Associations between functional and symbolic play and expressive language in children with autism spectrum disorder: a naturalistic study

Objectives This study examined developmental play and expressive language in children with autism spectrum disorder (ASD) and typically developing (TD) peers in a naturalistic context and investigated associations between these domains.Methods The study included 20 children with ASD and 20 TD children matched on cognitive level. Play behaviors were coded using the Developmental Play Assessment, and expressive language measures were derived from naturalistic language samples, including Mean Length of Utterance (MLU), Total Number of Words (TNW), and Number of Different Words (NDW).Results A trend toward lower functional play was observed in children with ASD (p = 0.072, r = 0.29), whereas no group difference was found in MLU. Children with ASD demonstrated significantly lower symbolic play (r = 0.39), TNW (r = 0.43), and NDW (r = 0.41) than TD peers. Within the ASD group, symbolic play was positively associated with MLU (ρ = 0.68, 95% CI [0.36, 0.85]), TNW (ρ = 0.69, 95% CI [0.44, 0.83]), and NDW (ρ = 0.53, 95% CI [0.21, 0.71], whereas functional play was not.Conclusion These findings highlight the association between symbolic play and expressive language in children with ASD and demonstrate the value of direct observational assessment in naturalistic contexts.