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Mia Crystle, Tepanta Fossett, Ph.D.

The effects of non-directive play therapy on the syntactic structures of children with autism spectrum disorder

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Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in three core areas which include social interaction, language, and patterns of behavior (Santengelo, 2012). Children with ASD have also demonstrated difficulty with using language appropriately in context due to their lack in theory of mind. Consistent with theory of mind, the ability to take the perspective of others, children with ASD have also demonstrated difficulty with using language appropriately in context (Durrleman, 2009). Westby (1980) describes a relationship between cognition and language and suggests that these processes can be assessed through play, by observing children engaging in play and noting the level of language or communication produced. If they do not produce language, the motor skills demonstrated during play may be used to provide support for target language and cognitive skill level. Non-directive play, one of several different types of play, is a play-based treatment that encourages the use of verbal language. This involves playing alongside the child and closely imitating what they are doing while providing commentary that is appropriate (Cogher, 1999). An area of language difficulty for children with ASD is syntactic abilities. Difficulty with syntax affects the ability to create sentence structures (Durrleman, 2009). There are many different interventions for language impairment for children with ASD (Hsieh, 2018). These treatments are often table task treatments, and some allow children with ASD to only engage in non-verbal communication.  

The purpose of this proposed study is to determine whether a traditional therapy approach or a non-direct play approach is more effective in treating language delays, characterized by deficits in syntactic abilities in children with ASD. The experimental question asked in this study is whether there are significant differences in different syntactic structures when engaging in non-directive play as compared with a table task/nonverbal treatment for children with autism? This study will use a between subject group design. Participants will be 50 elementary aged children with a primary diagnosis of ASD. All will be assessed prior to treatment to determine the areas of deficit with syntactic structures relative to developmental norms. Twenty-five of the children will be exposed to non-directive play while the remaining 25 children will be exposed to a table task/nonverbal treatment. Participants will be randomly placed into one of the two groups. They will be exposed to their assigned treatment for one hour for five days over the span of one month. After one month, they will be reassessed, and results will determine which type of treatment demonstrates significant progress. Results of this study are expected to provide evidence about the role of play in advancing language development in children with ASD.


Cogher, L. (1999). The use of non-directive play in speech and language therapy. Child Language Teaching and Therapy, 8-9.

Durrleman, S. & Zufferey, S. (2009). The nature of syntactic impairment in autism. Rivista di Grammatica Generativa, 34, 57-61.

Hsieh, M., Lynch, G., & Madison, C. (2018). Intervention techniques used with autism spectrum disorder by speech-language pathologist in the United States and Taiwan: A descriptive analysis of practice in clinical settings. American Journal of Speech-Language Pathology, 27, 1096.

Santangelo, S. L. & Tsatsanis, K. (2005). What is known about autism. American Journal of Pharmacogenomics, 5, 71.

Westby, C. (1980). Assessment of cognitive and language abilities through play. Language, Speech, and Hearing Services in Schools, 11, 154-168.

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