Importance: Play is the primary occupation in childhood and fundamental to occupational therapy practice.

Objective: To evaluate a play intervention in special school settings.

Design: Pre- and postinvolvement of a 7-mo play program.

Setting: Four special schools in Victoria, Australia, for children with IQs < 70.

Participants: Thirty-eight children with diagnoses including intellectual disability, autism, and global developmental delay, 7 teachers, 2 speech pathologists, and 2 occupational therapists.

Intervention: Learn to Play Therapy for 1 hr per week over a 7-mo period.

Outcomes and Measures: Pre–post outcome measures included children’s pretend play skills, language, social skills, emotional regulation, and academic competence.

Results: Mean age of 38 children (15 girls and 23 boys) at baseline was 5 yr 7 mo (SD = 0.46 yr). Results showed significant changes in children’s pretend play (p = .03), ability to recall sentences (p = .02), social skills (p = .022), and academic competence (p = .012). Learn to Play had a large effect on children’s narrative skills (d = 2.72). At follow-up, object substitution at baseline influenced expressive language (p < .001), narrative mean language utterance (MLU; p = .015), social skills (p < .001), and academic competence (p < .001); elaborate play at baseline plus time influenced social skills (p < .001); and elaborate play at baseline influenced narrative MLU (p =. 016), sentence recall (p = .009), and academic competence (p = .001).

Conclusions and Relevance: Embedding pretend play within practice positively influenced children’s language, narrative, social, and academic skills.

Plain-Language Summary: This study adds to the limited research on play-based therapy programs in special school settings for children with an IQ of less than 70. Children participated in Learn to Play Therapy, during which an occupational therapist, who has observed and assessed the child’s play and understands the child’s play abilities, played beside the child. Learn to Play Therapy is a child-centered therapy that is used to increase a child’s ability to self-initiate and enjoy pretend play. The positive impacts of supporting the children’s pretend play ability were highlighted by increases in their pretend play, language, social skills, academic competence, and narrative language after participating in Learn to Play Therapy in their special schools.

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