# What evidence-based therapy approaches build Play Skills in early childhood?

Canonical: https://pinnacleblooms.org/ask/what-evidence-based-therapy-approaches-build-play-skills-in-early-childhood
Publisher: Pinnacle Blooms Network / Bharath Healthcare Laboratories Private Limited

Play skills in early childhood are best built through naturalistic developmental behavioural interventions (NDBIs) — child-led, play-embedded approaches such as JASPER, the Early Start Denver Model and Pivotal Response Treatment, plus DIR/Floortime and play-based occupational therapy, all supported by systematic reviews. AbilityScore® is part of Pinnacle’s developmental assessment. Diagnosis, where needed, requires an appropriately qualified healthcare professional.

*Play is the work of childhood — and for children who find it hard, the right approaches turn isolated, repetitive activity into shared, joyful learning.*

## In short
The strongest evidence base for building play skills in early childhood comes from **naturalistic developmental behavioural interventions (NDBIs)** — child-led, play-embedded teaching delivered in everyday routines. Approaches such as JASPER, the Early Start Denver Model and Pivotal Response Treatment, alongside DIR/Floortime and play-based occupational therapy, are supported by systematic reviews for advancing object play, symbolic play and joint attention. Selection is matched to the child's developmental profile, not the diagnosis alone.

## The science
- **JASPER** (Joint Attention, Symbolic Play, Engagement and Regulation) — manualised, RCT-supported; directly targets play diversity, sequencing and shared engagement.
- **Early Start Denver Model (ESDM)** — an NDBI fusing developmental and ABA principles within natural play; trial evidence for play and social-communication gains in toddlers.
- **Pivotal Response Treatment (PRT)** — uses child choice, natural reinforcement and turn-taking to expand spontaneous, motivated play.
- **DIR/Floortime** — follows the child's lead through affect-based interaction to climb the developmental ladder of two-way play and symbolic thinking.
- **Occupational and play-based therapy** — addresses the sensory, motor and praxis foundations that underpin exploratory and pretend play.

Common active ingredients across these models: following the child's lead, embedding goals in motivating routines, scaffolding the next developmental step, and high rates of responsive adult contingency.

## When to refer
Refer for a developmental check where a child shows little spontaneous or pretend play, limited joint attention, repetitive object use, or play that is not progressing in complexity with age — particularly alongside social-communication concerns.

## The Pinnacle way
Developmental measurement supports care planning; diagnosis requires an appropriately qualified healthcare professional., under qualified clinician care — never from an app or form. A clinician-administered structured assessment profiles a child's [play skills](/play-skills) across object, social and symbolic domains, then matches an NDBI-aligned plan delivered through [play-based developmental therapy](/play-therapy) and our [AbilityScore® assessment](/ask/what-is-the-abilityscore-and-how-is-it-calculated).

## Trusted sources
WHO and CDC developmental milestone guidance; ASHA guidance on naturalistic social-communication intervention; Cochrane reviews of early intervention for autistic children; AAP developmental surveillance guidance.

**Next step —** Partner with us to build a play-skills programme for your caseload. [Connect with a Pinnacle clinical team](/play-therapy).

This is general information, not a diagnosis — individual assessment and diagnosis require an appropriately qualified healthcare professional.

## Sources
- ASHA — naturalistic social-communication intervention guidance: https://www.asha.org
- Cochrane — early intervention reviews for autistic children: https://www.cochrane.org
- CDC — developmental milestones and play: https://www.cdc.gov
- AAP — developmental surveillance guidance: https://www.aap.org

## Connected topics and perspectives
- Abilities: https://pinnacleblooms.org/ask/abilities
- Therapist: https://pinnacleblooms.org/ask/lens/stakeholder/therapist
- Social: https://pinnacleblooms.org/ask/lens/domain/social
- Support: https://pinnacleblooms.org/ask/lens/intent/support
- Act: https://pinnacleblooms.org/ask/lens/lifecycle/act
- Behaviour Therapy: https://pinnacleblooms.org/ask/lens/route/behaviour-therapy
- Family Empowerment: https://pinnacleblooms.org/ask/lens/empowerment/family_empowerment

## Related question paths

### Understand the subject
- Play Skills: Developmental Meaning and Clinical Significance: https://pinnacleblooms.org/ask/what-does-play-skills-represent-developmentally-and-when-is-a-delay-in-it-clinically-significant
- What is Play Skills in child development?: https://pinnacleblooms.org/ask/what-is-play-skills-in-child-development
- ICF Functioning Domain for Play Skills in Early Childhood: https://pinnacleblooms.org/ask/which-icf-functioning-domain-does-play-skills-map-to-in-early-childhood

### Recognise signs & concerns
- What Does a Delay in Play Skills Mean for My Child?: https://pinnacleblooms.org/ask/what-does-a-delay-in-play-skills-mean-for-my-child

### Understand assessment
- How is Play Skills measured and progress-tracked within a therapy plan?: https://pinnacleblooms.org/ask/how-is-play-skills-measured-and-progress-tracked-within-a-therapy-plan
- How is Play Skills assessed?: https://pinnacleblooms.org/ask/how-is-play-skills-assessed
- How Play Skills Are Defined and Measured in Early Childhood Research: https://pinnacleblooms.org/ask/how-is-play-skills-defined-and-measured-as-a-developmental-construct-in-early-childhood-research
- How is Play Skills scored on the AbilityScore?: https://pinnacleblooms.org/ask/how-is-play-skills-scored-on-the-abilityscore
- Amber Zone for Play Skills — What It Means: https://pinnacleblooms.org/ask/my-child-is-in-the-amber-zone-for-play-skills-what-does-that-mean
- Green Zone for Play Skills — What It Means: https://pinnacleblooms.org/ask/my-child-is-in-the-green-zone-for-play-skills-what-does-that-mean
- My child is in the red zone for Play Skills — what does that mean?: https://pinnacleblooms.org/ask/my-child-is-in-the-red-zone-for-play-skills-what-does-that-mean
- What does a Play Skills AbilityScore of 0–100 mean for my child?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-0-100-in-play-skills-mean-for-my-child
- What does an AbilityScore of 100–200 in Play Skills mean for my child?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-100-200-in-play-skills-mean-for-my-child
- What does an AbilityScore of 200–300 in Play Skills mean for my child?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-200-300-in-play-skills-mean-for-my-child
- What does an AbilityScore of 300–400 in Play Skills mean for my child?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-300-400-in-play-skills-mean-for-my-child
- What does an AbilityScore of 400–500 in Play Skills mean for my child?: https://pinnacleblooms.org/ask/what-does-an-abilityscore-of-400-500-in-play-skills-mean-for-my-child

### Explore therapy & support
- Building Play Through Evidence-Based Therapy: https://pinnacleblooms.org/ask/what-evidence-based-therapy-approaches-build-play-in-early-childhood
- Evidence-based therapy approaches for Play & Imagination: https://pinnacleblooms.org/ask/what-evidence-based-therapy-approaches-build-play-and-imagination-in-early-childhood
- Evidence-based therapy approaches that build pretend-play: https://pinnacleblooms.org/ask/what-evidence-based-therapy-approaches-build-pretend-play-in-early-childhood
- Evidence-Based Approaches to Building Social Skills Early: https://pinnacleblooms.org/ask/what-evidence-based-therapy-approaches-build-social-skills-in-early-childhood
- Evidence-Based Therapy for Early Social Development: https://pinnacleblooms.org/ask/what-evidence-based-therapy-approaches-build-social-development-in-early-childhood
- What evidence-based therapy approaches build socialisation in early childhood?: https://pinnacleblooms.org/ask/what-evidence-based-therapy-approaches-build-socialization-in-early-childhood
- How should a therapist prioritise a child in the amber zone for Play Skills?: https://pinnacleblooms.org/ask/how-should-a-therapist-prioritise-a-child-who-is-in-the-amber-zone-for-play-skills
- How to Prioritise a Green-Zone Play Skills Child: https://pinnacleblooms.org/ask/how-should-a-therapist-prioritise-a-child-who-is-in-the-green-zone-for-play-skills
- How should a therapist prioritise a child in the red zone for Play Skills?: https://pinnacleblooms.org/ask/how-should-a-therapist-prioritise-a-child-who-is-in-the-red-zone-for-play-skills
- Play Skills Amber Zone — Your Next Steps: https://pinnacleblooms.org/ask/my-child-is-in-the-amber-zone-for-play-skills-what-should-we-do-next
- Play Skills in the Green Zone — What to Do Next: https://pinnacleblooms.org/ask/my-child-is-in-the-green-zone-for-play-skills-what-should-we-do-next
- Play Skills red zone — your next steps: https://pinnacleblooms.org/ask/my-child-is-in-the-red-zone-for-play-skills-what-should-we-do-next

### At home & in everyday life
- How can I support my child's Play Skills?: https://pinnacleblooms.org/ask/how-can-i-support-my-child-s-play-skills
- How Therapy Improves Your Child's Play Skills: https://pinnacleblooms.org/ask/how-can-therapy-improve-my-child-s-play-skills
- What simple daily activities help build a child's Play Skills?: https://pinnacleblooms.org/ask/what-simple-daily-activities-help-build-a-child-s-play-skills