The Power of Symbolic Play in Emotional Development Through 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 how emotional themes are symbolized whereby children reveal their understanding of the world, their feelings and relationships, and how they see themselves in the symbols they choose in play. The DIR (Developmental, Individual Difference, Relationship) model provides the framework and context for understanding the unique proﬁles of all children, including those with autism, and the importance of elevating feelings and impulses to the level of symbolic ideas that support emotional and behavioral regulation. Children need play where interactive relationships with parents and caregivers help them climb the symbolic–emotional ladder, even when development is uneven, as in autism spectrum disorders. Examples illustrate children solving emotional challenges, exploring the range of emotions, developing reality testing, and reaching abstract levels of thought and empathy through symbolic play and conversations unifying emotions and intellect in early childhood development. Key words: autism, DIR, emotional development, parent–child interactions, relationships, symbolic play

THE MEANING OF SYMBOLS with me to London. You can do things you cannot do in Neverland. It’s nice in London! Peter Pan is a beloved character for many You’ll be safe!” Peter responds, “No, sorry, people, representing the child who does not no! I know how to swim away from crocodiles want to grow up. Consider the following sce- here. And I don’t want to grow up. You can’t nario in which 61/2-year-old Joey plays with play in London. I don’t want to be a lawyer! action figures and his mother in his story of It’s boring! I want to play!! Stay here Wendy, Peter Pan, Peter Pan yells loudly at Captain we will play forever!” Hook, “You will not hurt anyone anymore,” Joey’s voice is intense and shaky as he as he seizes him on the deck and throws him clenches the figures in this scene. He is wear- ferociously into the pirate ship’s dungeon. He ing his beloved green Peter Pan suit, which tells Wendy, “No more bad guys anymore!” transforms him into his ever-victorious hero, He then finds the crocodile and starts to twist who expresses his wishes that he could al- rubber bands around its mouth. Wendy pleads ways live in Neverland where he can shape his withhimtogowithher,“ButPeter,come world. In play, Joey can express his fears and feelings, and he can regain control and regulate his emotions, find safe solutions for his problems, and access reasoning to bridge his symbolic ideas to reality. In his inner world, Author Affiliation: Profectum Foundation, Mendham, New Jersey. Joey’s Peter generates excitement encompassing both anxiety and victory. The author has indicated that she has no financial and no nonfinancial relationships to disclose. What does this play scene tell us about Joey? His choice of symbols is quite common Corresponding Author: Serena Wieder, PhD, Profec- tum Foundation, 140 Riverside Dr, New York, NY and even obvious, beloved by many children. 10024 ([email protected]). Who would not welcome a ship that soars DOI: 10.1097/TLD.0000000000000126 through the sky, pixie dust to make you fly, 259

friends who join your adventures, and an en- mental, Individual Difference, Relationship- emy you always defeat? Joey has read the story based model; Greenspan & Wieder, 1998) as of Peter Pan and seen the movie many times a framework (illustrated in Figure 1), the arti- and reenacts these images with toys and in cle provides an explanation of how children, his mind. But for Joey, the meaning of his through play, climb the successive levels of play is his own. Its repetition is essential for emotional–symbolic development, with steps him as he struggles with learning challenges of the ladder illustrated in Figure 2 and dis- at school and resistance to the increasing de- cussed later, allowing them to differentiate mands of reality. His play helps him restrain reality from fantasy and self-regulate the de- his impulses and conquer his fears and grow- velopmental anxieties inherent in this process ing sense of inadequacy, providing respite and (Greenspan & Wieder, 1998). The DIR model a safety zone in which to work on his turbu- and developmental ladder illustrate the inte- lent emotions and communicate his thoughts gration of affect and intellect, the hierarchy and feelings. of emotional development, and how symbolic choices and play relate to other aspects of de- Symbols have personal meanings velopment, including individual differences in When adults play with children, they open affective, sensory, and motor processes. the window into children’s inner emotional A critical additional point is that children experiences through the symbols they choose with an autism spectrum disorder (ASD), al- and stories they create. Joey’s version Peter though often thought to be unable to play Pan is his own story. It is one example of how imaginatively, do have the potential to play children symbolize emotional themes in early and to climb the symbolic ladder when in- development through play, whereby they re- tervention is tailored to their unique pro- veal their understanding of the world, their files. This occurs when intervention promotes feelings, their relationships, and how they see multiple forms of symbolic expression (see themselves. Who or what they choose varies, Wieder & Greenspan, 2003; Wieder & Wachs, and the content does not matter as long as 2012). it is meaningful to them. When children activate symbols in their minds and make the Formation and function of symbols symbols their own, although such symbols in development may be familiar to others, they are imbued A symbol can capture an element of reality with the individual child’s unique emotions by representing real objects, ideas, or behav- and thoughts, which find safety in symbolic ior, but it is not the real thing. Rather, sym- pretense where children can project, exper- bols are expressed through words, images, iment, and seize powers they realize might drama, movement, art, or music. The child’s not be available in reality, thus finding ways symbols reflect functional levels of emotional to understand their emotions and regulate development along a developmental hierar- their behavior. This symbolic process is essen- chy or ladder, as represented in Figure 2. This tial for emotional development and emotional usually begins with symbols representing the regulation. child’s personal experiences of being cared for and loved, where all needs can be met. Interface between symbolic Imagine play with teddy bears, feeding play and emotional development food, and using doctor kits. Later, symbols This article describes the interface between capture more complex emotions and drives symbolic development and emotional devel- such as anger, fear, jealousy, aggression, com- opment seen through play as they mirror each petition, rivalry, fairness, compassion, and jus- other as children grow. It is a process that orig- tice, consistent with the growing child’s ex- inates in the signaling between infants and panding awareness of reality. Symbolic func- parents early in life. Using the DIR (Develop- tion is crucial for emotional and behavioral

Figure 2. Illustration of Functional Emotional Developmental Levels (FEDLs) that constitute the steps of 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- later in this article. Deficits in free play, how- opmental anxiety that accompanies this ex- ever, have been linked to problems with men- panding emotional range. Anxiety, poor reg- tal health, including childhood disorders such ulation, and aggression may reflect poor sym- as anxiety and depression (Gray, 2011). bolization, which can be associated with poor impulse control and acting out. This can stem The role of pretend play from possible challenges with comprehen- Historically, the role of pretend play in de- sion, empathy, and theory of mind, as well velopment has been debated by psycholo- as with sensory processing and environmen- gists. In 1933, Vygotsky (published in English tal difficulties and threats that derail develop- in 1967) described how a child moves for- ment. Without symbolic expression to com- ward in development through play activity, a municate and negotiate, there is no safety. process starting with imagining experience in real life, separating from the real objects and The importance of play and affect action into pretense, substituting images on in development the basis of what they mean, so that a stick Play has long been revered as the “work” or a galloping action can mean riding a horse of childhood. Few topics have been studied (with no horse in sight), and creates ideas that as extensively as play in the development express his wishes. In play, the child suspends of intellect, language, movement, social reality and becomes what he wishes to be, just skills, cognition, and self-regulation, both like Peter Pan in a ship that flies, as illustrated historically and currently. Historically, re- previously. In that example, Joey’s ideas were searchers have described the stages and freed from the reality and constraints of the functions of play (Piaget, 1962; Singer & objects in his play. He could imagine what he Singer, 1992; Vygotsky, 1967); more recently, wished, and he expressed meanings through researchers have examined the relationship play and words. He insisted on play and loved and pathways between symbolic play and to play, clearly taking pleasure in doing so, language (McCune, 1995, 2010; Orr & Geva, but anxiety intruded on his wishful thinking 2015; Westby, 1988). Others have examined and feelings. the relationship between motor development Vygotsky (1967) also argued that creating or visual object recognition and symbolic imaginative play is the means or pathway to development (Smith & Jones, 2011). But abstract thinking. In contrast, Piaget (1962) fewer studies have given attention to the role described play as an epiphenomenon of other of affect, which is the experience of emotion skills, such as adult interaction and language, that accompanies the child’s development of that actually cause development. He argued symbols and representational play, as well as that play does not promote development but in daily living. reflects it. Neither Vygotsky nor Piaget put Affect finds a home in psychological theo- great emphasis on emotional development ries of development, attachment, affect reg- and the role of affect, focusing more on cogni- ulation, affective communication, mentaliza- tive development. Other researchers have ar- tion, therapeutic approaches, and more. As gued that play helps foster development but an example, Feldman and Greenbaum (1977) that it is only one of several routes to devel- studied the role of affect regulation and syn- opment, called equifinality, thus minimizing chrony in the play of mothers with their typ- the role of play in development as a unique ical infants. The researchers found that these contributor (Lillard et al., 2013). were precursors of symbolic competence at the age of 3 years. Similar attention has not Uniting the silos of development been given to the capacities of children on through play the autism spectrum to engage in symbolic Whereas the components of development pretend play beyond functional and simple such as language, fine and gross motor, cogni- imitative use of objects. This gap is discussed tion, and social–emotional abilities have been

studied, it is important to consider how these work of dynamic-developmental systems that developments occur simultaneously in order bring unity to emotion, experience, and rea- to understand a child’s functioning as an in- soning. This model represents the theory dividual. Understanding emotional develop- and provides the context for understand- ment depends on examining the interaction ing and supporting symbolic development between what the child’s biology brings into (Greenspan & Wieder, 1998; Wieder, 1996; the world and how relationships and the envi- Wieder & Greenspan, 2003). The components ronment shape developmental capacities. As of the DIR model are described in the sections illustrated in Figure 1, Greenspan and Wieder that follow. (1998, 2005) integrated these components in the DIR model, in which child–parent inter- “D”—Developmental capacities of active relationships are viewed as the key to emotional and intellectual functioning advancing emotional and cognitive develop- Regulation and shared attention ment. The DIR is an integrated theory, which (between infant and caregiver) utilizes a primary methodology of free play, known as Floortime. This provides the frame- From birth to 3 months of age, infants’ ca- work to examine the role of affect in symbol pacity for calm, focused interest in the sights formation in all children. During Floortime, and sounds of the outer world grows and children are free to play in any way they pre- serves as a means to be calm, attend, and fer, and it is up to children to initiate themes share their interests with their caregivers as that are treated as intentional as they carry on they look around the world. Regulation is back and forth interactions with their parents by no means automatic. It may vary depend- or clinicians and later, their peers. ing on the biological capacities or individual differences with which newborns enter the THE DIR MODEL world and how they experience their environments. Even very young infants can con- The DIR model, as illustrated in Figure 1, vey comfort or stress to their parents who are has moved away from the silos of develop- learning to support their infant’s behavioral ment, where each aspect of development has and emotional regulation. Parents play impor- been measured and reported as a separate do- tant roles in supporting their infants’ devel- main, although domains sometimes could be opment of smooth cycles of sleep and alert- added together to yield a developmental or ness, ability to focus and shift attention, and intellectual quotient identifying deficits and to adapt to internal and external sensations, strengths. This approach did not capture how movement, and emotions. The capacity for children actually function, where multiple do- behavioral and emotional regulation expands mains must function simultaneously to sup- in duration, range, and stability as children de- port comprehension, communication, relat- velop and share attention first with their par- ing, creating ideas, and regulating emotions. ents and then with others. Shared attention In DIR, the domains interact with each other is between people, whereas later, joint atten- as children interact with caregivers and the tion emerges as parents and infant attend to environment to create capacities that will sup- the same object as they play with it or look at port functional emotional and intellectual ca- it, such as a toy or book or an activity. Both pacities. Each capacity emerges in synchrony shared attention and joint attention are usually with brain and body development early in life pleasurable. and continues to develop as the subsequent capacities emerge. Together they build the Forming attachments and engaging foundation for lifelong relating and learning. in relationships The DIR model introduced major paradigm During the first 4–5 months, infants and shifts from behavioral frameworks to a frame- parents become increasingly intimate as they

interact with each other with warmth, trust, when old means fail to solve new difficul- andattunement.Theyusealltheirsensesto ties, leading to new discoveries and means of enjoy each other through looks, hugs, songs, problem solving. For example, when crying and movement, setting the stage for all rela- alone does not get toddlers what they want, tionships in life. A secure attachment is sup- they discover that they need to point or pull ported by a parent’s sensitivity and insight theirparentovertowhattheydesire,orto (Oppenheim, Koren-Karie, Dolev, & Yirmiya, wait. 2012). Over time, the growing infant will need to remain related and engaged across the full Creating emotional ideas range of emotions, even when disappointed, Between 18 and 36 months, toddlers be- scared, angry, or feeling other stress. As chil- gin to represent or symbolize their intentions, dren develop, the range of emotions expands feelings, and ideas in imaginative play, us- and they are expressed through symbols, as ing gestures, words, and objects symbolically. described later. Toddlers now may pick up the toy phone to call Daddy, or they may set up a picnic Intentional two-way affective or tea party for Mommy or a friend. A tod- communication dler playing symbolically may examine the Between 4 and 10 months, the purpose- sick baby with the doctor kit or repair the ful, continuous flow of interactions with ges- car with play tools, substituting objects or tures and reciprocating emotions gets under- gestures as needed to express ideas. Images way. Infants begin to act purposefully, as they form in toddlers’ minds, so they can think mature and gain awareness of their bodies ahead without seeing actual toys and can now and the functions they can perform. As in- imagine the objects in context, such as hav- fants gain motor control over their bodies, ing tea with one’s dolls with the tea set now they are better able to communicate their de- infused with the pleasure of having shared sires and intentions. With the emerging abil- the delicious tea and cookies with mother ities to reach, sit and turn, crawl and creep, (Winnicott, 1971). These first symbolic ideas give and take objects, and vocalize, infants’ come from experiences in real life that can awareness of the interpersonal world grows, now be enacted in personal pretend dramas as does their awareness of their body in space as the child experiments with different roles and in relation to others who also may be and feelings and begins to discover magical moving. thinking.

Complex social problem solving Emotional thinking, logic, and sense and emerging sense of self of reality Between 9 and 18 months, infants—now At about 3 years, young children begin to emerging toddlers—develop the capacity to combine ideas to tell a story as they develop problem-solve using social interactions. Most more logical thinking and better understand- have learned the back and forth rhythm of ing of themselves and others and of what is interactive emotional signaling, and they be- real or not real. Their stories may use imagina- gin to use this ability to think about and solve tive characters and animal figures who talk, as their problems, such as how to do what they well as fantasy figures, from princesses and want and find emotionally meaningful, such fairy godmothers to witches or wizards, as as bringing Mommy to the cabinet where the they discover the need for more power to cookies are. Their senses work with their mo- encounter the conflicts and challenges in life. tor systems and emerging language skills as At this point, they also become able to take on they interact with others to solve problems, the perspective of others in different roles or begin to differentiate their sense of self from conversations. Just as with Joey’s Peter Pan, others, and develop thinking. Challenges arise each story has personal meaning and often is

replayed in various ways. Children’s advanc- fant’s first experience is through physical ing reasoning skills help them build sequen- caregiving practices shaped by cultural val- tial bridges, and their stories become increas- ues and beliefs. The infant’s body is the first ingly logical with a beginning, middle, and object of discovery and it is the sensory in- end. For example, children may begin to re- formation the infant takes in through touch, linquish magical thinking as the solution to sound, smell, vision, interoceptive sensations, everything and may begin to create logical and movement in space that are the sources fantasies. They can now plan an idea for an of relational, linguistic, and cognitive devel- adventure in space, or be a hero defeating an opment to be assimilated in unique ways. enemy to bring justice, or they may step into Consider the example of Joey again. He was future roles with which they identify, such as born with a reactive and intense nervous sys- parenthood, expanding their narratives with tem. Joey relied on symbolic play and self-talk more characters, prediction, theory of mind, when he was alone to modulate his anxiety and empathy. Over the next few years, chil- and practice solutions for his fears. He held dren’s emotional and mental abilities move to- onto magical thinking where he could be suc- ward abstract thinking and they develop the cessful but was also excited by the danger ability to distinguish reality from fantasy, self in his play scenarios. He did not understand from nonself, one feeling from another, and the interaction between his fears and excite- how to take time and space into account. ment and was driven to fight his enemies with This capacity develops further through child- poor control over his impulsiveness. Other hood into multicausal and comparative think- children may have other reasons for identifying, relativistic or gray-area thinking, and self- ing with Peter Pan or any superhero fighting reflection, which are the top rungs on the evil. In some cases, children try to understand developmental ladder illustrated in Figure 2. the motives of bad guys whom they see as At any of these functional emotional devel- very powerful by assuming their power in play opmental levels, variations may exist in the ro- and thereby also know that the bad guy can- bustness, stability, and completeness of these not get them. It sometimes is a counterpho- capacities. As seen with Joey, stress related to bic attempt to not be afraid of the bad guy’s health or learning difficulties, family change aggression. Some are able to alternate roles as and parental stress, losses, and moves, along they develop abstract thinking to explain why with other events, can throw a child and fam- good guys and bad guys both fight but one is ily off course. At all times, it is critical to meet “good” and the other “bad.” Whichever role individual children at the level at which they they experiment with, it is important to make are functioning in the moment. Either over- meaning of their intent and not to confuse or underestimating a child’s ability and emo- symbolic play with the real thing. tional status has risks. A developmental per- In the DIR model, careful attention is paid spective means that it is important to pursue to the body, sensory processing, postural progress at any age, and the length of time control, motor planning, visual–spatial and progress takes may vary for each child as road- auditory capacities of children, and the ways blocks or gaps are identified and need to be they support or compromise functioning addressed (Greenspan & Wieder, 2006). in other areas of development, especially emotionally and their sense of self. The DIR “I”—Individual differences in sensory model (Greenspan & Wieder, 1999) added modulation, sensory processing, a theoretical framework for understanding sensory affective processing, and motor every child’s unique profile and the impact planning and sequencing of altered patterns of sensory responsiveness Every infant enters the world with unique on the development of children with sensory characteristics determined by biology (genes) processing challenges before these were even interacting with the environment. The in- recognized as a diagnostic feature of ASD.

Biologically based individual differences are feel safe, accepted, and loved, taking priority the result of genetic, prenatal, perinatal, over all other goals across the life span. and maturational variations and/or deficits, Together, the “D,” the “I,” and the “R” pro- including problems with modulation in each vide a unified dynamic framework to iden- sensory modality (overresponsive, underre- tify each child’s strengths and challenges. The sponsive, and sensory craving), sensory-based DIR model can guide the experiences pro- motor disorder (dyspraxia and postural disor- vided by parents and caregivers to advance de- der), and sensory processing (comprehension velopment for all children and interventions and expression) in each modality (Miller, when needed. Schoen, & Nielson, 2012). Essential for symbolic development is sensory-affective DIR’S DEVELOPMENTAL SEQUENCE: processing in each modality, which is the abil- FROM SIGNALS TO SYMBOLS ity to perceive, interpret, and react to affect, including the capacity to connect “intent” Symbolic abilities build on the foundation and affect to motor planning and sequencing, of the aforementioned developmental pro- language, and symbols (Greenspan, 2002). cesses defined in the DIR model that start at These processing capacities are relevant to birth. The newborn must adapt to the myr- all children and especially so for children with iad of sensations he or she experiences as ASD (Greenspan & Wieder, 1998, 1999). Re- the external world impinges. Some infants cent brain studies support this contention, do so smoothly, establishing rhythms of sleep finding divergent connectivity in the limbic and alert wakefulness. They share attention structures and the fusiform gyrus related to re- easily, looking and referencing their parents, ciprocal communication and facial emotional soothe easily when upset, and develop self- processing in children with ASD, differenti- calming mechanisms over time. Others are ating them from children with sensory pro- fussy, hard to soothe, and need more coreg- cessing disorders, although both share white ulation to dampen the distress and heighten matter brain disruption (Chang et al., 2014). their focus for shared attention. Either way, these are the infant’s first emotional commu- “R”—Relationships and interactions nications (Tronick, 1989), and the caregiver’s Relationships not only activate develop- attunement to the infant’s sensory-affective ment but also serve as a base from which signaling provides the preverbal foundation children can move into the world with for attachment as well as regulation (Schore, curiosity and confidence to explore, dis- 2014). cover, learn, and master. Attachment theory From the start, parent or caregiver–infant informs the DIR model (Bowlby, 1988; interactions involve an exchange of emotional Dolev, Oppenheim, Koren-Karie, & Yirmiya, affective signals. The emotional signal con- 2014; Greenspan & Wieder, 2006) and veys intent before engaging in an action. promotes sensitive and attuned interaction For example, the baby may look intensely at and insight. Relationships go beyond primary you deciphering who you are, before break- attachments, however, to expand reciprocal ing into a smile, but if he feels scared or interactions with other caregivers to attain distressed, may grimace and hold his breath emotional constancy across an affective before starting to cry. When the parent re- range and to support differentiation and sponds to these signals and reaches for the individuation and identifications and social baby, she or he can preempt action and help roles in later life. Relationships that offer the baby modulate the intensity of emotions attuned and responsive interaction are the before crying or biting, for example. The “real vehicles for learning, encouraging initiative thing,” which may be signaled by intense and intentionality, respecting a child’s own alarmed crying or tantrum, does not have to agency, and also providing the security to happen when the signal conveys intent and

the parent can reassure the baby with a sooth- symbol that can be transformed in many ways ing tone of voice and holding or moving the as the child’s ideation grows. Thus, children baby. Even an older infant or young toddler expand their symbolic adventures by playing can read the signals of a parent’s impatience not only with their parents but also with other or disapproval and knows when not to inter- caregivers and children. rupt or make demands, regulating his or her However, affective experiences are not behavior by staying out of the way. The mem- only pleasurable, they also may be frighten- ory of the looks and actions, infused with af- ing, angry, or even traumatic, encompassing fect, will soon turn into mentalized images a range of feelings. Often parents seek to sup- of the child’s experience and perceptions at press negative affects quickly, for example, by the time. Through this process, signals be- saying, “Don’t be angry (or scared), it’s okay,” come the precursors of symbols (Greenspan even before accepting the feeling or identify- & Shanker, 2004; Winnicott, 1971). Signaling ing the cause for the child. Although positive continues throughout life, carried by affect feelings are more desired and comfortable, all expressed through facial expressions, tone of feelings need to be accepted for children to voice, eye contact, posture, movement, inten- feel safe and learn to understand their experi- sity, and timing, conveying positive and neg- ence in order to share and self-regulate rather ative meanings and feelings with many varia- than act impulsively or withdraw. Sometimes tions. How these are expressed depends on children’s negative affect is intuitive and pro- individual differences of both the child and vides an important signal to the parents of anx- the caregiver. iety, danger, or lack of readiness. Avoidance is another important signal to be understood. Preverbal signals Is this process automatic? Not necessarily. As noted previously, in the DIR model, If the presymbolic level of signaling does not regulation and shared attention are the first develop or is not robust, the child may not building blocks of development. They set the have capacities to develop self-regulation and stage for engagement and attachment and sub- may expect to be intruded upon and over- sequent developmental capacities. Preverbal whelmed. If children’s signals are not read or signals abound as parents and infants connect they are unable to signal back, they may not and share affect as they “fall in love,” with in- get the support they need from their caregiver creasing number of gestures to communicate to feel safe or to change the environment. and ways to solve problems together. Motor Children then may have difficulty using affect development advances simultaneously as the as a symbolic signal to cope with and regu- 7- or 8-month-old baby reaches for a desired late feelings and to find solutions, with pos- object the baby’s mother is holding, or as the sible stress increasing and anxiety escalating walking toddler pulls the parent’s hand to- and overwhelming them. In such instances, ward the object the toddler wants. In each children’s symbolic level may become fraught case, these presymbolic actions stem from with fear and aggression as their behavior desire and the earlier interactions that gave disorganizes. the objects meaning (Schore, 2014; Tronick, Only regulated affects can serve as signals. 1989). Later, as toddlers develop, they do If a caregiver misses the child’s signal, such as not have to see the swing in the backyard not seeing frustration building and does not to recreate the pleasure of that experience; help in time, the child may act out. If a care- rather, they can imagine the delight they ex- giver overreacts or underreacts to a child’s sig- perience when they are swinging and their nals, for example, when the child is anxious motherturnstheswingintoajourneytothe or scared, the child can feel overwhelmed and moon and acts as the copilot. The swing is not fail to get soothing reciprocal interactions or just the fun swing perceived earlier, but it is the help to form the symbols needed to un- now an internalized image, which becomes a derstand his or her feelings. Such children

then may have difﬁculty using affective inter- ing the object or experience and the affect actions to regulate and may be unable to read that accompanied it. A freestanding percep- and respond to soothing calming affective sig- tion that becomes an internal symbol contin- nals their caregivers offer in efforts to coreg- ues to take on meanings through experience. ulate. The interaction between children’s ca- Ana could then cuddle her teddy bear when pacity to signal and parents’ sensitivity is a she is alone, feeling the comfort and security critical factor in this process of development associated with her mom and can give her (Greenspan & Shanker, 2004; Oppenheim baby doll a teddy when playing and doing for et al., 2012). the baby what was done for her.

Separating from perceptions of the The dual coding of experience “real thing” and symbolic meaning It is emotional signaling that enables chil- Many have described the sequence of sym- dren to separate perceptions from fixed pre- bolic play, as when children reenact the use dictable actions and to free their perceptions of a small object demonstrating its real use, or so as to acquire emotional meanings that be- substitute an object or gesture to show that come symbols. When children register sensa- they are drinking tea at a tea party, or feed- tion of what they see, hear, smell, or taste, or ing the baby doll or teddy bear with a toy experience when they move, in their minds, bottle but, lacking that, by substituting a long the sensation is coupled with the emotion felt block to represent the bottle. At such times, at the same time. The affective experience they are demonstrating cognitive abilities and may be one of pleasure, curiosity, pride, or functional play (Kasari, Chang, & Patterson, discomfort, worry, fear, or anxiety. 2013; Westby, 1988). But is that all? This pre- The experience could be stressful or invig- tense also has emotional meaning stemming orating, as in the following examples. Sally from children’s own affective experiences of watches mommy walk toward her high chair being fed, looking at their mother’s smiling with a small bowl of cut up grapes and face, or hearing their father’s cajoling voice smiles in anticipation signaling her apprecia- to eat a little more. The teddy bear was one of tion. Danny waves his arms with excitement, Ana’s first gifts. It stood watch over her as her keeping his gaze on Daddy as he is about to mother cared for her, eventually becoming roll the yellow ball toward Danny, so that a transitional object representing her mother Danny shifts his gaze to reach for the ball to when she left the room at night or went to push it back, already anticipating its return. school, helping her self-regulate and reinforc- Ana cuddles her teddy bear blankie as she is ing the image or symbol of her mother in her cuddled before bedtime. Benny frowns as he mind (Winnicott, 1971). sees mommy putting on her coat and starts to This dual coding of experience applies to all whimper as she soothingly reassures him that experience in early development where affect she is going to work and will be back soon. takes the lead in learning (Greenspan, 2002). These perceptions are simultaneous, with Words also take on symbolic meaning through an emotion and an action. When a person this dual coding. A baby first learns through is able to perceive without being driven to the signals he receives from a caregiver who act out or expect another’s action, the per- lets him know that the bathwater is still too son is left with a freestanding image in mind hot as the adult’s voice escalates, “Hot, hot!,” related to the action and the experience of and then calmly reassures the baby, “Just a how it felt. So, Danny’s yellow ball is not just minute, we’ll splash in just a minute.” The another object, but it takes on special mean- baby does not understand the temperature of ing and becomes an image coded with the the water or the length of a minute, but these pleasure he experiences playing with his fa- words take on emotional meanings that help ther. The image becomes a symbol represent- the child stay regulated while observing the

caregiver get the bath ready. When waiting prior events help children better understand seems frustrating, the caregiver might help experience, know what to anticipate, and the baby be patient by singing a song, or pro- find new solutions to needs and fears. For the viding some toys to throw in, smiling and ap- first time, children can integrate experiences plauding how well the baby throws, or how from the past into the present and plan for happy the fish is to be back in the water and the future as they imagine what will come then giving a tender hug and kiss while lifting next. Images also foster creativity as they are the baby into the tub and saying things about no longer bound by time and space in reality. loving the baby so much and how much fun Examining the emotional content of play they can have. So this is the secret of “love,” during the first few years of life, whether the secret ingredient is affect, and the pro- symbolized through words, toys, language, cess is the dual coding of experience, where mime, stories, movement, or art, now severed emotion and intellect are one and language or from reality, reveals children’s understanding actions have more than one meaning. of the world, their feelings and relationships, and how they see and experience themselves CLIMBING THE SYMBOLIC LADDER (Wieder, 1996; Wieder & Greenspan 2003, IN EMOTIONAL DEVELOPMENT 2006; Wieder & Wachs, 2012). They reenact their personal worlds striving toward mastery Social–emotional constructs are often of visiting the doctor, or understanding the identified together as if they are one set of reasons to fix the car, or shop, and cook. They skills. Or, emotional is coupled with behavior enjoy dressing up for different roles or using and regulation. It can be difficult to describe figures to represent the characters involved a child’s inner emotional life, especially when as they practice being in someone else’s shoes young. But symbolic interests or preoccupa- and what it feels like. One hears how good the tions can indicate some of what is going on in food tastes, or the doctor saying, “No shots the child’s inner life. Emotional development today!” or the squeals of jumping in puddles has a unique trajectory, integrating all aspects with friends as they move from reality to sym- of development reflected as one climbs the bols, first “reliving” real experiences and then symbolic ladder and as symbolic play is moving on to fantasy. guided by emotions based on this hierarchy. Beginning with dependency, children’s first The choice of symbols symbols are used to reenact experiences of be- Children share not only language to com- ing cared for and loved. Later, they move on to municate and create ideas but also sym- discover emerging expectations often repre- bols transmitted through culture representing sented by symbolic figures they come to love emotional development. Examining the sym- that accompany their journeys. First, they may bolic play and preferences children express, experience Barney as a big cuddly dinosaur the symbols they adopt from shows and books who sings of happy families and love, “I love they love to see and hear repeatedly, offers you, you love me, we’re a happy family . . . .” insight into their inner experiences. When ButthenBarneyalsoasksthemto“Clean they begin to play with these figures, it is no up, clean up, everybody do your share . . . ”, longer a replication of real life as earlier but a investing them with their first responsibility pathway to discovering themselves. Whom for taking care of themselves and others. Men- they dress up as or the play figures they tal images start with real objects that enable choose, whom they form alliances with, and children to think about those objects when whom they rescue or vanquish in battle now the objects are not physically present. They reveals more complex emotions as they iden- allow the child to think about experiences tify with more complex representations. before, during, and after their occurrence. Consider Sesame Street, where urban char- Visualizing what they heard and imagining acters learn letters and numbers and friend-

ships reign, even with grouches and villains, encounter threats and begin to deal with life each one unique and no one more beloved more on their own. In the Three Little Bears, than Elmo. Or, go to the woods and find poor Goldilocks has to deal with getting lost and Winnie-the-Pooh forever searching for honey, with her hunger and fatigue as she searches supported by a group of friends to solve his for home. She discovers a house in the woods problems. In both, there is another character and helps herself to porridge and rest, only to like Christopher Robin, who can help. And be awakened, feeling terrified, by the bears. Dora and Diego venture out into the world dis- The Three Little Pigs are evicted and have to covering new places, searching for answers, manage life on their own. There are wolves finding adventure. Or, Thomas the Train en- out in the world and two must be rescued counters countless challenges on his job, in- by their brother, who was wise and built cluding stronger and more competitive trains his house out of brick, whereas they chose that pass him by. Good Night Moon signals sticks and straw. How different they each are. that it is time to go to bed with gentle farewells In Jack and the Beanstalk, Jack finally cuts to the child’s world. The underlying emo- down the beanstalk to the dismay of the giant tional task to be mastered is separation. Words chasing him, seeking the golden eggs. What a and visual images prepare the child to transi- heroic and reparative act after giving away the tion from the familiar world into sleep. These cow for a few beans. And lovely Cinderella characters represent preschoolers as they dis- is surrounded by chirping birds as she gets cover more of the world, have to think for ready for the ball unbeknown to her jealous themselves, and figure out who they are in the and mean stepsisters who rip her dress off, process. Symbols unite emotions and thinking consumed with jealousy. Fantasy and realistic and action as problems are solved. Emotions images blur with dragons and knights, fairy expand from caregiving to separation, to striv- godmothers, and witches; it does not matter. ing for independence, with curiosity, adven- The emotions are so vivid and so are the sym- ture, some fear, competition and loss, and vic- bols representing them. Such stories usher tory. There are many developing emotions on children up another rung on the developmen- the symbolic ladder, all true to life and sym- tal ladder. Their value depends on the care- bolized safely with increasing elaboration of givers’ response to their children’s emotions ideas as preschoolers prepare for reality. when they act the stories in play or during their conversations about how the characters The development of fantasy felt and how they feel to encourage theory of Each culture provides symbols related to mind, motives and perspective taking, emo- emotional development, handed down from tional thinking, and abstract abilities. legends, fairy tales, and stories transmitted over generations. Between three and six Hierarchy of symbolized affects years, there is a leap, taking children beyond Emotional and symbolic development, the emotional reality-based themes described now expressed in play and language, expand previously into fantasy so that they can em- in parallel fashion. As indicated earlier, the brace magical thinking as they move back first themes reflect the essence of infants’ and and forth from outside-in to inside-out, with toddlers’ lives, as they depend on caregivers the space in between described by Winnicott for care, protection, enjoyment, and love in (1971) in Playing and Reality.Forsome,fan- order to build attachments and the secure tasy is fueled by classic fairy tales and books foundation for what is to come. With devel- parents read to children, with words now con- opment, symbolic play moves on to reflect veying intense emotions related to the child’s transition themes related to separation, disap- growing awareness of feelings. Here too is a pointment, loss, sadness, and fears. Children hierarchy of emotional tasks advancing devel- begin to symbolize the necessity to be more opment as children begin to realize they may assertive and independent as their play

assumes more control and power to deal with more elaborate and coherent, with a begin- competition, threats, battles, and disaster, ning, middle, and end, with multiple charac- with the incumbent feelings of danger, anger, ters, and with movement through time and jealousy, defeat, and victory, but also show space. All symbolic forms pitch in, and chil- compassion and empathy. While first accom- dren use toys, drama, drawing, movement or panied by magical thinking and fantasies, dance, art and music, or some blend of all of more realistic and logical solutions are found them. The specific characters do not matter, as children develop, leading into integrating but what they symbolize is everlasting and es- abstract themes, such as embracing fairness, sential for understanding what is real or not kindness, empathy, justice, and morality. real, what is me or not me, and the mastery of Inherent in development is the realization the full range of emotions, with imagination to of “good guys and bad guys.” Mommy might discover the unknown and move forward un- be the first “bad guy” when she says, “No!” til judgment and reality testing become well to more candy or Daddy might set limits on established. throwing things when the child is angry. Par- ents coregulate strong emotions until they Developmental anxiety: When symbols can be expressed safely. The idyllic omnipo- are bigger than “life” tent all giving parent begins to fade as chil- Throughout development, psychological dren discover their own desires and separate- and emotional transitions generate ex- ness. “Bad guys” also appear at nursery school pectable anxiety related to growing aware- when told you have to share, that is, give up ness of self and others and facing the un- your toy, or another child just grabs it. So, known. Consider infants who realize that they the seeds have been planted and transform are looking at someone they do not know, or into cultural symbols from powerful kings, 3-year-olds having to separate from their par- kind fairies, to pirates, dragons, evil kings, and ents at nursery school. Whereas most children monsters, all with magical powers for better master these anxieties with limited stress, and for worse. By four or five years, children some tend to be hypersensitive to sensations create their own ideas as they discover the and experience affect intensely. Some are power of their ideas and defeat the bad, or overly fearful and reactive to body damage, turn bad into good, and have the dead come aggression, and unpredictable events. Others back to life, often depending on such super- are thrown into panic when they turn around heroes as Superman, Spiderman, and Batman. and do not see their parent and feel lost Soon they venture into space to take sides in in space. Some have catastrophic reactions Star Wars. to not finding needed objects or to thinking something has broken. Others feel helpless or Reality testing frustrated when they cannot organize a task By this developmental point, children have and especially when they do not understand been launched into testing reality. They need what is being said because they are so anx- control and power to keep climbing up the ious or because comprehension fails them. ladder as they continue to develop and be- Still others live in dangerous environments or gin to understand the bigger world. Their lan- have witnessed violence. guage has developed, and they now may em- As development advances, anxiety can stem ploy it to negotiate, detect deceptiveness, and from the child’s imagination when symbols assess trust in the service of defeating their en- become greater than life. Symbols elicit feel- emies and exercising their power, be they a ings where inside and outside meet. Images king or wizard or superhero, or a fairy god- and labels become embellished with power- mother or queen or Wonder Woman. This is ful affects that can be positive with princesses, crucial, as pirates, giants, witches, and mon- kindly godmothers and fairies, benevolent sters await, ready for battle. Stories become kings and leaders, or negative with monsters,

dragons, and witches that feel all too real. come back to life, and experiment again. The With this polarization, magical thinking turns more children play, the more they will re- alligators, dinosaurs, and other frightening im- alize they are creating the ideas and choos- ages into “bad guys” in countless stories, as ing the symbols that they can change, lead- adults moderate the anxiety. Verbal reassuring to flexibility and resilience. Most children ances may work partially, if at all, and may love to play, embracing the complexity with have to be repeated again and again. Daddy many enjoying the mix of excitement and may have to check under the bed, search the fear that they overcome by winning. Play also closet, and throw out the scary lions and mon- promotes building of executive function be- sters night after night. If children do not yet cause, in play, children have to organize and have access to magical thinking where they sequence ideas and be able to take some- can defeat their enemies and create the safety one else’s perspective. Developmental anxi- they need, or a parent is not there to coregu- ety thus provides the tension and opportunity late their fears, anxiety ensues. If a parent dis- to test what is real or not real, what is inside misses a child’s fears or overreacts to a child’s and outside, and what can be shared and ne- anxiety, the children may feel overwhelmed gotiated with others. and may not get the reassuring reciprocal in- Although children can enjoy playing by teractions that can help them form the sym- themselves, and can be heard speaking to bols they need to understand their feelings. themselves at such times, to reach its heights, Children then have difficulty using affective symbolic play requires reciprocity and de- interactions to regulate; they may be unable pends on interaction with a parent or care- to read and respond to soothing calming af- giver who expands on the children’s ideas, en- fective signals; and they may act out aggres- courages communication, and assumes roles sively or withdraw and become constricted. to help them elaborate, thus supporting their This is evident when a child becomes avoidant abilities to explore a wider range of feelings. of emotional themes and restricts play to safe When a child plays with another person, it is dependency themes or will not play pretend. easy to guess who the “bad guy” always is. The Others may stay immersed in their fantasies, interaction supports the child’s emotional reg- but rarely as the “bad guy,” and hold onto ulation of feelings and impulses, as well as control, having difficulty judging cues, rec- comprehension, perspective taking, and em- ognizing deception, or interpreting affects. pathy. The level of symbolic play is related to Counterintuitively, it is useful to “deepen the parental willingness to engage in games of fan- plot” of themes the child starts and then pulls tasy, tolerate emotional themes, and facilitate away from. This provides more time to grap- creativity. Alternatively, parental intrusive- ple with motives, what the other side is think- ness, depression, and anxiety are associated ing, explore alternative solutions, integrate with reduced rates of symbolic play (Singer & more emotions, and appreciate that symbolic Singer, 2005). Not all parents join their child’s play is all about ideas and feelings, not actions, spontaneous symbolic play and prefer other danger, or disapproval. Without symbols and ways of playing, such as sports, construc- symbolic play or conversations, anxiety may tion, or board games that are also important persist beyond what is expected developmen- avenues for dealing with emotional and so- tally; the child may become stressed, con- cial development. Similarly, play experiences stricted, and act out, and these reactions can with other children can help discern the per- take precedence over reasoning because anx- spectives of others who may agree or disagree iety can derail logic and reality testing. and have different intentions and motives. Play with friends, siblings, and school mates The power of symbols also helps children learn the “rules” of social In symbolic play, a child can have power, play and games as they develop self-regulation make the rules, practice different solutions, and understand risk and competition.

DO CHILDREN WITH AUTISM ENGAGE reported gains in cognition, language, and IN SYMBOLIC PLAY? reduction of autism symptoms, but the researchers did not examine symbolic play in Whether children with autism engage in their outcome studies of 18- to 30-month- symbolic play and how their play compares olds, nor in their 6-year follow-up (Dawson with children with developmental delays and et al., 2010; Estes et al., 2015). In contrast, typical children has been debated over many Kasari et al. (2013) did target play as an out- years. The play of children with ASD has been come, but primarily using short-term inter- described as simple, stereotypical, and rely- ventions and outcomes. They questioned the ing on sensory manipulation of the toys, as view that children with autism were not com- well as lacking in affect and theory of mind. petent or did not understand pretend play, Impaired symbolic play was once even con- but rather hypothesized that they may rarely sidered a symptom of ASD, and more severe engage in play with adults and may not have symptoms of ASD were associated with lower had enough adult support to shape and sup- symbolic play ability, along with lower cogni- port their play skills. Although functional play tive and language development. Like so much (i.e., using toys as intended) and pretend acts of the research in autism, most studies have can be prompted, such play does not automat- been limited to examining autism symptoms ically turn into the creative, spontaneous, and and cognitive or language level, rather than enjoyable experience of pretense. With lim- addressing the multiple domains of develop- ited play experience that is not matched to ment involved in symbolic play and what it the child’s developmental readiness to learn represents. Attempts focused on answering to play, pretend roles and thematic play may whether symbolic play advances cognition, not be attained. Kasari and colleagues’ JASPER or whether a certain level of cognition or lan- program (Joint Attention, Symbolic Play, Emo- guage was needed to advance symbolic play, tional Regulation) first targets joint attention or both, could not be ascertained. Past re- and engagement to establish developmental search has been variable with regard to levels readiness for symbolic play. Following this, of play, kinds of autism, numbers of children higher levels of play are supported by using studied, whom they played with, different set- the child’s ideas and prompting to expand tings, and so forth, and, therefore, inconclu- the diversity of play skills, encouraging longer sive (Thiemann-Bourque, Brady, & Fleming, play periods. Kasari, Paparella, Freeman, and 2012). Jaromi (2008) found significant gains in joint Furthermore, assessments such as cogni- attention and joint engagement. Additionally, tive or language tests usually do not focus a longitudinal study of 3- to 4-year olds showed on play. Intervention efforts to address play these gains related to language outcomes at 8– tend to be directive or focus on skills and do 9 years of age (Kasari, Gulsrud, Wong, Kwon, not help children expand or generalize, let & Locke, 2010). These studies of underlying alone address emotional meanings. In some precursors related to symbolic development approaches, the play may be unrelated to the advanced the field of behavioral interventions, interests of the child or have little meaning to which now include more naturalistic play the child. Such reasons suggest why the po- paradigms in early intervention (Schreibman tential benefits of symbolic play interventions et al., 2015). Beyond this, there is recognition have not been reached in treating autism. DIR that more longitudinal research is needed on is the exception. the level of a child’s play as a diagnostic fea- Recent advances in early intervention have ture, how play skills unfold over time, and in- brought attention back to play, but not always creased focus on play in intervention to study as a targeted outcome. The Early Start Den- multiple domains (Stanley & Konstantareas, ver model included play interventions and 2006).

Assessing symbolic competence potential for changing such patterns, which Although helpful, the emphasis in the in- may be masking higher symbolic potential, terventions discussed thus far has not been can be assessed by increasing interactions at- on symbolic play or emotional themes as in- tuned to more subtle signals and providing the tended targets, but on skills often taught in affect to support emotional symbolic expres- behavioral modes; nor has the development sion, while also treating underlying sensory, of relationship capacities that support sym- language, motor, and regulatory challenges. bolic function, a core deficit of autism, been Recent randomized controlled trial (RCT) part of those investigations. Although infants research on interventions using play with and toddlers now are screened as young as parents and children (e.g., Casenhiser, Binns, 9 months of age, and diagnosed at risk for McGill, Morderer, & Shanker, 2014; Solomon, ASD as early as 18 months of age, they are Van Egeren, Mahoney, Quon-Huber, & not necessarily screened for the precursors of Zimmerman, 2014) have shown that, when symbolic competence. relationship-based intervention focuses on In the DIR model, relationships are central developmental capacities with interactions to development, where sensitivity and respon- tailored to the individual profile of the child, siveness support tailoring interactions to indi- such as in Floortime (Greenspan & Wieder, vidual differences. Clinicians working in the 2006, 2007), children may be able to develop DIR model, including the author, report ob- capacities for symbolic play, communication, servations of how individual differences have and thinking, even when development is great bearing on play, as seen in the many chil- uneven. More importantly, researchers have dren with ASD who play and communicate dif- begun to focus on the core deficits in autism, ferently (Wieder & Wachs, 2012). Extensive relating and communicating, rather than practice-based evidence in the form of case the typical outcome measures using IQ and reports, case studies, and observations of chil- language skills tests. dren as they advance emotionally and symbol- Recent RCT studies based on Floortime, ically are observed in the following and later called play and parent-mediated interven- examples. Because of individual differences, tions, have used methods related to the DIR some children with ASD present with verbal model with children with ASD as old as 5 capacities and strong auditory memory. They years of age. They have shown that when par- maybeabletorepeatwholebooksandlabel ents provide play interventions coached by countless items but be unable to use language consultant experts (with demonstrated fi- meaningfully or to have conversations, lack- delity), autism symptoms and severity signif- ing comprehension or the ability to retrieve icantly reduce, and functional emotional de- what they want to express even though they velopmental levels advance (Solomon et al., have symbolic ideas. Other children with ASD 2014). Solomon’s PLAY project compared may have relatively stronger motor and visual outcomes for 128 children in a year-long inter- capacities; for example, they may line up their vention in five sites receiving coaching in play toys or love marble runs, construction, board to improve caregiver–child interactions, plus games, or puzzles that have specific destina- community service, with outcomes for chil- tions and strategies but may be unable to en- dren randomized to receive community ser- gage in motor-based interactive problem solv- vices only. The outcomes showed large treating that is unstructured, as required in sym- ment effects for parent and child interactional bolic play. They may have ideas but not the behaviors as well as significant improvements executive function skills to organize and se- on a standard measure for diagnosing autism, quence their thoughts or intent into symbolic although no differences were found for lan- play or tales. Those who have more signifi- guage and IQ scores. Mothers in the experi- cant difficulties may present as aimless. The mental treatment using play also were found

to be less directive and to experience less care is an essential ingredient in these stud- stress and depression (Solomon et al., 2014). ies, with play providing the opportunity to In another play-based RCT intervention for reach higher symbolic levels and improve re- autism, which focused on the effectiveness lating and communicating. But even the year- of social-interaction model, Casenhiser et al. long interventions did not fully examine the (2014) reported significant improvements in long-term development of symbolic capaci- autism symptoms, social communication, and ties and how these capacities relate to emo- parent–child interactions in the intervention tional development. Although not yet part of group but not in language skills when mea- the existing research base, observations from sured by standardized language assessments. long-term clinical intervention by this author By analyzing their data with a focus on com- and other experienced clinicians provide in- municative acts, the researchers showed that sight and illustrate that children with autism children in the group whose parents were can advance symbolically across a range of coached in how to play with their chil- emotional experience when symbolic devel- dren outperformed the community treatment opment continues to be supported through group. The authors noted that these results interactive play and conversation as children underscore the importance of functional lan- grow older (Delahooke, 2017; Greenspan & guage measures reflecting conversational abil- Wieder, 2006; Wieder & Wachs, 2012). ity and the importance of parent–child interactions in guiding and evaluating treatment CASE ILLUSTRATIONS for children with autism. In another large RCT, Pickles et al. (2016) The following four vignettes of symbolic reported on a 6-year follow-up of PACT play represent children who have differ- (Parents and Children Together), a parent- ent DIR profiles common in ASDs. All mediated intervention with 152 children with received comprehensive DIR intervention, autism. This research team also found ev- which helped them develop capacities for idence of the importance of teaching par- shared attention, relating, preverbal com- ents how to play with their children with munication, and social problem solving—in ASD. The treatment group of parents received other words, the foundations for symbolic feedback on how to interact more effectively play. The children in these examples are com- while watching their videotaped play with posites of multiple children. All were impeded their children. Parents played daily with their by the unevenness of their development and children in addition to standard care. Results exhibited different rates of progress with vari- indicated that parent-mediated interventions ations in language, visual–spatial abilities, mo- significantly reduced autism severity scores. tor planning, and motor and executive func- Children in the experimental treatment con- tions. Despite these delays, all of the children dition initiated more interactions with their moved forward using their relationship and parents and showed better receptive and ex- emotional capacities to cope with inner and pressive language communication after 1 year outer experiences. When poor comprehen- of intervention, with continued effects 6 years sion, poor reality testing, and social stress im- later (Pickles et al., 2016). pinged, they had symbolic resources to keep Studies showing the effectiveness of parent- advancing with the help of symbolic function mediated interventions with children with in play and conversations with parents and ASD that are focused on the core deficits of other caregivers. relating and communicating support the importance of working with parents relationally Suzie to carry on their daily playful interactions to Suzie teases her mom by withholding the help their children advance in the most impor- piece of play pizza she asks for, and she pleads tant ways. This added component to standard again. She holds out a piece and sees her

Mom’s glee but then pulls it back and watches character from his perceptions of it. One day her dismay. Suddenly she appears worried and Sam decides that the figures are going swim- throws it at her. Somewhat surprised, Mom ming in an imagined pool in the space in front notices the alarm in her eyes and instead of of him. He “drops” each into the pool one at a reacting, smiles gently and warmly says, “Let’s time. He keeps describing the figures in frag- share it!” and they each take a pretend bite, mented phrases and waits for his mom to ac- repairing the rupture. Suzie then offers her a knowledge each one. Suddenly, Elmo refuses drink, holding out a red block, and takes an- to jump into the pool. Mom asks Elmo what is other for herself. The vivid signaling, pauses, wrong and he says, “I can’t swim.” When mom gaze, tone of voice, and even alarm are the tries to reassure Elmo that Big Bird the Life- important elements of affect expressed in this guard will help him, he says, “Lifeguards don’t 40-s interaction by this playful mom who sees swim” (he has never seen a lifeguard in the the benefit of Suzie’s assertiveness but also water). Mom offers other figures who might her ambivalence. She sensitively repairs their help Elmo, but he despairingly says, “No one pizza party and recognizes her relief and ap- can help me!” When mom asks whether he preciation. At 4 years of age, Suzie still has is afraid, he nods. She then asks Sam whether few words but she can name pizza and say, he could help Elmo and he says, “Do this!” as “no” and “here.” She can pretend to eat the he makes frantic swimming motions with his pizza and substitute an object, which would arms, still not moving off his spot. Suddenly, have given her “credit” in typical assessments he notices Super Grover wearing a cape (like of presymbolic functional play. But this would Superman) and asks, “Super Grover, will you not have captured the flow of back and forth help me?” with a sigh of great relief. Sam’s interactions, thinking and feelings she actually story continues as these small figures con- shared with her mother as she experimented verse, trying to resolve Sam’s fears. with her power, or her ability to recognize her Mom knew that Sam was very worried mother’s signals to self-regulate. These are the about going to camp because Sam would be essential play experiences that will support asked to swim, and she sensitively supported a trusting relationship and Suzie’s emotional his problem solving, using play to practice. and symbolic development. His language was fragmented, he felt lost in space, he did not move, he was visually bound Sam to the appearance of the figures, and he pre- Sam is a tall 7-year-old boy who always ferred the small figures with whom he felt wears red shirts and who loves small Disney secure and which he loved as a younger child and Sesame Street figures. He enters the play- and still clung to. So many sensory, motor, room, rushes to the drawer he expects them visual spatial, and language challenges con- to be in, and does not find them. He appears stantly confronted him and curtailed his utterly frantic, his eyes darting and glazed, and progress. Yet, Sam could use play to tell a story he is unable to process directions and has no about his fears, which he initiated and per- sense of how to look around the room. Once sisted as he actively tried to solve his problem. figures are placed in his hands, Sam plops Sam’s mom did not correct his perceptions or down on the floor and starts arranging the direct his actions but kept the conversation toys, rarely moving from the spot. His mother going, providing affect cues while talking to sits immediately in front of him so that he his little figure friends. She asked simple ques- knows exactly where she is. When he feels tions or echoed his feelings and gave feedback calm, Sam begins to share an idea. At first, when ideas did not make sense. Mom let Su- he names the characters, with each defined per Grover “save the day,” after which Sam by appearance; so Ernie is not just Ernie but felt all was not lost, and he told Elmo, “You Ernie catching a ball or Ernie in the bathtub, can do it!” The next day Sam did go into the suggesting that Sam is unable to separate the pool.

Sam’s was the play of a child with autism. off his head with his scepter and declares, The DIR-based treatment started when Sam “Now I am not the king anymore, I’m Daniel!” was 2 years of age, as his multiple challenges Simply put, Daniel used play to explore new became apparent and a comprehensive inter- roles and “magic,” experimenting with how vention program was put in place. It was not he could be himself and yet also enjoy pre- clear how long it would take, when he would tense, so important for a little boy now fac- talk, climb, run, play, or how he would think. ing the bigger world. Pretending to be some- His arousal level was low, he was poorly co- one else appeared to concern him when he ordinated, had limited language, and did not first looked in the mirror dressed as a king know what to do with toys. He clung to his and he wanted to be sure he could undo this, little figures, which escorted him for many hence the request to make the king disappear. years, and as he advanced, so did they. The in- The magic his father gave him invested him tervention followed basic principles of shared with power, but he was not quite sure he attention, engagement, and 2-way communi- was ready for this or even understood it yet. cation, building on the playfulness, joyful af- His parents dramatized bowing to the king fect, and excitement that he and his mother with great pride to show him the honor due a could share while therapies and inclusion pro- king. But Daniel wanted a partner and turned ceeded. Sam’s relationship with his mother to his mom to be his queen, again reassured flourished, and he progressed to becoming when she declared she was mommy again. Al- symbolic with his little figures where every though somewhat anxious, Daniel persisted word he uttered was meaningful. At 7 years and tried again, this time in charge. This ex- of age, he knew how he felt and he knew perience supported by his attuned parents al- how others felt, displaying capacities for ab- lowed Daniel to think about who he was and stract thinking, empathy, and theory of mind. what meaning this had. It was not just “dress Sam’s rate of progress increased and he was up” and a “play act,” but emotional experi- included in regular education. ence that gave him mastery to imagine himself as a king in relation to others, which ex- panded into many ideas over time. Daniel These moments of transformation ad- Daniel wants to be a king, but what is a king vanced Daniel’s symbolic level and he began to a 41/2-year-old? He puts on a cape and crown to take on more powerful figures drawn from and holds onto a magic wand (his scepter) as such stories as Alladin and Toy Story.Butit his parents sit nearby. He looks in the mir- took the security of relationships and lots of ror for a moment and backs away, abruptly play with his parents to advance Daniel, who asking his father to make the king disappear. had apraxia and preferred to be a play actor Although not quite sure why his son asks him in his dramas to manipulating multiple toys. to do this, Daniel’s father prompts him to say His curiosity led him to ask the Genie to go the magic words, and Daniel recites, “Abra into the magic lamp and, when he played Buzz cadabra, hocus pocus, make the king disap- Lightyear, he thought he should go to jail for pear!” Dad swiftly swipes the crown off the lying to Zurg, but then he turned Buzz into king’s head and puts it behind his back. Daniel ababysohewouldnothavetostayinjail. sees this and begins to reach behind his back He used symbolic play to understand and ex- for it, when Dad again asks him to say the plore his emotions and advanced ideas as he magic words to get it back. Then Daniel of- became more logical. fers a crown to his Mom, and they repeat the drama. Mom reassures Daniel that she is Benny mommy again when he uses the magic words, Benny begs his mother to buy him a suit and and his relief is palpable. Daniel then decides tie. He is wearing his Superman shirt and al- to try his magic on himself and tilts the crown ready wears dark boxy glasses. “Why Benny?”

With stumbled words and lots of gestures, he help Benny reflect on his stories and wishes shows mom how he would swipe open his and consider ways to play with friends. shirt and jacket, take off his glasses like Clark A year later, Benny brings history lessons Kent, and be ready to “Save the Day.” He will into his play, explaining how the colonists be Superman! Benny has no doubts this will won the Revolutionary War, but then he work. Asked what “save the day” means, he becomes distressed when he realizes that repeats the words like a mantra and finally so many British soldiers died. He wonders says, “I will help people, be nice to people.” whether we should have shared the victory, In his mind’s eye, he is soaring through the sky full of compassion as he identifies with the to reach pirates who want to steal his Shop- weaker force. By the time he reaches the civil kins (small toy foods you shop for), or stop the war, Benny is still very empathic, but now he robbers escaping the Paw Patrol (small puppy can use logical and abstract thinking to un- police characters who keep you safe), or put derstand the reasons for the war. For Benny, the bullies in jail, allowing just a glimmer of symbolic play also gave him a way to think reality to sink in. As Superman, he could save through and understand history and literature his own day and the social anxiety and bul- as he advanced. lying he sometimes encounters. Month after month, Benny alternates between Superman, Batman, and Spiderman, ever victorious in de- Summary of how the DIR model feating evil and defying anyone who dares advances emotional development block the Polar Express. Superman is his fa- in these examples vorite. After all, he has dark hair, brown eyes, All these children were on the autism spec- andglassesjustlikehim.Atbedtime,hesome- trum and demonstrated symbolic play capac- times threatens to become invisible, so he ities that advanced their emotional develop- never has to relinquish his power and fight ment, sense of self, resilience, empathy, and for justice. logical and abstract thinking. Each one’s nar- Is this pretense or something more? The rative reflects an inner journey and attempts meanings of Benny’s symbols are obvious, but to cope with the underlying stress inherent in he is 5 years older than most children on development and a life often fraught with so- this mission. He expresses his fantasies clearly cial, learning, and environmental challenges. and repetitively. He navigates so many levels But each narrative is also coupled with the of symbols from little Shopkins to feed the strength of relationships with parents, teach- world, to yelping puppies who bounce and ers, and therapists who share this journey and bite to bring down their tormentors, to the provide the security and encouragement to invincible superheroes who defeat evil and advance. save the day. As he climbs up and down and The DIR model provided the vehicle that up again on the symbolic ladder, Benny is con- enabled all of these children to keep climbing tending with the challenges and angst of his the symbolic ladder. Not every child reaches own life. Does he not yet understand reality? the same capacity but integrated intervention He actually does, but his grasp is inconsistent nurtures every child’s potential. Clinical ex- and fractures when comprehension fails, and perience with symbolic play over many years his naivete´ and wish to be friends with and as offers insights that are difficult to capture competent as his peers lands him in a pool of in RCTs but demonstrate that many children confusion and vulnerability. His symbolic pre- with autism can, in fact, engage in symbolic tense provides respite and the time he needs play, especially using the DIR model, where to still be the little guy wishing to fight back emotional development and symbolic devel- (his Paw Patrol) but still must be rescued by a opment are targeted explicitly and where they superhero, and he plays both roles. The sen- go hand in hand (Wieder, 1996; Wieder & sitive responses of his mother and therapists Greenspan, 2003).

The question is not whether children with emotional development and embracing all de- autism can play, but what challenges might velopmental capacities. Development has its get in the way and how to strengthen and in- own time table and so does symbolic develop- crease the child’s abilities for pretense. There ment, so it is important to support all forms may be deficits in developmental capacities or and levels of symbolizing as the child devel- individual differences in sensory motor pro- ops. Symbolic function includes play, as well cessing that can be treated, such as auditory as conversations, drama, art, music, dance, processing or praxis. But clinical and research and movement. Furthermore, it is not possi- evidence confirms that parent–child interac- ble to discuss play and symbolism without also tions are important for progress, and symbolic recognizing their role in the development of play provides the essential interventions to de- language, narrative, and literacy. Play offers velop emotional, social, and abstract thinking the opportunity to create ideas and stories, capacities. It is important to understand all interacting with others. This sets the founda- children from the point of view of emotional tion for understanding history and literature, and developmental levels. as well as for playing and working with peers. In all its forms, symbolic play offers a safe CONCLUSION way to practice, reenact, understand, and master the full range of emotional ideas, experi- “If you want your children to be intelligent, ences, and feelings. It provides distance from read them fairy tales. If you want them to be real life and immediate needs, so that children more intelligent, read them more fairy tales” can differentiate self from others (i.e., through (Albert Einstein, Library of Congress Blogs, different roles in play) and self from the envi- 2013). Perhaps Einstein was capturing the no- ronment(i.e.,notboundbytimeandspace). tion that fairy tales hold the magic for children The goal is to elevate feelings and impulses to to decipher their emotions and problems, the level of ideas and to express these through understand people representing different words and play, supporting emotional reg- views and feelings, and open their minds ulation and self-control. Through play, the to imagination, discovery, and intelligence. child develops abilities to transform reality Fairy tales are symbolic play tales, certainly into symbols or images that reflect their mean- not all happily-ever-after stories; rather, their ings and provide the opportunity to explore protagonists each find unique solutions for and differentiate the full range of emotions. In life’s unfolding challenges and victories. play, the child defines his emotions in his sto- In this article, I set out to describe the role ries, organizes the sequence, and determines of emotions in symbolic play for all children the outcomes. This abstract level of symbolic and to illuminate how play interactions with thinking leads to a differentiated sense of self parents or other partners reflect the child’s and others, bringing along capacities for em- ideas, concerns, feelings, and desires. Sym- pathy and reflection, and preparing the child bolic play is a powerful vehicle for supporting emotionally and intellectually for the future.

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