Top Lang Disorders Vol. 37, No. 3, pp. 259–281 The Power ... › ovidfiles › ... · 262 TOPICS IN LANGUAGE DISORDERS/JULY–SEPTEMBER 2017 regulation and the mastery of typical

Top Lang DisordersVol. 37, No. 3, pp. 259–281Copyright c© 2017 Wolters Kluwer Health, Inc. All rights reserved.

The Power of Symbolic Playin Emotional DevelopmentThrough the DIR Lens

Serena Wieder

Symbolic play is a powerful vehicle for supporting emotional development and communication.It embraces all developmental capacities. This article describes how symbols are formed and howemotional themes are symbolized whereby children reveal their understanding of the world, theirfeelings and relationships, and how they see themselves in the symbols they choose in play. TheDIR (Developmental, Individual Difference, Relationship) model provides the framework and con-text for understanding the unique profiles of all children, including those with autism, and theimportance of elevating feelings and impulses to the level of symbolic ideas that support emotionaland behavioral regulation. Children need play where interactive relationships with parents andcaregivers help them climb the symbolic–emotional ladder, even when development is uneven, asin autism spectrum disorders. Examples illustrate children solving emotional challenges, exploringthe range of emotions, developing reality testing, and reaching abstract levels of thought and em-pathy through symbolic play and conversations unifying emotions and intellect in early childhooddevelopment. Key words: autism, DIR, emotional development, parent–child interactions,relationships, symbolic play

THE MEANING OF SYMBOLS

Peter Pan is a beloved character for manypeople, representing the child who does notwant to grow up. Consider the following sce-nario in which 61/2-year-old Joey plays withaction figures and his mother in his story ofPeter Pan, Peter Pan yells loudly at CaptainHook, “You will not hurt anyone anymore,”as he seizes him on the deck and throws himferociously into the pirate ship’s dungeon. Hetells Wendy, “No more bad guys anymore!”He then finds the crocodile and starts to twistrubber bands around its mouth. Wendy pleadswith him to go with her, “But Peter, come

Author Affiliation: Profectum Foundation,Mendham, New Jersey.

The author has indicated that she has no financial andno nonfinancial relationships to disclose.

Corresponding Author: Serena Wieder, PhD, Profec-tum Foundation, 140 Riverside Dr, New York, NY10024 ([email protected]).

DOI: 10.1097/TLD.0000000000000126

with me to London. You can do things youcannot do in Neverland. It’s nice in London!You’ll be safe!” Peter responds, “No, sorry,no! I know how to swim away from crocodileshere. And I don’t want to grow up. You can’tplay in London. I don’t want to be a lawyer!It’s boring! I want to play!! Stay here Wendy,we will play forever!”

Joey’s voice is intense and shaky as heclenches the figures in this scene. He is wear-ing his beloved green Peter Pan suit, whichtransforms him into his ever-victorious hero,who expresses his wishes that he could al-ways live in Neverland where he can shape hisworld. In play, Joey can express his fears andfeelings, and he can regain control and regu-late his emotions, find safe solutions for hisproblems, and access reasoning to bridge hissymbolic ideas to reality. In his inner world,Joey’s Peter generates excitement encompass-ing both anxiety and victory.

What does this play scene tell us aboutJoey? His choice of symbols is quite commonand even obvious, beloved by many children.Who would not welcome a ship that soarsthrough the sky, pixie dust to make you fly,

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260 TOPICS IN LANGUAGE DISORDERS/JULY–SEPTEMBER 2017

friends who join your adventures, and an en-emy you always defeat? Joey has read the storyof Peter Pan and seen the movie many timesand reenacts these images with toys and inhis mind. But for Joey, the meaning of hisplay is his own. Its repetition is essential forhim as he struggles with learning challengesat school and resistance to the increasing de-mands of reality. His play helps him restrainhis impulses and conquer his fears and grow-ing sense of inadequacy, providing respite anda safety zone in which to work on his turbu-lent emotions and communicate his thoughtsand feelings.

Symbols have personal meanings

When adults play with children, they openthe window into children’s inner emotionalexperiences through the symbols they chooseand stories they create. Joey’s version PeterPan is his own story. It is one example of howchildren symbolize emotional themes in earlydevelopment through play, whereby they re-veal their understanding of the world, theirfeelings, their relationships, and how they seethemselves. Who or what they choose varies,and the content does not matter as long asit is meaningful to them. When children ac-tivate symbols in their minds and make thesymbols their own, although such symbolsmay be familiar to others, they are imbuedwith the individual child’s unique emotionsand thoughts, which find safety in symbolicpretense where children can project, exper-iment, and seize powers they realize mightnot be available in reality, thus finding waysto understand their emotions and regulatetheir behavior. This symbolic process is essen-tial for emotional development and emotionalregulation.

Interface between symbolicand emotional development

This article describes the interface betweensymbolic development and emotional devel-opment seen through play as they mirror eachother as children grow. It is a process that orig-inates in the signaling between infants andparents early in life. Using the DIR (Develop-

mental, Individual Difference, Relationship-based model; Greenspan & Wieder, 1998) asa framework (illustrated in Figure 1), the arti-cle provides an explanation of how children,through play, climb the successive levels ofemotional–symbolic development, with stepsof the ladder illustrated in Figure 2 and dis-cussed later, allowing them to differentiatereality from fantasy and self-regulate the de-velopmental anxieties inherent in this process(Greenspan & Wieder, 1998). The DIR modeland developmental ladder illustrate the inte-gration of affect and intellect, the hierarchyof emotional development, and how symbolicchoices and play relate to other aspects of de-velopment, including individual differences inaffective, sensory, and motor processes.

A critical additional point is that childrenwith an autism spectrum disorder (ASD), al-though often thought to be unable to playimaginatively, do have the potential to playand to climb the symbolic ladder when in-tervention is tailored to their unique pro-files. This occurs when intervention promotesmultiple forms of symbolic expression (seeWieder & Greenspan, 2003; Wieder & Wachs,2012).

Formation and function of symbolsin development

A symbol can capture an element of realityby representing real objects, ideas, or behav-ior, but it is not the real thing. Rather, sym-bols are expressed through words, images,drama, movement, art, or music. The child’ssymbols reflect functional levels of emotionaldevelopment along a developmental hierar-chy or ladder, as represented in Figure 2. Thisusually begins with symbols representing thechild’s personal experiences of being caredfor and loved, where all needs can be met.Imagine play with teddy bears, feeding playfood, and using doctor kits. Later, symbolscapture more complex emotions and drivessuch as anger, fear, jealousy, aggression, com-petition, rivalry, fairness, compassion, and jus-tice, consistent with the growing child’s ex-panding awareness of reality. Symbolic func-tion is crucial for emotional and behavioral


The Power of Symbolic Play in Emotional Development 261

Figure 1. Representation of the DIR model (Developmental, Individual Difference, Relationship-Based).Copyright 2017 by Serena Wieder. Shared by permission of the author.

Figure 2. Illustration of Functional Emotional Developmental Levels (FEDLs) that constitute the stepsof the developmental ladder children must climb as they move toward emotional–symbolic maturity.Copyright 2017 by Serena Wieder. Shared by permission of the author.



regulation and the mastery of typical devel-opmental anxiety that accompanies this ex-panding emotional range. Anxiety, poor reg-ulation, and aggression may reflect poor sym-bolization, which can be associated with poorimpulse control and acting out. This can stemfrom possible challenges with comprehen-sion, empathy, and theory of mind, as wellas with sensory processing and environmen-tal difficulties and threats that derail develop-ment. Without symbolic expression to com-municate and negotiate, there is no safety.

The importance of play and affectin development

Play has long been revered as the “work”of childhood. Few topics have been studiedas extensively as play in the developmentof intellect, language, movement, socialskills, cognition, and self-regulation, bothhistorically and currently. Historically, re-searchers have described the stages andfunctions of play (Piaget, 1962; Singer &Singer, 1992; Vygotsky, 1967); more recently,researchers have examined the relationshipand pathways between symbolic play andlanguage (McCune, 1995, 2010; Orr & Geva,2015; Westby, 1988). Others have examinedthe relationship between motor developmentor visual object recognition and symbolicdevelopment (Smith & Jones, 2011). Butfewer studies have given attention to the roleof affect, which is the experience of emotionthat accompanies the child’s development ofsymbols and representational play, as well asin daily living.

Affect finds a home in psychological theo-ries of development, attachment, affect reg-ulation, affective communication, mentaliza-tion, therapeutic approaches, and more. Asan example, Feldman and Greenbaum (1977)studied the role of affect regulation and syn-chrony in the play of mothers with their typ-ical infants. The researchers found that thesewere precursors of symbolic competence atthe age of 3 years. Similar attention has notbeen given to the capacities of children onthe autism spectrum to engage in symbolicpretend play beyond functional and simpleimitative use of objects. This gap is discussed

later in this article. Deficits in free play, how-ever, have been linked to problems with men-tal health, including childhood disorders suchas anxiety and depression (Gray, 2011).

The role of pretend play

Historically, the role of pretend play in de-velopment has been debated by psycholo-gists. In 1933, Vygotsky (published in Englishin 1967) described how a child moves for-ward in development through play activity, aprocess starting with imagining experience inreal life, separating from the real objects andaction into pretense, substituting images onthe basis of what they mean, so that a stickor a galloping action can mean riding a horse(with no horse in sight), and creates ideas thatexpress his wishes. In play, the child suspendsreality and becomes what he wishes to be, justlike Peter Pan in a ship that flies, as illustratedpreviously. In that example, Joey’s ideas werefreed from the reality and constraints of theobjects in his play. He could imagine what hewished, and he expressed meanings throughplay and words. He insisted on play and lovedto play, clearly taking pleasure in doing so,but anxiety intruded on his wishful thinkingand feelings.

Vygotsky (1967) also argued that creatingimaginative play is the means or pathway toabstract thinking. In contrast, Piaget (1962)described play as an epiphenomenon of otherskills, such as adult interaction and language,that actually cause development. He arguedthat play does not promote development butreflects it. Neither Vygotsky nor Piaget putgreat emphasis on emotional developmentand the role of affect, focusing more on cogni-tive development. Other researchers have ar-gued that play helps foster development butthat it is only one of several routes to devel-opment, called equifinality, thus minimizingthe role of play in development as a uniquecontributor (Lillard et al., 2013).

Uniting the silos of developmentthrough play

Whereas the components of developmentsuch as language, fine and gross motor, cogni-tion, and social–emotional abilities have been



studied, it is important to consider how thesedevelopments occur simultaneously in orderto understand a child’s functioning as an in-dividual. Understanding emotional develop-ment depends on examining the interactionbetween what the child’s biology brings intothe world and how relationships and the envi-ronment shape developmental capacities. Asillustrated in Figure 1, Greenspan and Wieder(1998, 2005) integrated these components inthe DIR model, in which child–parent inter-active relationships are viewed as the key toadvancing emotional and cognitive develop-ment. The DIR is an integrated theory, whichutilizes a primary methodology of free play,known as Floortime. This provides the frame-work to examine the role of affect in symbolformation in all children. During Floortime,children are free to play in any way they pre-fer, and it is up to children to initiate themesthat are treated as intentional as they carry onback and forth interactions with their parentsor clinicians and later, their peers.

THE DIR MODEL

The DIR model, as illustrated in Figure 1,has moved away from the silos of develop-ment, where each aspect of development hasbeen measured and reported as a separate do-main, although domains sometimes could beadded together to yield a developmental orintellectual quotient identifying deficits andstrengths. This approach did not capture howchildren actually function, where multiple do-mains must function simultaneously to sup-port comprehension, communication, relat-ing, creating ideas, and regulating emotions.In DIR, the domains interact with each otheras children interact with caregivers and theenvironment to create capacities that will sup-port functional emotional and intellectual ca-pacities. Each capacity emerges in synchronywith brain and body development early in lifeand continues to develop as the subsequentcapacities emerge. Together they build thefoundation for lifelong relating and learning.

The DIR model introduced major paradigmshifts from behavioral frameworks to a frame-

work of dynamic-developmental systems thatbring unity to emotion, experience, and rea-soning. This model represents the theoryand provides the context for understand-ing and supporting symbolic development(Greenspan & Wieder, 1998; Wieder, 1996;Wieder & Greenspan, 2003). The componentsof the DIR model are described in the sectionsthat follow.

“D”—Developmental capacities ofemotional and intellectual functioning

Regulation and shared attention(between infant and caregiver)

From birth to 3 months of age, infants’ ca-pacity for calm, focused interest in the sightsand sounds of the outer world grows andserves as a means to be calm, attend, andshare their interests with their caregivers asthey look around the world. Regulation isby no means automatic. It may vary depend-ing on the biological capacities or individualdifferences with which newborns enter theworld and how they experience their envi-ronments. Even very young infants can con-vey comfort or stress to their parents who arelearning to support their infant’s behavioraland emotional regulation. Parents play impor-tant roles in supporting their infants’ devel-opment of smooth cycles of sleep and alert-ness, ability to focus and shift attention, andto adapt to internal and external sensations,movement, and emotions. The capacity forbehavioral and emotional regulation expandsin duration, range, and stability as children de-velop and share attention first with their par-ents and then with others. Shared attentionis between people, whereas later, joint atten-tion emerges as parents and infant attend tothe same object as they play with it or look atit, such as a toy or book or an activity. Bothshared attention and joint attention are usuallypleasurable.

Forming attachments and engagingin relationships

During the first 4–5 months, infants andparents become increasingly intimate as they



interact with each other with warmth, trust,and attunement. They use all their senses toenjoy each other through looks, hugs, songs,and movement, setting the stage for all rela-tionships in life. A secure attachment is sup-ported by a parent’s sensitivity and insight(Oppenheim, Koren-Karie, Dolev, & Yirmiya,2012). Over time, the growing infant will needto remain related and engaged across the fullrange of emotions, even when disappointed,scared, angry, or feeling other stress. As chil-dren develop, the range of emotions expandsand they are expressed through symbols, asdescribed later.

Intentional two-way affectivecommunication

Between 4 and 10 months, the purpose-ful, continuous flow of interactions with ges-tures and reciprocating emotions gets under-way. Infants begin to act purposefully, as theymature and gain awareness of their bodiesand the functions they can perform. As in-fants gain motor control over their bodies,they are better able to communicate their de-sires and intentions. With the emerging abil-ities to reach, sit and turn, crawl and creep,give and take objects, and vocalize, infants’awareness of the interpersonal world grows,as does their awareness of their body in spaceand in relation to others who also may bemoving.

Complex social problem solvingand emerging sense of self

Between 9 and 18 months, infants—nowemerging toddlers—develop the capacity toproblem-solve using social interactions. Mosthave learned the back and forth rhythm ofinteractive emotional signaling, and they be-gin to use this ability to think about and solvetheir problems, such as how to do what theywant and find emotionally meaningful, suchas bringing Mommy to the cabinet where thecookies are. Their senses work with their mo-tor systems and emerging language skills asthey interact with others to solve problems,begin to differentiate their sense of self fromothers, and develop thinking. Challenges arise

when old means fail to solve new difficul-ties, leading to new discoveries and means ofproblem solving. For example, when cryingalone does not get toddlers what they want,they discover that they need to point or pulltheir parent over to what they desire, or towait.

Creating emotional ideas

Between 18 and 36 months, toddlers be-gin to represent or symbolize their intentions,feelings, and ideas in imaginative play, us-ing gestures, words, and objects symbolically.Toddlers now may pick up the toy phoneto call Daddy, or they may set up a picnicor tea party for Mommy or a friend. A tod-dler playing symbolically may examine thesick baby with the doctor kit or repair thecar with play tools, substituting objects orgestures as needed to express ideas. Imagesform in toddlers’ minds, so they can thinkahead without seeing actual toys and can nowimagine the objects in context, such as hav-ing tea with one’s dolls with the tea set nowinfused with the pleasure of having sharedthe delicious tea and cookies with mother(Winnicott, 1971). These first symbolic ideascome from experiences in real life that cannow be enacted in personal pretend dramasas the child experiments with different rolesand feelings and begins to discover magicalthinking.

Emotional thinking, logic, and senseof reality

At about 3 years, young children begin tocombine ideas to tell a story as they developmore logical thinking and better understand-ing of themselves and others and of what isreal or not real. Their stories may use imagina-tive characters and animal figures who talk, aswell as fantasy figures, from princesses andfairy godmothers to witches or wizards, asthey discover the need for more power toencounter the conflicts and challenges in life.At this point, they also become able to take onthe perspective of others in different roles orconversations. Just as with Joey’s Peter Pan,each story has personal meaning and often is



replayed in various ways. Children’s advanc-ing reasoning skills help them build sequen-tial bridges, and their stories become increas-ingly logical with a beginning, middle, andend. For example, children may begin to re-linquish magical thinking as the solution toeverything and may begin to create logicalfantasies. They can now plan an idea for anadventure in space, or be a hero defeating anenemy to bring justice, or they may step intofuture roles with which they identify, such asparenthood, expanding their narratives withmore characters, prediction, theory of mind,and empathy. Over the next few years, chil-dren’s emotional and mental abilities move to-ward abstract thinking and they develop theability to distinguish reality from fantasy, selffrom nonself, one feeling from another, andhow to take time and space into account.This capacity develops further through child-hood into multicausal and comparative think-ing, relativistic or gray-area thinking, and self-reflection, which are the top rungs on thedevelopmental ladder illustrated in Figure 2.

At any of these functional emotional devel-opmental levels, variations may exist in the ro-bustness, stability, and completeness of thesecapacities. As seen with Joey, stress related tohealth or learning difficulties, family changeand parental stress, losses, and moves, alongwith other events, can throw a child and fam-ily off course. At all times, it is critical to meetindividual children at the level at which theyare functioning in the moment. Either over-or underestimating a child’s ability and emo-tional status has risks. A developmental per-spective means that it is important to pursueprogress at any age, and the length of timeprogress takes may vary for each child as road-blocks or gaps are identified and need to beaddressed (Greenspan & Wieder, 2006).

“I”—Individual differences in sensorymodulation, sensory processing,sensory affective processing, and motorplanning and sequencing

Every infant enters the world with uniquecharacteristics determined by biology (genes)interacting with the environment. The in-

fant’s first experience is through physicalcaregiving practices shaped by cultural val-ues and beliefs. The infant’s body is the firstobject of discovery and it is the sensory in-formation the infant takes in through touch,sound, smell, vision, interoceptive sensations,and movement in space that are the sourcesof relational, linguistic, and cognitive devel-opment to be assimilated in unique ways.

Consider the example of Joey again. He wasborn with a reactive and intense nervous sys-tem. Joey relied on symbolic play and self-talkwhen he was alone to modulate his anxietyand practice solutions for his fears. He heldonto magical thinking where he could be suc-cessful but was also excited by the dangerin his play scenarios. He did not understandthe interaction between his fears and excite-ment and was driven to fight his enemies withpoor control over his impulsiveness. Otherchildren may have other reasons for identify-ing with Peter Pan or any superhero fightingevil. In some cases, children try to understandthe motives of bad guys whom they see asvery powerful by assuming their power in playand thereby also know that the bad guy can-not get them. It sometimes is a counterpho-bic attempt to not be afraid of the bad guy’saggression. Some are able to alternate roles asthey develop abstract thinking to explain whygood guys and bad guys both fight but one is“good” and the other “bad.” Whichever rolethey experiment with, it is important to makemeaning of their intent and not to confusesymbolic play with the real thing.

In the DIR model, careful attention is paidto the body, sensory processing, posturalcontrol, motor planning, visual–spatial andauditory capacities of children, and the waysthey support or compromise functioningin other areas of development, especiallyemotionally and their sense of self. The DIRmodel (Greenspan & Wieder, 1999) addeda theoretical framework for understandingevery child’s unique profile and the impactof altered patterns of sensory responsivenesson the development of children with sensoryprocessing challenges before these were evenrecognized as a diagnostic feature of ASD.



Biologically based individual differences arethe result of genetic, prenatal, perinatal,and maturational variations and/or deficits,including problems with modulation in eachsensory modality (overresponsive, underre-sponsive, and sensory craving), sensory-basedmotor disorder (dyspraxia and postural disor-der), and sensory processing (comprehensionand expression) in each modality (Miller,Schoen, & Nielson, 2012). Essential forsymbolic development is sensory-affectiveprocessing in each modality, which is the abil-ity to perceive, interpret, and react to affect,including the capacity to connect “intent”and affect to motor planning and sequencing,language, and symbols (Greenspan, 2002).

These processing capacities are relevant toall children and especially so for children withASD (Greenspan & Wieder, 1998, 1999). Re-cent brain studies support this contention,finding divergent connectivity in the limbicstructures and the fusiform gyrus related to re-ciprocal communication and facial emotionalprocessing in children with ASD, differenti-ating them from children with sensory pro-cessing disorders, although both share whitematter brain disruption (Chang et al., 2014).

“R”—Relationships and interactions

Relationships not only activate develop-ment but also serve as a base from whichchildren can move into the world withcuriosity and confidence to explore, dis-cover, learn, and master. Attachment theoryinforms the DIR model (Bowlby, 1988;Dolev, Oppenheim, Koren-Karie, & Yirmiya,2014; Greenspan & Wieder, 2006) andpromotes sensitive and attuned interactionand insight. Relationships go beyond primaryattachments, however, to expand reciprocalinteractions with other caregivers to attainemotional constancy across an affectiverange and to support differentiation andindividuation and identifications and socialroles in later life. Relationships that offerattuned and responsive interaction are thevehicles for learning, encouraging initiativeand intentionality, respecting a child’s ownagency, and also providing the security to

feel safe, accepted, and loved, taking priorityover all other goals across the life span.

Together, the “D,” the “I,” and the “R” pro-vide a unified dynamic framework to iden-tify each child’s strengths and challenges. TheDIR model can guide the experiences pro-vided by parents and caregivers to advance de-velopment for all children and interventionswhen needed.

DIR’S DEVELOPMENTAL SEQUENCE:FROM SIGNALS TO SYMBOLS

Symbolic abilities build on the foundationof the aforementioned developmental pro-cesses defined in the DIR model that start atbirth. The newborn must adapt to the myr-iad of sensations he or she experiences asthe external world impinges. Some infantsdo so smoothly, establishing rhythms of sleepand alert wakefulness. They share attentioneasily, looking and referencing their parents,soothe easily when upset, and develop self-calming mechanisms over time. Others arefussy, hard to soothe, and need more coreg-ulation to dampen the distress and heightentheir focus for shared attention. Either way,these are the infant’s first emotional commu-nications (Tronick, 1989), and the caregiver’sattunement to the infant’s sensory-affectivesignaling provides the preverbal foundationfor attachment as well as regulation (Schore,2014).

From the start, parent or caregiver–infantinteractions involve an exchange of emotionalaffective signals. The emotional signal con-veys intent before engaging in an action.For example, the baby may look intensely atyou deciphering who you are, before break-ing into a smile, but if he feels scared ordistressed, may grimace and hold his breathbefore starting to cry. When the parent re-sponds to these signals and reaches for thebaby, she or he can preempt action and helpthe baby modulate the intensity of emotionsbefore crying or biting, for example. The “realthing,” which may be signaled by intensealarmed crying or tantrum, does not have tohappen when the signal conveys intent and



the parent can reassure the baby with a sooth-ing tone of voice and holding or moving thebaby. Even an older infant or young toddlercan read the signals of a parent’s impatienceor disapproval and knows when not to inter-rupt or make demands, regulating his or herbehavior by staying out of the way. The mem-ory of the looks and actions, infused with af-fect, will soon turn into mentalized imagesof the child’s experience and perceptions atthe time. Through this process, signals be-come the precursors of symbols (Greenspan& Shanker, 2004; Winnicott, 1971). Signalingcontinues throughout life, carried by affectexpressed through facial expressions, tone ofvoice, eye contact, posture, movement, inten-sity, and timing, conveying positive and neg-ative meanings and feelings with many varia-tions. How these are expressed depends onindividual differences of both the child andthe caregiver.

Preverbal signals

As noted previously, in the DIR model,regulation and shared attention are the firstbuilding blocks of development. They set thestage for engagement and attachment and sub-sequent developmental capacities. Preverbalsignals abound as parents and infants connectand share affect as they “fall in love,” with in-creasing number of gestures to communicateand ways to solve problems together. Motordevelopment advances simultaneously as the7- or 8-month-old baby reaches for a desiredobject the baby’s mother is holding, or as thewalking toddler pulls the parent’s hand to-ward the object the toddler wants. In eachcase, these presymbolic actions stem fromdesire and the earlier interactions that gavethe objects meaning (Schore, 2014; Tronick,1989). Later, as toddlers develop, they donot have to see the swing in the backyardto recreate the pleasure of that experience;rather, they can imagine the delight they ex-perience when they are swinging and theirmother turns the swing into a journey to themoon and acts as the copilot. The swing is notjust the fun swing perceived earlier, but it isnow an internalized image, which becomes a

symbol that can be transformed in many waysas the child’s ideation grows. Thus, childrenexpand their symbolic adventures by playingnot only with their parents but also with othercaregivers and children.

However, affective experiences are notonly pleasurable, they also may be frighten-ing, angry, or even traumatic, encompassinga range of feelings. Often parents seek to sup-press negative affects quickly, for example, bysaying, “Don’t be angry (or scared), it’s okay,”even before accepting the feeling or identify-ing the cause for the child. Although positivefeelings are more desired and comfortable, allfeelings need to be accepted for children tofeel safe and learn to understand their experi-ence in order to share and self-regulate ratherthan act impulsively or withdraw. Sometimeschildren’s negative affect is intuitive and pro-vides an important signal to the parents of anx-iety, danger, or lack of readiness. Avoidanceis another important signal to be understood.

Is this process automatic? Not necessarily.If the presymbolic level of signaling does notdevelop or is not robust, the child may nothave capacities to develop self-regulation andmay expect to be intruded upon and over-whelmed. If children’s signals are not read orthey are unable to signal back, they may notget the support they need from their caregiverto feel safe or to change the environment.Children then may have difficulty using affectas a symbolic signal to cope with and regu-late feelings and to find solutions, with pos-sible stress increasing and anxiety escalatingand overwhelming them. In such instances,children’s symbolic level may become fraughtwith fear and aggression as their behaviordisorganizes.

Only regulated affects can serve as signals.If a caregiver misses the child’s signal, such asnot seeing frustration building and does nothelp in time, the child may act out. If a care-giver overreacts or underreacts to a child’s sig-nals, for example, when the child is anxiousor scared, the child can feel overwhelmed andfail to get soothing reciprocal interactions orthe help to form the symbols needed to un-derstand his or her feelings. Such children



then may have difficulty using affective inter-actions to regulate and may be unable to readand respond to soothing calming affective sig-nals their caregivers offer in efforts to coreg-ulate. The interaction between children’s ca-pacity to signal and parents’ sensitivity is acritical factor in this process of development(Greenspan & Shanker, 2004; Oppenheimet al., 2012).

Separating from perceptions of the“real thing”

It is emotional signaling that enables chil-dren to separate perceptions from fixed pre-dictable actions and to free their perceptionsso as to acquire emotional meanings that be-come symbols. When children register sensa-tion of what they see, hear, smell, or taste, orexperience when they move, in their minds,the sensation is coupled with the emotion feltat the same time. The affective experiencemay be one of pleasure, curiosity, pride, ordiscomfort, worry, fear, or anxiety.

The experience could be stressful or invig-orating, as in the following examples. Sallywatches mommy walk toward her high chairwith a small bowl of cut up grapes andsmiles in anticipation signaling her apprecia-tion. Danny waves his arms with excitement,keeping his gaze on Daddy as he is about toroll the yellow ball toward Danny, so thatDanny shifts his gaze to reach for the ball topush it back, already anticipating its return.Ana cuddles her teddy bear blankie as she iscuddled before bedtime. Benny frowns as hesees mommy putting on her coat and starts towhimper as she soothingly reassures him thatshe is going to work and will be back soon.

These perceptions are simultaneous, withan emotion and an action. When a personis able to perceive without being driven toact out or expect another’s action, the per-son is left with a freestanding image in mindrelated to the action and the experience ofhow it felt. So, Danny’s yellow ball is not justanother object, but it takes on special mean-ing and becomes an image coded with thepleasure he experiences playing with his fa-ther. The image becomes a symbol represent-

ing the object or experience and the affectthat accompanied it. A freestanding percep-tion that becomes an internal symbol contin-ues to take on meanings through experience.Ana could then cuddle her teddy bear whenshe is alone, feeling the comfort and securityassociated with her mom and can give herbaby doll a teddy when playing and doing forthe baby what was done for her.

The dual coding of experienceand symbolic meaning

Many have described the sequence of sym-bolic play, as when children reenact the useof a small object demonstrating its real use, orsubstitute an object or gesture to show thatthey are drinking tea at a tea party, or feed-ing the baby doll or teddy bear with a toybottle but, lacking that, by substituting a longblock to represent the bottle. At such times,they are demonstrating cognitive abilities andfunctional play (Kasari, Chang, & Patterson,2013; Westby, 1988). But is that all? This pre-tense also has emotional meaning stemmingfrom children’s own affective experiences ofbeing fed, looking at their mother’s smilingface, or hearing their father’s cajoling voiceto eat a little more. The teddy bear was one ofAna’s first gifts. It stood watch over her as hermother cared for her, eventually becominga transitional object representing her motherwhen she left the room at night or went toschool, helping her self-regulate and reinforc-ing the image or symbol of her mother in hermind (Winnicott, 1971).

This dual coding of experience applies to allexperience in early development where affecttakes the lead in learning (Greenspan, 2002).Words also take on symbolic meaning throughthis dual coding. A baby first learns throughthe signals he receives from a caregiver wholets him know that the bathwater is still toohot as the adult’s voice escalates, “Hot, hot!,”and then calmly reassures the baby, “Just aminute, we’ll splash in just a minute.” Thebaby does not understand the temperature ofthe water or the length of a minute, but thesewords take on emotional meanings that helpthe child stay regulated while observing the



caregiver get the bath ready. When waitingseems frustrating, the caregiver might helpthe baby be patient by singing a song, or pro-viding some toys to throw in, smiling and ap-plauding how well the baby throws, or howhappy the fish is to be back in the water andthen giving a tender hug and kiss while liftingthe baby into the tub and saying things aboutloving the baby so much and how much funthey can have. So this is the secret of “love,”the secret ingredient is affect, and the pro-cess is the dual coding of experience, whereemotion and intellect are one and language oractions have more than one meaning.

CLIMBING THE SYMBOLIC LADDERIN EMOTIONAL DEVELOPMENT

Social–emotional constructs are oftenidentified together as if they are one set ofskills. Or, emotional is coupled with behaviorand regulation. It can be difficult to describea child’s inner emotional life, especially whenyoung. But symbolic interests or preoccupa-tions can indicate some of what is going on inthe child’s inner life. Emotional developmenthas a unique trajectory, integrating all aspectsof development reflected as one climbs thesymbolic ladder and as symbolic play isguided by emotions based on this hierarchy.Beginning with dependency, children’s firstsymbols are used to reenact experiences of be-ing cared for and loved. Later, they move on todiscover emerging expectations often repre-sented by symbolic figures they come to lovethat accompany their journeys. First, they mayexperience Barney as a big cuddly dinosaurwho sings of happy families and love, “I loveyou, you love me, we’re a happy family . . . .”But then Barney also asks them to “Cleanup, clean up, everybody do your share . . . ”,investing them with their first responsibilityfor taking care of themselves and others. Men-tal images start with real objects that enablechildren to think about those objects whenthe objects are not physically present. Theyallow the child to think about experiencesbefore, during, and after their occurrence.Visualizing what they heard and imagining

prior events help children better understandexperience, know what to anticipate, andfind new solutions to needs and fears. For thefirst time, children can integrate experiencesfrom the past into the present and plan forthe future as they imagine what will comenext. Images also foster creativity as they areno longer bound by time and space in reality.

Examining the emotional content of playduring the first few years of life, whethersymbolized through words, toys, language,mime, stories, movement, or art, now severedfrom reality, reveals children’s understandingof the world, their feelings and relationships,and how they see and experience themselves(Wieder, 1996; Wieder & Greenspan 2003,2006; Wieder & Wachs, 2012). They reenacttheir personal worlds striving toward masteryof visiting the doctor, or understanding thereasons to fix the car, or shop, and cook. Theyenjoy dressing up for different roles or usingfigures to represent the characters involvedas they practice being in someone else’s shoesand what it feels like. One hears how good thefood tastes, or the doctor saying, “No shotstoday!” or the squeals of jumping in puddleswith friends as they move from reality to sym-bols, first “reliving” real experiences and thenmoving on to fantasy.

The choice of symbols

Children share not only language to com-municate and create ideas but also sym-bols transmitted through culture representingemotional development. Examining the sym-bolic play and preferences children express,the symbols they adopt from shows and booksthey love to see and hear repeatedly, offersinsight into their inner experiences. Whenthey begin to play with these figures, it is nolonger a replication of real life as earlier but apathway to discovering themselves. Whomthey dress up as or the play figures theychoose, whom they form alliances with, andwhom they rescue or vanquish in battle nowreveals more complex emotions as they iden-tify with more complex representations.

Consider Sesame Street, where urban char-acters learn letters and numbers and friend-



ships reign, even with grouches and villains,each one unique and no one more belovedthan Elmo. Or, go to the woods and find poorWinnie-the-Pooh forever searching for honey,supported by a group of friends to solve hisproblems. In both, there is another characterlike Christopher Robin, who can help. AndDora and Diego venture out into the world dis-covering new places, searching for answers,finding adventure. Or, Thomas the Train en-counters countless challenges on his job, in-cluding stronger and more competitive trainsthat pass him by. Good Night Moon signalsthat it is time to go to bed with gentle farewellsto the child’s world. The underlying emo-tional task to be mastered is separation. Wordsand visual images prepare the child to transi-tion from the familiar world into sleep. Thesecharacters represent preschoolers as they dis-cover more of the world, have to think forthemselves, and figure out who they are in theprocess. Symbols unite emotions and thinkingand action as problems are solved. Emotionsexpand from caregiving to separation, to striv-ing for independence, with curiosity, adven-ture, some fear, competition and loss, and vic-tory. There are many developing emotions onthe symbolic ladder, all true to life and sym-bolized safely with increasing elaboration ofideas as preschoolers prepare for reality.

The development of fantasy

Each culture provides symbols related toemotional development, handed down fromlegends, fairy tales, and stories transmittedover generations. Between three and sixyears, there is a leap, taking children beyondthe emotional reality-based themes describedpreviously into fantasy so that they can em-brace magical thinking as they move backand forth from outside-in to inside-out, withthe space in between described by Winnicott(1971) in Playing and Reality. For some, fan-tasy is fueled by classic fairy tales and booksparents read to children, with words now con-veying intense emotions related to the child’sgrowing awareness of feelings. Here too is ahierarchy of emotional tasks advancing devel-opment as children begin to realize they may

encounter threats and begin to deal with lifemore on their own. In the Three Little Bears,Goldilocks has to deal with getting lost andwith her hunger and fatigue as she searchesfor home. She discovers a house in the woodsand helps herself to porridge and rest, only tobe awakened, feeling terrified, by the bears.The Three Little Pigs are evicted and have tomanage life on their own. There are wolvesout in the world and two must be rescuedby their brother, who was wise and builthis house out of brick, whereas they chosesticks and straw. How different they each are.In Jack and the Beanstalk, Jack finally cutsdown the beanstalk to the dismay of the giantchasing him, seeking the golden eggs. What aheroic and reparative act after giving away thecow for a few beans. And lovely Cinderellais surrounded by chirping birds as she getsready for the ball unbeknown to her jealousand mean stepsisters who rip her dress off,consumed with jealousy. Fantasy and realisticimages blur with dragons and knights, fairygodmothers, and witches; it does not matter.The emotions are so vivid and so are the sym-bols representing them. Such stories usherchildren up another rung on the developmen-tal ladder. Their value depends on the care-givers’ response to their children’s emotionswhen they act the stories in play or duringtheir conversations about how the charactersfelt and how they feel to encourage theory ofmind, motives and perspective taking, emo-tional thinking, and abstract abilities.

Hierarchy of symbolized affects

Emotional and symbolic development,now expressed in play and language, expandin parallel fashion. As indicated earlier, thefirst themes reflect the essence of infants’ andtoddlers’ lives, as they depend on caregiversfor care, protection, enjoyment, and love inorder to build attachments and the securefoundation for what is to come. With devel-opment, symbolic play moves on to reflecttransition themes related to separation, disap-pointment, loss, sadness, and fears. Childrenbegin to symbolize the necessity to be moreassertive and independent as their play



assumes more control and power to deal withcompetition, threats, battles, and disaster,with the incumbent feelings of danger, anger,jealousy, defeat, and victory, but also showcompassion and empathy. While first accom-panied by magical thinking and fantasies,more realistic and logical solutions are foundas children develop, leading into integratingabstract themes, such as embracing fairness,kindness, empathy, justice, and morality.

Inherent in development is the realizationof “good guys and bad guys.” Mommy mightbe the first “bad guy” when she says, “No!”to more candy or Daddy might set limits onthrowing things when the child is angry. Par-ents coregulate strong emotions until theycan be expressed safely. The idyllic omnipo-tent all giving parent begins to fade as chil-dren discover their own desires and separate-ness. “Bad guys” also appear at nursery schoolwhen told you have to share, that is, give upyour toy, or another child just grabs it. So,the seeds have been planted and transforminto cultural symbols from powerful kings,kind fairies, to pirates, dragons, evil kings, andmonsters, all with magical powers for betterand for worse. By four or five years, childrencreate their own ideas as they discover thepower of their ideas and defeat the bad, orturn bad into good, and have the dead comeback to life, often depending on such super-heroes as Superman, Spiderman, and Batman.Soon they venture into space to take sides inStar Wars.

Reality testing

By this developmental point, children havebeen launched into testing reality. They needcontrol and power to keep climbing up theladder as they continue to develop and be-gin to understand the bigger world. Their lan-guage has developed, and they now may em-ploy it to negotiate, detect deceptiveness, andassess trust in the service of defeating their en-emies and exercising their power, be they aking or wizard or superhero, or a fairy god-mother or queen or Wonder Woman. This iscrucial, as pirates, giants, witches, and mon-sters await, ready for battle. Stories become

more elaborate and coherent, with a begin-ning, middle, and end, with multiple charac-ters, and with movement through time andspace. All symbolic forms pitch in, and chil-dren use toys, drama, drawing, movement ordance, art and music, or some blend of all ofthem. The specific characters do not matter,but what they symbolize is everlasting and es-sential for understanding what is real or notreal, what is me or not me, and the mastery ofthe full range of emotions, with imagination todiscover the unknown and move forward un-til judgment and reality testing become wellestablished.

Developmental anxiety: When symbolsare bigger than “life”

Throughout development, psychologicaland emotional transitions generate ex-pectable anxiety related to growing aware-ness of self and others and facing the un-known. Consider infants who realize that theyare looking at someone they do not know, or3-year-olds having to separate from their par-ents at nursery school. Whereas most childrenmaster these anxieties with limited stress,some tend to be hypersensitive to sensationsand experience affect intensely. Some areoverly fearful and reactive to body damage,aggression, and unpredictable events. Othersare thrown into panic when they turn aroundand do not see their parent and feel lostin space. Some have catastrophic reactionsto not finding needed objects or to thinkingsomething has broken. Others feel helpless orfrustrated when they cannot organize a taskand especially when they do not understandwhat is being said because they are so anx-ious or because comprehension fails them.Still others live in dangerous environments orhave witnessed violence.

As development advances, anxiety can stemfrom the child’s imagination when symbolsbecome greater than life. Symbols elicit feel-ings where inside and outside meet. Imagesand labels become embellished with power-ful affects that can be positive with princesses,kindly godmothers and fairies, benevolentkings and leaders, or negative with monsters,



dragons, and witches that feel all too real.With this polarization, magical thinking turnsalligators, dinosaurs, and other frightening im-ages into “bad guys” in countless stories, asadults moderate the anxiety. Verbal reassur-ances may work partially, if at all, and mayhave to be repeated again and again. Daddymay have to check under the bed, search thecloset, and throw out the scary lions and mon-sters night after night. If children do not yethave access to magical thinking where theycan defeat their enemies and create the safetythey need, or a parent is not there to coregu-late their fears, anxiety ensues. If a parent dis-misses a child’s fears or overreacts to a child’sanxiety, the children may feel overwhelmedand may not get the reassuring reciprocal in-teractions that can help them form the sym-bols they need to understand their feelings.Children then have difficulty using affectiveinteractions to regulate; they may be unableto read and respond to soothing calming af-fective signals; and they may act out aggres-sively or withdraw and become constricted.This is evident when a child becomes avoidantof emotional themes and restricts play to safedependency themes or will not play pretend.Others may stay immersed in their fantasies,but rarely as the “bad guy,” and hold ontocontrol, having difficulty judging cues, rec-ognizing deception, or interpreting affects.Counterintuitively, it is useful to “deepen theplot” of themes the child starts and then pullsaway from. This provides more time to grap-ple with motives, what the other side is think-ing, explore alternative solutions, integratemore emotions, and appreciate that symbolicplay is all about ideas and feelings, not actions,danger, or disapproval. Without symbols andsymbolic play or conversations, anxiety maypersist beyond what is expected developmen-tally; the child may become stressed, con-stricted, and act out, and these reactions cantake precedence over reasoning because anx-iety can derail logic and reality testing.

The power of symbols

In symbolic play, a child can have power,make the rules, practice different solutions,

come back to life, and experiment again. Themore children play, the more they will re-alize they are creating the ideas and choos-ing the symbols that they can change, lead-ing to flexibility and resilience. Most childrenlove to play, embracing the complexity withmany enjoying the mix of excitement andfear that they overcome by winning. Play alsopromotes building of executive function be-cause, in play, children have to organize andsequence ideas and be able to take some-one else’s perspective. Developmental anxi-ety thus provides the tension and opportunityto test what is real or not real, what is insideand outside, and what can be shared and ne-gotiated with others.

Although children can enjoy playing bythemselves, and can be heard speaking tothemselves at such times, to reach its heights,symbolic play requires reciprocity and de-pends on interaction with a parent or care-giver who expands on the children’s ideas, en-courages communication, and assumes rolesto help them elaborate, thus supporting theirabilities to explore a wider range of feelings.When a child plays with another person, it iseasy to guess who the “bad guy” always is. Theinteraction supports the child’s emotional reg-ulation of feelings and impulses, as well ascomprehension, perspective taking, and em-pathy. The level of symbolic play is related toparental willingness to engage in games of fan-tasy, tolerate emotional themes, and facilitatecreativity. Alternatively, parental intrusive-ness, depression, and anxiety are associatedwith reduced rates of symbolic play (Singer &Singer, 2005). Not all parents join their child’sspontaneous symbolic play and prefer otherways of playing, such as sports, construc-tion, or board games that are also importantavenues for dealing with emotional and so-cial development. Similarly, play experienceswith other children can help discern the per-spectives of others who may agree or disagreeand have different intentions and motives.Play with friends, siblings, and school matesalso helps children learn the “rules” of socialplay and games as they develop self-regulationand understand risk and competition.



DO CHILDREN WITH AUTISM ENGAGEIN SYMBOLIC PLAY?

Whether children with autism engage insymbolic play and how their play compareswith children with developmental delays andtypical children has been debated over manyyears. The play of children with ASD has beendescribed as simple, stereotypical, and rely-ing on sensory manipulation of the toys, aswell as lacking in affect and theory of mind.Impaired symbolic play was once even con-sidered a symptom of ASD, and more severesymptoms of ASD were associated with lowersymbolic play ability, along with lower cogni-tive and language development. Like so muchof the research in autism, most studies havebeen limited to examining autism symptomsand cognitive or language level, rather thanaddressing the multiple domains of develop-ment involved in symbolic play and what itrepresents. Attempts focused on answeringwhether symbolic play advances cognition,or whether a certain level of cognition or lan-guage was needed to advance symbolic play,or both, could not be ascertained. Past re-search has been variable with regard to levelsof play, kinds of autism, numbers of childrenstudied, whom they played with, different set-tings, and so forth, and, therefore, inconclu-sive (Thiemann-Bourque, Brady, & Fleming,2012).

Furthermore, assessments such as cogni-tive or language tests usually do not focuson play. Intervention efforts to address playtend to be directive or focus on skills and donot help children expand or generalize, letalone address emotional meanings. In someapproaches, the play may be unrelated to theinterests of the child or have little meaning tothe child. Such reasons suggest why the po-tential benefits of symbolic play interventionshave not been reached in treating autism. DIRis the exception.

Recent advances in early intervention havebrought attention back to play, but not alwaysas a targeted outcome. The Early Start Den-ver model included play interventions and

reported gains in cognition, language, andreduction of autism symptoms, but the re-searchers did not examine symbolic play intheir outcome studies of 18- to 30-month-olds, nor in their 6-year follow-up (Dawsonet al., 2010; Estes et al., 2015). In contrast,Kasari et al. (2013) did target play as an out-come, but primarily using short-term inter-ventions and outcomes. They questioned theview that children with autism were not com-petent or did not understand pretend play,but rather hypothesized that they may rarelyengage in play with adults and may not havehad enough adult support to shape and sup-port their play skills. Although functional play(i.e., using toys as intended) and pretend actscan be prompted, such play does not automat-ically turn into the creative, spontaneous, andenjoyable experience of pretense. With lim-ited play experience that is not matched tothe child’s developmental readiness to learnto play, pretend roles and thematic play maynot be attained. Kasari and colleagues’ JASPERprogram (Joint Attention, Symbolic Play, Emo-tional Regulation) first targets joint attentionand engagement to establish developmentalreadiness for symbolic play. Following this,higher levels of play are supported by usingthe child’s ideas and prompting to expandthe diversity of play skills, encouraging longerplay periods. Kasari, Paparella, Freeman, andJaromi (2008) found significant gains in jointattention and joint engagement. Additionally,a longitudinal study of 3- to 4-year olds showedthese gains related to language outcomes at 8–9 years of age (Kasari, Gulsrud, Wong, Kwon,& Locke, 2010). These studies of underlyingprecursors related to symbolic developmentadvanced the field of behavioral interventions,which now include more naturalistic playparadigms in early intervention (Schreibmanet al., 2015). Beyond this, there is recognitionthat more longitudinal research is needed onthe level of a child’s play as a diagnostic fea-ture, how play skills unfold over time, and in-creased focus on play in intervention to studymultiple domains (Stanley & Konstantareas,2006).



Assessing symbolic competence

Although helpful, the emphasis in the in-terventions discussed thus far has not beenon symbolic play or emotional themes as in-tended targets, but on skills often taught inbehavioral modes; nor has the developmentof relationship capacities that support sym-bolic function, a core deficit of autism, beenpart of those investigations. Although infantsand toddlers now are screened as young as9 months of age, and diagnosed at risk forASD as early as 18 months of age, they arenot necessarily screened for the precursors ofsymbolic competence.

In the DIR model, relationships are centralto development, where sensitivity and respon-siveness support tailoring interactions to indi-vidual differences. Clinicians working in theDIR model, including the author, report ob-servations of how individual differences havegreat bearing on play, as seen in the many chil-dren with ASD who play and communicate dif-ferently (Wieder & Wachs, 2012). Extensivepractice-based evidence in the form of casereports, case studies, and observations of chil-dren as they advance emotionally and symbol-ically are observed in the following and laterexamples. Because of individual differences,some children with ASD present with verbalcapacities and strong auditory memory. Theymay be able to repeat whole books and labelcountless items but be unable to use languagemeaningfully or to have conversations, lack-ing comprehension or the ability to retrievewhat they want to express even though theyhave symbolic ideas. Other children with ASDmay have relatively stronger motor and visualcapacities; for example, they may line up theirtoys or love marble runs, construction, boardgames, or puzzles that have specific destina-tions and strategies but may be unable to en-gage in motor-based interactive problem solv-ing that is unstructured, as required in sym-bolic play. They may have ideas but not theexecutive function skills to organize and se-quence their thoughts or intent into symbolicplay or tales. Those who have more signifi-cant difficulties may present as aimless. The

potential for changing such patterns, whichmay be masking higher symbolic potential,can be assessed by increasing interactions at-tuned to more subtle signals and providing theaffect to support emotional symbolic expres-sion, while also treating underlying sensory,language, motor, and regulatory challenges.

Recent randomized controlled trial (RCT)research on interventions using play withparents and children (e.g., Casenhiser, Binns,McGill, Morderer, & Shanker, 2014; Solomon,Van Egeren, Mahoney, Quon-Huber, &Zimmerman, 2014) have shown that, whenrelationship-based intervention focuses ondevelopmental capacities with interactionstailored to the individual profile of the child,such as in Floortime (Greenspan & Wieder,2006, 2007), children may be able to developcapacities for symbolic play, communication,and thinking, even when development isuneven. More importantly, researchers havebegun to focus on the core deficits in autism,relating and communicating, rather thanthe typical outcome measures using IQ andlanguage skills tests.

Recent RCT studies based on Floortime,called play and parent-mediated interven-tions, have used methods related to the DIRmodel with children with ASD as old as 5years of age. They have shown that when par-ents provide play interventions coached byconsultant experts (with demonstrated fi-delity), autism symptoms and severity signif-icantly reduce, and functional emotional de-velopmental levels advance (Solomon et al.,2014). Solomon’s PLAY project comparedoutcomes for 128 children in a year-long inter-vention in five sites receiving coaching in playto improve caregiver–child interactions, pluscommunity service, with outcomes for chil-dren randomized to receive community ser-vices only. The outcomes showed large treat-ment effects for parent and child interactionalbehaviors as well as significant improvementson a standard measure for diagnosing autism,although no differences were found for lan-guage and IQ scores. Mothers in the experi-mental treatment using play also were found



to be less directive and to experience lessstress and depression (Solomon et al., 2014).

In another play-based RCT intervention forautism, which focused on the effectivenessof social-interaction model, Casenhiser et al.(2014) reported significant improvements inautism symptoms, social communication, andparent–child interactions in the interventiongroup but not in language skills when mea-sured by standardized language assessments.By analyzing their data with a focus on com-municative acts, the researchers showed thatchildren in the group whose parents werecoached in how to play with their chil-dren outperformed the community treatmentgroup. The authors noted that these resultsunderscore the importance of functional lan-guage measures reflecting conversational abil-ity and the importance of parent–child inter-actions in guiding and evaluating treatmentfor children with autism.

In another large RCT, Pickles et al. (2016)reported on a 6-year follow-up of PACT(Parents and Children Together), a parent-mediated intervention with 152 children withautism. This research team also found ev-idence of the importance of teaching par-ents how to play with their children withASD. The treatment group of parents receivedfeedback on how to interact more effectivelywhile watching their videotaped play withtheir children. Parents played daily with theirchildren in addition to standard care. Resultsindicated that parent-mediated interventionssignificantly reduced autism severity scores.Children in the experimental treatment con-dition initiated more interactions with theirparents and showed better receptive and ex-pressive language communication after 1 yearof intervention, with continued effects 6 yearslater (Pickles et al., 2016).

Studies showing the effectiveness of parent-mediated interventions with children withASD that are focused on the core deficits ofrelating and communicating support the im-portance of working with parents relationallyto carry on their daily playful interactions tohelp their children advance in the most impor-tant ways. This added component to standard

care is an essential ingredient in these stud-ies, with play providing the opportunity toreach higher symbolic levels and improve re-lating and communicating. But even the year-long interventions did not fully examine thelong-term development of symbolic capaci-ties and how these capacities relate to emo-tional development. Although not yet part ofthe existing research base, observations fromlong-term clinical intervention by this authorand other experienced clinicians provide in-sight and illustrate that children with autismcan advance symbolically across a range ofemotional experience when symbolic devel-opment continues to be supported throughinteractive play and conversation as childrengrow older (Delahooke, 2017; Greenspan &Wieder, 2006; Wieder & Wachs, 2012).

CASE ILLUSTRATIONS

The following four vignettes of symbolicplay represent children who have differ-ent DIR profiles common in ASDs. Allreceived comprehensive DIR intervention,which helped them develop capacities forshared attention, relating, preverbal com-munication, and social problem solving—inother words, the foundations for symbolicplay. The children in these examples are com-posites of multiple children. All were impededby the unevenness of their development andexhibited different rates of progress with vari-ations in language, visual–spatial abilities, mo-tor planning, and motor and executive func-tions. Despite these delays, all of the childrenmoved forward using their relationship andemotional capacities to cope with inner andouter experiences. When poor comprehen-sion, poor reality testing, and social stress im-pinged, they had symbolic resources to keepadvancing with the help of symbolic functionin play and conversations with parents andother caregivers.

Suzie

Suzie teases her mom by withholding thepiece of play pizza she asks for, and she pleadsagain. She holds out a piece and sees her



Mom’s glee but then pulls it back and watchesher dismay. Suddenly she appears worried andthrows it at her. Somewhat surprised, Momnotices the alarm in her eyes and instead ofreacting, smiles gently and warmly says, “Let’sshare it!” and they each take a pretend bite,repairing the rupture. Suzie then offers her adrink, holding out a red block, and takes an-other for herself. The vivid signaling, pauses,gaze, tone of voice, and even alarm are theimportant elements of affect expressed in this40-s interaction by this playful mom who seesthe benefit of Suzie’s assertiveness but alsoher ambivalence. She sensitively repairs theirpizza party and recognizes her relief and ap-preciation. At 4 years of age, Suzie still hasfew words but she can name pizza and say,“no” and “here.” She can pretend to eat thepizza and substitute an object, which wouldhave given her “credit” in typical assessmentsof presymbolic functional play. But this wouldnot have captured the flow of back and forthinteractions, thinking and feelings she actuallyshared with her mother as she experimentedwith her power, or her ability to recognize hermother’s signals to self-regulate. These are theessential play experiences that will supporta trusting relationship and Suzie’s emotionaland symbolic development.

Sam

Sam is a tall 7-year-old boy who alwayswears red shirts and who loves small Disneyand Sesame Street figures. He enters the play-room, rushes to the drawer he expects themto be in, and does not find them. He appearsutterly frantic, his eyes darting and glazed, andhe is unable to process directions and has nosense of how to look around the room. Oncefigures are placed in his hands, Sam plopsdown on the floor and starts arranging thetoys, rarely moving from the spot. His mothersits immediately in front of him so that heknows exactly where she is. When he feelscalm, Sam begins to share an idea. At first,he names the characters, with each definedby appearance; so Ernie is not just Ernie butErnie catching a ball or Ernie in the bathtub,suggesting that Sam is unable to separate the

character from his perceptions of it. One daySam decides that the figures are going swim-ming in an imagined pool in the space in frontof him. He “drops” each into the pool one at atime. He keeps describing the figures in frag-mented phrases and waits for his mom to ac-knowledge each one. Suddenly, Elmo refusesto jump into the pool. Mom asks Elmo what iswrong and he says, “I can’t swim.” When momtries to reassure Elmo that Big Bird the Life-guard will help him, he says, “Lifeguards don’tswim” (he has never seen a lifeguard in thewater). Mom offers other figures who mighthelp Elmo, but he despairingly says, “No onecan help me!” When mom asks whether heis afraid, he nods. She then asks Sam whetherhe could help Elmo and he says, “Do this!” ashe makes frantic swimming motions with hisarms, still not moving off his spot. Suddenly,he notices Super Grover wearing a cape (likeSuperman) and asks, “Super Grover, will youhelp me?” with a sigh of great relief. Sam’sstory continues as these small figures con-verse, trying to resolve Sam’s fears.

Mom knew that Sam was very worriedabout going to camp because Sam would beasked to swim, and she sensitively supportedhis problem solving, using play to practice.His language was fragmented, he felt lost inspace, he did not move, he was visually boundto the appearance of the figures, and he pre-ferred the small figures with whom he feltsecure and which he loved as a younger childand still clung to. So many sensory, motor,visual spatial, and language challenges con-stantly confronted him and curtailed hisprogress. Yet, Sam could use play to tell a storyabout his fears, which he initiated and per-sisted as he actively tried to solve his problem.Sam’s mom did not correct his perceptions ordirect his actions but kept the conversationgoing, providing affect cues while talking tohis little figure friends. She asked simple ques-tions or echoed his feelings and gave feedbackwhen ideas did not make sense. Mom let Su-per Grover “save the day,” after which Samfelt all was not lost, and he told Elmo, “Youcan do it!” The next day Sam did go into thepool.



Sam’s was the play of a child with autism.The DIR-based treatment started when Samwas 2 years of age, as his multiple challengesbecame apparent and a comprehensive inter-vention program was put in place. It was notclear how long it would take, when he wouldtalk, climb, run, play, or how he would think.His arousal level was low, he was poorly co-ordinated, had limited language, and did notknow what to do with toys. He clung to hislittle figures, which escorted him for manyyears, and as he advanced, so did they. The in-tervention followed basic principles of sharedattention, engagement, and 2-way communi-cation, building on the playfulness, joyful af-fect, and excitement that he and his mothercould share while therapies and inclusion pro-ceeded. Sam’s relationship with his motherflourished, and he progressed to becomingsymbolic with his little figures where everyword he uttered was meaningful. At 7 yearsof age, he knew how he felt and he knewhow others felt, displaying capacities for ab-stract thinking, empathy, and theory of mind.Sam’s rate of progress increased and he wasincluded in regular education.

Daniel

Daniel wants to be a king, but what is a kingto a 41/2-year-old? He puts on a cape and crownand holds onto a magic wand (his scepter) ashis parents sit nearby. He looks in the mir-ror for a moment and backs away, abruptlyasking his father to make the king disappear.Although not quite sure why his son asks himto do this, Daniel’s father prompts him to saythe magic words, and Daniel recites, “Abracadabra, hocus pocus, make the king disap-pear!” Dad swiftly swipes the crown off theking’s head and puts it behind his back. Danielsees this and begins to reach behind his backfor it, when Dad again asks him to say themagic words to get it back. Then Daniel of-fers a crown to his Mom, and they repeatthe drama. Mom reassures Daniel that she ismommy again when he uses the magic words,and his relief is palpable. Daniel then decidesto try his magic on himself and tilts the crown

off his head with his scepter and declares,“Now I am not the king anymore, I’m Daniel!”

Simply put, Daniel used play to explore newroles and “magic,” experimenting with howhe could be himself and yet also enjoy pre-tense, so important for a little boy now fac-ing the bigger world. Pretending to be some-one else appeared to concern him when hefirst looked in the mirror dressed as a kingand he wanted to be sure he could undo this,hence the request to make the king disappear.The magic his father gave him invested himwith power, but he was not quite sure hewas ready for this or even understood it yet.His parents dramatized bowing to the kingwith great pride to show him the honor due aking. But Daniel wanted a partner and turnedto his mom to be his queen, again reassuredwhen she declared she was mommy again. Al-though somewhat anxious, Daniel persistedand tried again, this time in charge. This ex-perience supported by his attuned parents al-lowed Daniel to think about who he was andwhat meaning this had. It was not just “dressup” and a “play act,” but emotional experi-ence that gave him mastery to imagine him-self as a king in relation to others, which ex-panded into many ideas over time.

These moments of transformation ad-vanced Daniel’s symbolic level and he beganto take on more powerful figures drawn fromsuch stories as Alladin and Toy Story. But ittook the security of relationships and lots ofplay with his parents to advance Daniel, whohad apraxia and preferred to be a play actorin his dramas to manipulating multiple toys.His curiosity led him to ask the Genie to gointo the magic lamp and, when he played BuzzLightyear, he thought he should go to jail forlying to Zurg, but then he turned Buzz intoa baby so he would not have to stay in jail.He used symbolic play to understand and ex-plore his emotions and advanced ideas as hebecame more logical.

Benny

Benny begs his mother to buy him a suit andtie. He is wearing his Superman shirt and al-ready wears dark boxy glasses. “Why Benny?”



With stumbled words and lots of gestures, heshows mom how he would swipe open hisshirt and jacket, take off his glasses like ClarkKent, and be ready to “Save the Day.” He willbe Superman! Benny has no doubts this willwork. Asked what “save the day” means, herepeats the words like a mantra and finallysays, “I will help people, be nice to people.”In his mind’s eye, he is soaring through the skyto reach pirates who want to steal his Shop-kins (small toy foods you shop for), or stop therobbers escaping the Paw Patrol (small puppypolice characters who keep you safe), or putthe bullies in jail, allowing just a glimmer ofreality to sink in. As Superman, he could savehis own day and the social anxiety and bul-lying he sometimes encounters. Month aftermonth, Benny alternates between Superman,Batman, and Spiderman, ever victorious in de-feating evil and defying anyone who daresblock the Polar Express. Superman is his fa-vorite. After all, he has dark hair, brown eyes,and glasses just like him. At bedtime, he some-times threatens to become invisible, so henever has to relinquish his power and fightfor justice.

Is this pretense or something more? Themeanings of Benny’s symbols are obvious, buthe is 5 years older than most children onthis mission. He expresses his fantasies clearlyand repetitively. He navigates so many levelsof symbols from little Shopkins to feed theworld, to yelping puppies who bounce andbite to bring down their tormentors, to theinvincible superheroes who defeat evil andsave the day. As he climbs up and down andup again on the symbolic ladder, Benny is con-tending with the challenges and angst of hisown life. Does he not yet understand reality?He actually does, but his grasp is inconsistentand fractures when comprehension fails, andhis naivete and wish to be friends with and ascompetent as his peers lands him in a pool ofconfusion and vulnerability. His symbolic pre-tense provides respite and the time he needsto still be the little guy wishing to fight back(his Paw Patrol) but still must be rescued by asuperhero, and he plays both roles. The sen-sitive responses of his mother and therapists

help Benny reflect on his stories and wishesand consider ways to play with friends.

A year later, Benny brings history lessonsinto his play, explaining how the colonistswon the Revolutionary War, but then hebecomes distressed when he realizes thatso many British soldiers died. He wonderswhether we should have shared the victory,full of compassion as he identifies with theweaker force. By the time he reaches the civilwar, Benny is still very empathic, but now hecan use logical and abstract thinking to un-derstand the reasons for the war. For Benny,symbolic play also gave him a way to thinkthrough and understand history and literatureas he advanced.

Summary of how the DIR modeladvances emotional developmentin these examples

All these children were on the autism spec-trum and demonstrated symbolic play capac-ities that advanced their emotional develop-ment, sense of self, resilience, empathy, andlogical and abstract thinking. Each one’s nar-rative reflects an inner journey and attemptsto cope with the underlying stress inherent indevelopment and a life often fraught with so-cial, learning, and environmental challenges.But each narrative is also coupled with thestrength of relationships with parents, teach-ers, and therapists who share this journey andprovide the security and encouragement toadvance.

The DIR model provided the vehicle thatenabled all of these children to keep climbingthe symbolic ladder. Not every child reachesthe same capacity but integrated interventionnurtures every child’s potential. Clinical ex-perience with symbolic play over many yearsoffers insights that are difficult to capturein RCTs but demonstrate that many childrenwith autism can, in fact, engage in symbolicplay, especially using the DIR model, whereemotional development and symbolic devel-opment are targeted explicitly and where theygo hand in hand (Wieder, 1996; Wieder &Greenspan, 2003).



The question is not whether children withautism can play, but what challenges mightget in the way and how to strengthen and in-crease the child’s abilities for pretense. Theremay be deficits in developmental capacities orindividual differences in sensory motor pro-cessing that can be treated, such as auditoryprocessing or praxis. But clinical and researchevidence confirms that parent–child interac-tions are important for progress, and symbolicplay provides the essential interventions to de-velop emotional, social, and abstract thinkingcapacities. It is important to understand allchildren from the point of view of emotionaland developmental levels.

CONCLUSION

“If you want your children to be intelligent,read them fairy tales. If you want them to bemore intelligent, read them more fairy tales”(Albert Einstein, Library of Congress Blogs,2013). Perhaps Einstein was capturing the no-tion that fairy tales hold the magic for childrento decipher their emotions and problems,understand people representing differentviews and feelings, and open their mindsto imagination, discovery, and intelligence.Fairy tales are symbolic play tales, certainlynot all happily-ever-after stories; rather, theirprotagonists each find unique solutions forlife’s unfolding challenges and victories.

In this article, I set out to describe the roleof emotions in symbolic play for all childrenand to illuminate how play interactions withparents or other partners reflect the child’sideas, concerns, feelings, and desires. Sym-bolic play is a powerful vehicle for supporting

emotional development and embracing all de-velopmental capacities. Development has itsown time table and so does symbolic develop-ment, so it is important to support all formsand levels of symbolizing as the child devel-ops. Symbolic function includes play, as wellas conversations, drama, art, music, dance,and movement. Furthermore, it is not possi-ble to discuss play and symbolism without alsorecognizing their role in the development oflanguage, narrative, and literacy. Play offersthe opportunity to create ideas and stories,interacting with others. This sets the founda-tion for understanding history and literature,as well as for playing and working with peers.

In all its forms, symbolic play offers a safeway to practice, reenact, understand, and mas-ter the full range of emotional ideas, experi-ences, and feelings. It provides distance fromreal life and immediate needs, so that childrencan differentiate self from others (i.e., throughdifferent roles in play) and self from the envi-ronment (i.e., not bound by time and space).The goal is to elevate feelings and impulses tothe level of ideas and to express these throughwords and play, supporting emotional reg-ulation and self-control. Through play, thechild develops abilities to transform realityinto symbols or images that reflect their mean-ings and provide the opportunity to exploreand differentiate the full range of emotions. Inplay, the child defines his emotions in his sto-ries, organizes the sequence, and determinesthe outcomes. This abstract level of symbolicthinking leads to a differentiated sense of selfand others, bringing along capacities for em-pathy and reflection, and preparing the childemotionally and intellectually for the future.

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