Has to show delay or difficulty in social skills

The rest are just characteristics that may or may not be present. Some children with autism do pretend play while others do not. However, I think it is a good prognosticator that your son is using pretend play. There are many characteristics of autism. Children may have some but not all of them and still be receive the diagnosis. But they have to have the 3 criterion listed in the first paragraph.

Hope that helps. I know you are confused. It's a difficult thing to accept.