Pretend Play and Social Engagement in Toddlers at High and Low Genetic Risk for Autism Spectrum Disorder

Cultivating the imagination: Caregiver input during pretend play with toddlers at elevated likelihood for autism

Toddlers with autism spectrum disorder (ASD) may exhibit less pretend play than their neurotypical counterparts. Previous research suggests that caregivers' input during play influences children's play behavior, and children's behavior may in turn prompt caregivers of differently developing children to talk about play in different ways. Caregiver input about pretend play during toy play at home was examined at 18- and 36-months in toddlers with an older sibling with ASD, who are at elevated likelihood (EL) for ASD (n = 40), and toddlers with typical likelihood (TL) for ASD (n = 12). EL toddlers were classified into three outcome groups: EL-ASD (n = 10), EL-no diagnosis (EL-ND; n = 14), or EL-language delays (EL-LD, n = 16). Caregiver utterances were categorized according to the types of pretend and non-pretend play suggested (e.g., pretending with inanimate objects vs. using objects for their intended function). Pretend utterances were further categorized as related or unrelated to the child's own actions. All caregivers produced proportionately more utterances about complex types of pretend play over time. At 36 months, caregivers of autistic toddlers produced proportionately fewer pretend play utterances, and proportionately fewer pretend play utterances were related to EL-ASD toddlers' actions compared to their neurotypical peers. These findings highlight bidirectional effects between caregivers and toddlers during play. While EL-ASD toddlers may provide less frequent opportunities for caregivers to talk about complex types of pretend play, the current study highlights caregivers' high levels of attunement to their toddlers' play skills.

Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match): A Virtual Parent-Mediated Intervention Package for Young Children with Developmental Disabilities

This study aimed to evaluate Promoting Reciprocal Relationships with Flexibility, Coaching, and Teaching (PRRFCT Match), a parent-mediated naturalistic developmental behavioral intervention package. An expansion from an earlier pilot study (see Kunze et al., 2021), PRRFCT Match incorporates virtual coaching between a novice coach and parent to implement evidence-based, applied behavior analytic (ABA) techniques during play to increase engagement and decrease unengaged behavior exhibited by their young child with developmental delays (26-50 months old). Ten parent-child dyads were matched with a coach in this concurrent multiple baseline design across participants. Simulating the clinical training level of a novice early interventionist, nine graduate student clinicians received training as coaches on PRRFCT Match implementation and weekly supervision by a research team member. All aspects of training and intervention were delivered virtually. A visual analysis of the data combined with Tau-U revealed a strong basic effect between clinician coaching and parent strategy use. For child participants, a visual analysis and Tau-U results suggest that most increased engagement and decreased their unengaged behavior during the intervention. High variability, overlap, and high engagement at baseline are discussed. This study shows promise for the PRRFCT Match intervention package. The ABA technologies mediated by parents during play increased child engagement and decreased unengagement for most participants.

Immediate Caregiving Environment of Young Children with Autism: Findings from the U.S. National Survey of Children's Health

Autism spectrum disorder (ASD) is a complex neurodevelopmental disability that negatively affects children's learning, motor behavior, social communication, and interaction. It was estimated that, in 2020, 1 in 36 children aged 8 years in the United States had ASD. Caring for children with ASD might exert significant psychological and emotional distress on parents. Receiving parental emotional support and fostering positive parent-child interactions at home have been identified as beneficial for the immediate caregiving environment for children with ASD. The current secondary analysis of the 2019-2020 National Survey of Children's Health examined parent-child interactions and accessible sources of emotional support for parents caring for 3-5-year-old children diagnosed with ASD (N = 243). Children with the following characteristics had higher odds of having ASD: male gender; having no private insurance or uninsured; and having less than excellent general health. Among parents, higher odds of caring for children with ASD were associated with accessing emotional support from various sources, especially from healthcare professionals and peers, and spending more time telling stories and/or singing to their children. Given these significant health disparities, educational interventions and strategies are needed to foster a positive home caregiving environment for young children with ASD, including equitable access to parent resources.

Story stems in early mother-infant interaction promote pretend play at 30 months

During early childhood, play develops through levels of sensory exploration and manipulation, to functional activities and during the second year of life to the level of pretend and symbolic play. However, little is known about the factors contributing to individual variations in the development of play. The present study investigated associations between maternal sensitivity and play conditions with different ways of engaging and participating and children's development of pretend play. Participants were 64 primiparous mothers and their 30-months-old children. Sensitivity was assessed using the Coding Interactive Behavior (CIB) coding system, and children's play was coded using the 12 Step Play Scale. Analyses showed no significant associations between sensitivity and children's play development but a play condition introducing a story stem was associated with a higher developmental play level and longer duration of pretend play compared to free interactive play. The findings suggest that the use of a story stem may promote pretend play in interactive settings with the mother.

Scoping review of behavioral coding measures used to evaluate parent responsiveness of children with autism or elevated risk of autism

LAY ABSTRACT

The topic of how parents react (e.g., how they talk and act) to their child with autism or elevated likelihood of autism, often called parent responsiveness, has been studied by researchers for over 50 years. Many methods for measuring behaviors around parent responsiveness have been created depending on what researchers were interested in discovering. For example, some include only the behaviors that the parent does/says in reacting to something the child does/says. Other systems look at all behaviors in a period of time between child and parent (e.g., who talked/acted first, how much the child or parent said/did). The purpose of this article was to provide a summary of how and what researchers looked at around parent responsiveness, describe the strengths and barriers of these approaches, and suggest a "best practices" method of looking at parent responsiveness. The model suggested could make it more possible to look across studies to compare study methods and results. The model could be used in the future by researchers, clinicians, and policymakers to provide more effective services to children and their families.

Four-year-old children's pretend play complexity during free play and story stem play and associations with maternal sensitivity

Theory and research have linked pretend play in early childhood with the development of language and theory of mind. In 102 mother-child dyads at 4.5 years, we examined whether (1) introducing a story stem (a play narrative with socioemotional dilemmas) in a mother-child play context increases pretend play complexity compared with mother-child free play; and (2) maternal sensitivity is associated with pretend play complexity. Further, we explored whether the story stem increased child pretend play complexity more in dyads with mothers with low sensitivity compared with highly sensitive mothers. Sensitivity was coded using Coding Interactive Behavior and pretend play complexity with a global, integrated measure of the developmental level and quantity of play. Using generalized estimating equations, we found that pretend play complexity was positively associated with introducing a story stem and maternal sensitivity. Mixed methods ancova showed no significant interaction between play situation and maternal sensitivity. The findings stress the importance of maternal sensitivity and participation for play and how introducing a story stem may help promote child pretend play complexity.

[Formula: see text]Parental interaction style, child engagement, and emerging executive function in fetal alcohol spectrum disorders (FASD)

Children with fetal alcohol spectrum disorders (FASD) are known to experience cognitive and neurobehavioral difficulties, including in areas of executive function and social skills development. Interventions for these challenges have focused on a number of areas, including parent-based training. Despite the general consensus that specific parenting styles consistent with an "authoritative" - warm but firm - parenting approach may influence behavioral self-regulation, it is not known what specific parental interaction styles are associated with child engagement and emerging executive function in this population. The current study used an observation-based behavioral coding scheme during parent-child play interactions and associated parent report-based executive function measures in children with FASD. Here, we demonstrate that parental interaction styles with increased responsive/child-oriented behavior and parental affect are associated with higher levels of child play engagement, while parental interaction that has increased achievement-orientation is associated with higher levels of emerging executive function in children with FASD. These findings help inform future studies on behavioral targets in parent-based training programs and highlight the importance of considering certain parental interaction styles during parent-child play.

Predictive Model Construction for Social–Emotional Competence of Toddlers in Shanghai, China: A Population-Based Study

Objective

To construct a simple model containing predictors derived from Chinese Learning Accomplishment Profile (C-LAP) to better the evaluation of the social–emotional development of toddlers aged 24–36 months.

Method

The test results by C-LAP system and demographic information of toddlers aged 24–36 months were collected between 2013 and 2019 in Shanghai, China, whose guardians were voluntary to accept the investigation. We developed a norm with the dataset based on the study population. With the norm, stepwise regression and best subset analysis were applied to select predictors.

Results

Relying on the norm established and stepwise regression and also the best subset analysis, an optimal model containing only 6 indicators was finally determined and the nomogram of the model was constructed. In the training and validation dataset, the AUCs of the optimal model were 0.95 (95% CI: 0.94–0.96) and 0.88 (95% CI: 0.85–0.90), respectively. When the cutoff point of the model was set at 0.04, its sensitivity in training and validation dataset was 0.969 and 0.949, respectively, and the specificity in training and validation dataset is 0.802 and 0.736, respectively.

Conclusion

A simplified predictive model which includes only 6 items derived from C-LAP is developed to evaluate the probabilities of being at risk of developmental problem in social–emotional development for toddlers aged 24–36 months. Meanwhile, specificity and sensitivity of the model may be high enough for future fast screening.

A Taxonomy of Social Errors in Human-Robot Interaction

Robotic applications have entered various aspects of our lives, such as health care and educational services. In such Human-robot Interaction (HRI), trust and mutual adaption are established and maintained through a positive social relationship between a user and a robot. This social relationship relies on the perceived competence of a robot on the social-emotional dimension. However, because of technical limitations and user heterogeneity, current HRI is far from error-free, especially when a system leaves controlled lab environments and is applied to in-the-wild conditions. Errors in HRI may either degrade a user’s perception of a robot’s capability in achieving a task (defined as performance errors in this work) or degrade a user’s perception of a robot’s socio-affective competence (defined as social errors in this work). The impact of these errors and effective strategies to handle such an impact remains an open question. We focus on social errors in HRI in this work. In particular, we identify the major attributes of perceived socio-affective competence by reviewing human social interaction studies and HRI error studies. This motivates us to propose a taxonomy of social errors in HRI. We then discuss the impact of social errors situated in three representative HRI scenarios. This article provides foundations for a systematic analysis of the social-emotional dimension of HRI. The proposed taxonomy of social errors encourages the development of user-centered HRI systems, designed to offer positive and adaptive interaction experiences and improved interaction outcomes.

Dyadic Synchrony and Responsiveness in the First Year: Associations with Autism Risk

In the first year of life, the ability to engage in sustained synchronous interactions develops as infants learn to match social partner behaviors and sequentially regulate their behaviors in response to others. Difficulties developing competence in these early social building blocks can impact later language skills, joint attention, and emotion regulation. For children at elevated risk for autism spectrum disorder (ASD), early dyadic synchrony and responsiveness difficulties may be indicative of emerging ASD and/or developmental concerns. As part of a prospective developmental monitoring study, infant siblings of children with ASD (high-risk group n = 104) or typical development (low-risk group n = 71), and their mothers completed a standardized play task when infants were 6, 9, and/or 12 months of age. These interactions were coded for the frequency and duration of infant and mother gaze, positive affect, and vocalizations, respectively. Using these codes, theory-driven composites were created to index dyadic synchrony and infant/maternal responsiveness. Multilevel models revealed significant risk group differences in dyadic synchrony and infant responsiveness by 12 months of age. In addition, high-risk infants with higher dyadic synchrony and infant responsiveness at 12 months received significantly higher receptive and expressive language scores at 36 months. The findings of the present study highlight that promoting dyadic synchrony and responsiveness may aid in advancing optimal development in children at elevated risk for autism. LAY SUMMARY: In families raising children with an autism spectrum disorder (ASD), younger siblings are at elevated risks for social communication difficulties. The present study explored whether social-communication differences were evident during a parent-child play task at 6, 9, and 12 months of age. For infant siblings of children with ASD, social differences during play were observed by 12 months of age and may inform ongoing monitoring and intervention efforts.

Observed Social Emotional Behavior at 22 Months Predicts a Later ASD Diagnosis in High-Risk Siblings

Social engagement, pretend play, and concern for another's distress represent fundamental features of typical social-emotional development in the second year. Children with autism spectrum disorder (ASD) display delays and deficits in these areas, and research on toddlers at heightened risk for ASD (HR; younger siblings of children with ASD) indicates these deficits may be apparent in toddlerhood. Prior research has examined these aspects of social-emotional development individually in HR toddlers. The present paper examines them jointly as predictors of ASD. We show that social engagement, pretend play, and empathic concern at 22-months each contribute uniquely to predicting later ASD diagnosis with high specificity and moderate sensitivity. Results have important implications for early diagnosis and intervention in young children with ASD.

Social endophenotypes in autism spectrum disorder: A scoping review

Endophenotypes are measurable markers of genetic vulnerability to current or future disorder. Autism spectrum disorder (ASD) is well-suited to be examined within an endophenotype framework given past and current emphases on the broader autism phenotype and early detection. We conducted a scoping review to identify potential socially-related endophenotypes of ASD. We focused on paradigms related to sociality (e.g., theory of mind (TOM), social attention), which comprise most of this literature. We integrated findings from traditional behavioral paradigms with brain-based measures (e.g., electroencephalography, functional magnetic resonance imaging). Broadly, infant research regarding social attention and responsivity (Research Domain Criteria (RDoC) domain of affiliation) and attention to faces and voices (social communication) finds consistent abnormality in vulnerable infant siblings. Several additional paradigms that have shown differences in vulnerable infants and young children include animacy perception tasks (perception and understanding of others), measures of recognition and response to familiar faces (attachment), and joint attention and false-belief tasks (understanding mental states). Research areas such as alexithymia (the perception and understanding of self), empathic responding, and vocal prosody may hold interest; however, challenges in measurement across populations and age ranges is a limiting factor. Future work should address sex differences and age dependencies, specificity to ASD, and heterogeneous genetic pathways to disorder within samples individuals with ASD and relatives.

Profiles of Early Actions and Gestures in Infants With an Older Sibling With Autism Spectrum Disorder

Purpose Infants with autism spectrum disorder (ASD) produce fewer play actions and gestures than neurotypical infants (e.g., Mastrogiuseppe et al., 2015; Veness et al., 2012; Zwaigenbaum et al., 2005). The purpose of this study was to investigate whether different "types" of actions and gestures are more or less likely to develop atypically in ASD. Method We examined eight types of actions and gestures longitudinally from ages 8 to 14 months in 80 infants with a heightened risk for developing ASD by virtue of having an affected older sibling (high risk [HR]; e.g., Ozonoff et al., 2011) and 25 infants with no such familial risk (low risk). Data were collected using the MacArthur-Bates Communicative Development Inventories (Fenson et al., 1994, 1993). Results HR infants later diagnosed with ASD showed less growth across nearly all types of actions and gestures compared to the low-risk comparison group. Importantly, these HR infants who were later diagnosed with ASD also exhibited reduced growth in frequent deictic gestures and in actions that involve object manipulation relative to HR infants with non-ASD language delay. Conclusions During infancy, it is challenging for clinicians to distinguish ASD from other early communicative delays (e.g., Camarata, 2014). Our results indicate that deictic gestures, as well as actions and gestures involving object manipulation, may be useful targets of surveillance strategies for HR infants and could support early detection efforts for ASD.

Social Behaviors of Children with ASD during Play with Siblings and Parents: Parental Perceptions

BACKGROUND

Both siblings and parents are important interactional partners for children with ASD, but we know little about whether these interactions differ between these two groups, or between older and younger siblings.

AIMS

To gather data about how parents perceive the interactional behaviors displayed by their child with ASD in play with their typically developing siblings and their parents.

METHODS AND PROCEDURES

Parents completed a questionnaire developed for this study about the behaviors their children with ASD demonstrated when interacting with a sibling or parent. Following factor analysis, a 29-item instrument with two factors was revealed. Factors were labelled Prosocial Interaction and Withdrawal/Agonism.

OUTCOMES AND RESULTS

In some families, children with ASD were reported to display significantly higher levels of negative interaction when playing with their older siblings in comparison to younger siblings. When playing with their children with ASD, parents reported significantly more negative interactions compared to when their children with ASD played with younger siblings. There were few differences reported for play behaviors with parents versus older siblings.

CONCLUSIONS AND IMPLICATIONS

Children with ASD appear to display different interactional behaviors depending upon their play partners within the family unit. This study could be used to inform researchers of different interaction strategies which may be useful in creating interventions.

Mothers' Perspectives on the Inclusion of Young Autistic Children in Kuwait

There is a lack of information on early childhood inclusive education and the parental perspectives towards the inclusion of autistic children in Kuwait. The aim of this study was to explore the perspectives and experiences amongst mothers of young autistic children regarding the inclusion of their children in general education kindergarten settings. Focus group and individual semi-structured interviews were conducted with (n = 34) Kuwaiti mothers of children with (ASD). The study participants were of the opinion that the behaviours unique to (ASD) can only be managed in highly structured special education settings. The themes that emerged from the interviews demonstrate that the general view amongst the study participants is that the inclusive educational model will not meet the autistic children's needs.

Application of the Still-Face Paradigm in Early Screening for High-Risk Autism Spectrum Disorder in Infants and Toddlers

Background: Although autism spectrum disorder (ASD) can currently be diagnosed at the age of 2 years, age at ASD diagnosis is still 40 months or even later. In order to early screening for ASD with more objective method, behavioral videos were used in a number of studies in recent years. Method: The still-face paradigm (SFP) was adopted to measure the frequency and duration of non-social smiling, protest behavior, eye contact, social smiling, and active social engagement in high-risk ASD group (HR) and typical development group (TD) (HR: n = 45; TD: n = 43). The HR group was follow-up until they were 2 years old to confirm final diagnosis. Machine learning methods were used to establish models for early screening of ASD. Results: During the face-to-face interaction (FF) episode of the SFP, there were statistically significant differences in the duration and frequency of eye contact, social smiling, and active social engagement between the two groups. During the still-face (SF) episode, there were statistically significant differences in the duration and frequency of eye contact and active social engagement between the two groups. The 45 children in the HR group were reclassified into two groups after follow-up: five children in the N-ASD group who were not meet the criterion of ASD and 40 children in the ASD group. The results showed that the accuracy of Support Vector Machine (SVM) classification was 83.35% for the SF episode. Conclusion: The use of the social behavior indicator of the SFP for a child with HR before 2 years old can effectively predict the clinical diagnosis of the child at the age of 2 years. The screening model constructed using SVM based on the SF episode of the SFP was the best. This also proves that the SFP has certain value in high-risk autism spectrum disorder screening. In addition, because of its convenient, it can provide a self-screening mode for use at home. Trial registration: Chinese Clinical Trial Registry, ChiCTR-OPC-17011995.

Resistance to temptation in toddlers at genetic risk for autism spectrum disorder

Children with autism spectrum disorder often demonstrate difficulties with self-regulation, although studies of this construct in young children with autism spectrum disorder are limited. In this study, developmental changes were examined using a measure of self-regulation appropriate for young children, resistance to temptation. At 22, 28, and 34 months, toddlers with an older sibling with autism spectrum disorder (high risk) and toddlers with typically developing older siblings (low risk) were presented with an appealing toy and instructed not to touch it. Observers coded whether or not children touched the toy and the strategies they used to resist touching it. At 36 months, children were assessed for autism spectrum disorder, yielding three groups: high risk children with autism spectrum disorder, high risk children without autism spectrum disorder, and low risk children. At 22 months, most children, regardless of group, touched the forbidden toy; at 28 and 34 months, many high risk children without autism spectrum disorder and low risk children resisted the temptation to touch the toy, whereas most of the children with autism spectrum disorder did not. Differences in delay strategies were also evident. Some, but not all group differences, were accounted for by differences in language ability. Results highlight one early index of impulse control that differentiates children with emerging autism spectrum disorder from age-mates prior to the third birthday.

From Using Tools to Using Language in Infant Siblings of Children with Autism

Forty-one high-risk infants (HR) with an older sibling with autism spectrum disorder (ASD) were observed longitudinally at 10, 12, 18 and 24 months of age during a tool use task in a play-like scenario. Changes in grasp types and functional actions produced with a spoon were assessed during elicited tool use. Outcome and vocabulary measures were available at 36 months, distinguishing: 11 HR-ASD, 15 HR-language delay and 15 HR-no delay. Fewer HR-ASD infants produced grasp types facilitating spoon use at 24 months and functional actions at 10 months than HR-no delay. Production of functional actions in HR infants at 10 months predicted word comprehension at 12 months and word production at 24 and 36 months.

Developmental Changes in Pretend Play from 22- to 34-Months in Younger Siblings of Children with Autism Spectrum Disorder

Developmental trajectories of children's pretend play and social engagement, as well as parent sensitivity and stimulation, were examined in toddlers with an older sibling with autism spectrum disorder (ASD, high risk; HR) and toddlers with typically-developing older siblings (low risk; LR). Children (N = 168, 97 boys, 71 girls) were observed at 22, 28, and 34 months during free play with a parent and elicited pretend play with an examiner. At 28 and 34 months, children were asked to imagine the consequences of actions pantomimed by the examiner on a pretend transformation task. At 36 months children were assessed for ASD, yielding 3 groups for comparison: HR children with ASD, HR children without ASD (HR-noASD), and LR children. Children in all 3 groups showed developmental changes, engaging in more bouts of pretend play and obtaining higher scores on the elicited pretend and transformation tasks with age, but children with ASD lagged behind the other 2 groups on most measures. Children with ASD were also less engaged with their parents or the examiner during play interactions than either LR or HR-noASD children, with minimal developmental change evident. Parents, regardless of group, were highly engaged with their children, but parents of HR-noASD children received somewhat higher ratings on stimulation than parents of LR children. Most group differences were not accounted for by cognitive functioning. Instead, lower social engagement appears to be an important correlate of less advanced pretend skills, with implications for understanding the early development of children with ASD and for early intervention.

Developmental Changes in Empathic Concern and Self-Understanding in Toddlers at Genetic Risk for Autism Spectrum Disorder

Toddlers with an older sibling with autism spectrum disorder (ASD) and low risk (LR) toddlers were observed at 22, 28, and 34 months during two empathy probes: a crying baby and an adult who pretended to hurt her finger. Toddlers with a later ASD diagnosis showed less empathic concern and self-distress at each age on both empathy probes than LR toddlers. HR toddlers with no diagnosis showed growth in empathic concern between 22 and 34 months in response to the adult's pain, differing from the children with ASD, but not the LR children, by 34 months. Developmental changes in parent-rated self-understanding showed a similar pattern. Results highlight individual differences in the social development of HR toddlers.

Object play in infants with autism spectrum disorder: A longitudinal retrospective video analysis

BACKGROUND AND AIMS

Early play behaviors may provide important information regarding later-diagnosed developmental delays. Play behaviors of young children with autism spectrum disorder (ASD) are restricted in diversity, frequency, and complexity. Most ASD research focuses on play in children over 18 months of age. This study examined three groups of infants (later diagnosed with ASD, later diagnosed with other developmental disorders, and typically developing) with the aims of: (1) describing the play behaviors of the three groups of infants at two time points (9-12 months and 15-18 months); (2) examining group differences in four hierarchical levels of play at both time points; (3) comparing groups with respect to the highest level of play achieved; and (4) determining if the highest level of play achieved by infants with developmental delays, including ASD, correlated with later developmental outcomes.

METHODS

The current study used longitudinal retrospective video analysis to examine object play behaviors of the three groups of infants (total n=92) at two time points (time 1: 9-12 months of age, and time 2: 15-18 months of age). Coding of play behaviors was based on existing literature and distribution of data from the current study. Developmental outcomes examined were measured using the Vineland Adaptive Behavior Scales, Childhood Autism Rating Scale, and a non-verbal developmental quotient calculated using visual reception scores from the Mullen Scales for Early Learning.

RESULTS

Results indicate group differences in play, with infants later diagnosed with ASD showing significantly less sophisticated play than those with typical development. In addition, modest but significant correlations were found between highest level of play achieved at time 2 (15-18 months) and later outcomes for those with developmental disorders, including ASD.

CONCLUSIONS AND IMPLICATIONS

Results suggest that examination of infant play behaviors is important for early screening and intervention planning to potentially mitigate effects on later developmental outcomes.

Predictors and Moderators of Spontaneous Pretend Play in Children with and without Autism Spectrum Disorder

Although pretend play has long been linked to children's normative cognitive development, inconsistent findings call for greater rigor in examining this relation (Lillard et al., 2013). Spontaneous pretend play is often impacted in atypical development, notably in autism spectrum disorder (ASD). Since ASD traits exist along a continuum in the general population, investigating how pretend play varies across the range of ASD symptoms by indexing variations in ASD traits in both typically developing and ASD populations may provide insight into how ASD symptoms may influence the relation between pretend play and associated processes in cognitive development. This study used rigorous observational methods to assess spontaneous pretend play. Specifically, 5-min free-play sessions with two discrete toy sets were double-coded by blinded coders (coder assignment counterbalanced). Key facets of pretense development [attribution of pretend properties (APP), object substitution (OS), imaginary objects] were examined. These facets of pretend play production were then analyzed in relation to ASD symptoms, as well as plausible, long-theorized correlates [theory of mind (ToM), verbal ability, familiarity, and interest in specific toys]. Forty children (M_age = 6;5, SD_age = 1.45; 29 males), six of whom met the threshold for ASD diagnosis via parent-reported ASD symptoms, participated in play sessions and completed measures of verbal IQ and ToM. Besides the measure of child ASD symptoms, parents completed a survey of their child's interest in and familiarity with the play session toys. Overall, greater ToM predicted more APP, and more interest in the toys presented predicted more OS. In terms of overall pretend play production, two results were counterintuitive. First, among children with more ASD symptoms, verbal ability marginally negatively predicted pretend play production. Second, among children with fewer ASD symptoms, ToM negatively predicted pretend play production. Further probing revealed that the negative effect of ASD symptoms on pretend play was simultaneously moderated by both variables: low ToM and high verbal ability both related to less pretend play production among children with more ASD symptoms. Implications for assessment and subsequent treatment for pretend ability among children with varying degrees of ASD symptoms, as well as for future research, are discussed.