Pretend play in children with a congenital visual impairment

Stefano Federici¹Alessandra Bardin¹Camilla Borsini¹Elisa Delvecchio¹Alessandro Lepri¹Federica Morelli^2,3,4Ilaria Scognamillo²Elena Cocchi⁵Luca Santini⁵Sabrina Signorini^3*

• ¹Department of Philosophy, Social and Human Sciences and Education, University of Perugia, Perugia, Umbria, Italy
• ²Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Lombardy, Italy
• ³Developmental Neuro-Ophthalmology Unit, Neurological Institute Foundation Casimiro Mondino (IRCCS), Pavia, Italy
• ⁴Service des Troubles du Spectre de l'Autisme et apparentés, Département de psychiatrie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Vaud, Switzerland
• ⁵David Chiossone Onlus, Genova, Italy

Background: Modern theories embrace a conception of pretend play as a behavior closely related to exploration, curiosity, and the affective domain, as well as problem solving and creative thinking. Although a widely studied construct, pretend play in children with a visual impairment has received little research attention. Objective: This study examined the influence of congenital visual impairments on symbolic skills by comparing differences in pretend play between 31 children (aged 3 to 9 years) with moderate to severe visual impairment or blindness with typically developing peers. Methods: The Affect in Play Scale was used as a measure of pretend play. A storytelling task, a parent-reported questionnaire, and the Emotion Regulation Checklist were used to examine the relationships between pretend play, creativity, and emotion regulation in both groups. Results: Results indicated that typically developing children demonstrated higher pretend play skills than their blind and visually impaired peers (p < .001), but there was no correlation between severity of impairment and play skills. Storytelling skills also appeared to be impaired in the population of children with blindness/visual impairment (p < .05), suggesting a link between pretend play and creativity. The data also showed a trend of negative correlation between emotion dysregulation and pretend play and storytelling performance in the visually impaired group, emphasizing that greater dysregulation was associated with lower pretend play skills. Conclusions: Our study has highlighted the importance of focusing a rehabilitation pathway on improving pretend play skills in the context of visual impairment to promote the development of the individual, supporting both cognitive and emotional dimensions.