Evidence-based therapy approaches that build pretend-play

Pretend-play is where a child rehearses the social, language and cognitive flexibility that underpins later learning — and it can be deliberately, evidence-informedly built.

In short

Symbolic and pretend-play is reliably built through developmentally sequenced, naturalistic approaches that embed adult scaffolding within child-led play. The strongest evidence supports Naturalistic Developmental Behavioural Interventions (NDBIs) — notably JASPER, which directly targets joint attention, symbol use and play diversity — alongside DIRFloortime-style affect-based engagement and structured peer-mediated play. These methods build pretend-play from functional object use toward sequenced, role-based and imaginative play.

The science

• JASPER (Joint Attention, Symbolic Play, Engagement and Regulation) — manualised, RCT-supported NDBI that scaffolds play acts along a developmental hierarchy (functional → symbolic → sequenced pretend), with measurable gains in spontaneous symbolic play and joint engagement.
• DIRFloortime / affect-based developmental approaches — follow the child's lead and use emotional engagement to expand circles of communication and elaborate imaginative themes.
• Naturalistic milieu and Enhanced Milieu Teaching — embed prompting, modelling and expansion of pretend acts within routines, supporting generalisation.
• Peer-mediated and adult-guided play — trained peers and graded scaffolding extend role-play and narrative complexity in inclusive settings.

Across approaches, the common active ingredients are following the child's interest, contingent imitation, graded prompting along a symbolic hierarchy, and explicit teaching of play schemes that generalise across partners and settings.

When to refer

Refer for a structured play and developmental profile when a child shows persistently restricted, repetitive or absent symbolic play relative to developmental age, limited joint attention, or play that does not progress beyond cause-and-effect manipulation.

The Pinnacle way

A clinical AbilityScore® and any diagnosis are formed only at a Pinnacle Blooms Network centre, under qualified clinician care — our clinician-administered structured assessment profiles where a child sits on the symbolic-play hierarchy and shapes targets. Explore how we build pretend-play in toddlers and our developmental and play-based therapy pathways.

Trusted sources

ASHA guidance on social communication and play-based intervention; AAP/HealthyChildren guidance on the role of play in development; WHO Nurturing Care Framework on responsive play.

Next step — Partner with a Pinnacle clinician to map a child's symbolic-play profile and intervention plan. Book a developmental play assessment.

This is general information, not a diagnosis — a clinical AbilityScore® and any diagnosis are formed only at a Pinnacle Blooms Network centre under qualified clinician care.