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Are pretend play skills more difficult to develop for children with Autism? 

Posted
Updated
ByMy Patient Advice
Author: Lucia Alvarez, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Yes, pretend play in autism often presents a particular challenge. Pretend or symbolic play involves imagining one thing as another, turning a block into a phone, or enacting scenarios with characters. For many autistic children, these leaps of imagination can feel less intuitive, so they may engage in play more literally or concretely.

Pretend play is a window into flexibility, perspective taking, and narrative thinking. When these cognitive and social skills interact differently or develop more slowly, imagining and enacting pretend scenarios becomes harder. However, that doesn’t mean pretend play is impossible, many children make progress with support and scaffolding.

Private Adult Autism Assessment

Why pretend play is trickier and how it manifests

Pretend play in autism requires abstract thinking, shifting from the literal to the imaginary. When that shift is hard, children may stay closer to concrete, structured interactions.

Literal use of objects

Instead of transforming a toy into something else, objects may remain used only as they are. A doll is held but seldom imagined as doing something different.

Limited role‑play and narrative

Children may struggle to assign roles, create plots or think ahead in a play sequence. Their play might lack the back‑and‑forth or theme progression typical in symbolic play.

Rigid, repeated play scripts

When symbolic play emerges, it may follow the same story or setup every time. Variation is minimized because the child knows what to expect and how it “works.”

Longer transition into imaginative play

Some children first play in sensory, manipulative or routine forms before gradually adding symbolic elements. The shift to pretend is often slower and more scaffolded.

Recognising that pretend play in autism is more difficult for many children helps caregivers and therapists approach it with patience, scaffolding and respect. With the right supports, imagination can grow, even if in its own time.

Visit providers like Autism Detect for assessment of play styles and guided support in nurturing symbolic play.

For a deeper dive into the science, diagnosis, and full treatment landscape, read our complete guide to Unusual Play Patterns.

Lucia Alvarez, MSc
Author

Lucia Alvarez is a clinical psychologist with a Master’s in Clinical Psychology and extensive experience providing evidence-based therapy and psychological assessment to children, adolescents, and adults. Skilled in CBT, DBT, and other therapeutic interventions, she has worked in hospital, community, and residential care settings. Her expertise includes grief counseling, anxiety management, and resilience-building, with a strong focus on creating safe, supportive environments to improve mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy. 

Dr. Rebecca Fernandez, MBBS
Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy. 

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