Analysis of play in children aged 2 to 4 with developmental language disorder

Viana, Júlia França; Benfica, Tainá Rossato; Siquara, Gustavo Marcelino; Souza, Ana Paula Ramos de

doi:10.1590/2317-1782/e20240098pt

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Original Article • CoDAS 38 (2) • 2026 • https://doi.org/10.1590/2317-1782/e20240098en linkcopy

Analysis of play in children aged 2 to 4 with developmental language disorder

Authorship SCIMAGO INSTITUTIONS RANKINGS

Purpose To analyze playing in children aged two to four years and eleven months with Developmental Language Disorder (DLD), and to investigate correlations between play, development dimensions, and the variables maternal education, family income and gestational age.

Methods This is quantitative, cross-sectional research, with 37 children aged between two and four years and eleven months, diagnosed by speech therapists with DLD. This diagnosis was confirmed using two instruments: the Labyrinth Scale which allows a differential assessment between DLD and Autism Spectrum Disorder (ASD) and the Dimensional Inventory of Child Development (IDADI) wich allows confirmation of language development delay, as well as assessment of other dimensions of child development. Play was assessed by analyzing the filming of the interaction between the child and the researcher during the collection of the Labyrinth Scale, considering expected levels for chronological age from two to five years. Based on the identified categories, descriptive and statistical analyses were performed on the variables maternal education, gestational age and family income.

Results Most children presented a delay of one level or more in play development, accompanied by a significant delay in expressive language. There was a statistical association between play and the fine motor dimension of child development.

Conclusion Children with DLD showed delay in play, and better development in play was positively associated with better performance in fine motor skills, suggesting its relevance as a space for cognitive development and subjectivation.

Keywords:
Games and Toys; Child Development; Socioeconomic Factors; Developmental Language Disorder; Gestational Age

Subscales	Cutoff score indicative of ASD
Social Interaction (SI)	≥3
Verbal Communication (VC)	≥4
Nonverbal Communication (NVC)	≥2
Rigid Behavior and Repetitive Gestures (RBRG)	≥4
Total Score	≥12

Expected age range	Level of Play
4 to 6 months	Sensorimotor exploration of objects and toys by putting them in the mouth, banging them, etc.
9 to 12 months	Explores the functioning of toys through simple intentional actions, such as rolling a ball, knocking down a tower, and action–reaction games.
12 months	Simple combination of toys.
18 to 24 months	Begins to play by reproducing everyday actions, displaying pre-symbolic behavior. Performs these actions on themselves and on dolls. Masters combined play with toys.
24 to 36 months	Masters pre-symbolic activities and begins to reach the symbolic level with simple narratives of thematic scenes.
36 to 59 months	Established symbolism with greater fantasy and dramatization.
60 months ahead	Board games with established rules played in groups.

Person	Age	Classification of play considering age group	Play Description	Receptive Communication and Language IDADI	Expressive Communication and Language IDADI
1	3y5m	Appropriate for the age range	Symbolic – dramatization present using language.	Typical	Significant delay
2	3y	Delayed by one level	Pre-symbolic – physical combination.	Delay alert	Significant delay
3	2y11m	Delayed by one level	Pre-symbolic –conventional combinations.	Delay alert	Significant delay
4	2y11m	Delayed by one level	Pre-symbolic – self-directed pretend play.	Delay	Significant delay
5	4y9m	Delayed by two levels or more	Combinatory play – presentation combination.	Significant delay	Significant delay
6	3y11m	Appropriate for the age range	Symbolic – dramatization without language.	Typical	Significant delay
7	3y10m	Appropriate for the age range	Symbolic – dramatization present using language.	Delay	Significant delay
8	3y10m	Delayed by one level	Pre-symbolic – child as agent.	Delay	Significant delay
9	3y10m	Delayed by one level	Pre-symbolic – conventional combinations.	Delay	Significant delay
10	3y4m	Delayed by one level	Pre-symbolic – child as agent.	Delay	Significant delay
11	4y6m	Delayed by one level	Pre-symbolic – child as agent.	Delay	Typical
12	4y1m	Delayed by two levels or more	Pre-symbolic – child as agent.	Significant delay	Significant delay
13	3y	Delayed by two levels or more	Simple play – cause and effect.	Delay	Significant delay
14	3y9m	Delayed by one level	Pre-symbolic – child as agent.	Typical	Significant delay
15	3y9m	Delayed by one level	Pre-symbolic – child as agent.	Typical	Delay alert
16	2y	Delayed by one level	Pre-symbolic – child as agent.	Significant delay	Significant delay
17	3y8m	Delayed by one level	Simple play – cause and effect.	Delay alert	Delay alert
18	2y8m	Appropriate for the age range	Symbolic – multi-scheme sequence.	Typical	Significant delay
19	3y11m	Delayed by two levels or more	Simple play – cause and effect.	Significant delay	Significant delay
20	3y1m	Delayed by one level	Pre-symbolic play - pretending to be self-directed	Typical	Significant delay
21	3y8m	Delayed by one level	Pre-symbolic – child as agent.	Significant delay	Significant delay
22	3y1m	Delayed by one level	Pre-symbolic – child as agent.	Delay	Delay
23	2y4m	Delayed by one level	Combinatory play – presentation combination.	Typical	Significant delay
24	2y	Delayed by two levels or more	Simple play – cause and effect.	Typical	Delay alert
25	2y	Delayed by one level	Simple play – cause and effect.	Delay alert	Delay
26	4y4m	Delayed by one level	Pre-symbolic – child as agent sublevel.	Significant delay	Significant delay
27	4y2m	Delayed by one level	Pre-symbolic – child as agent.	Significant delay	Significant delay
28	2y4m	Delayed by one level	Combinatory play – presentation combination.	Typical	Significant delay
29	4y4m	Delayed by one level	Pre-symbolic – child as agent.	Significant delay	Delay
30	2y9m	Delayed by one level	Pre-symbolic play - pretending to be self-directed	Typical	Significant delay
31	2y7m	Delayed by two levels or more	Combinatory play – presentation combination.	Typical	Significant delay
32	3y4m	Delayed by one level	Pre-symbolic – child as agent.	Typical	Delay alert
33	2y5m	Delayed by one level	Pre-symbolic – child as agent.	Typical	Significant delay
34	3y2m	Delayed by one level	Pre-symbolic play - pretending to be self-directed	Delay alert	Significant delay
35	2y11m	Delayed by one level	Pre-symbolic – child as agent.	Delay	Delay
36	2y4m	Appropriate for the age range	Pre-symbolic – child as agent.	Typical	Significant delay
37	3y7m	Delayed by one level	Pre-symbolic – child as agent.	Typical	Delay alert

	Categorization	Number (%)
Gestational Age	Less than 32 weeks	1 (3)
	32 to 36 weeks	27 (79)
	37 to 41 weeks	6 (18)
Maternal Education	Elementary Education	1 (2.6)
	High School	12 (31.5)
	Higher Education	25 (65.7)
Family Income	Up to 1 minimum wage	2 (7.6)
	Between 1 and 2 minimum wages	2 (7.6)
	Between 2 and 3 minimum wages	4 (15.3)
	Between 3 and 5 minimum wages	4 (15.3)
	Between 5 and 10 minimum wages	9 (34.6)
	More than 10 minimum wages	5 (19.2)

	Play classification		p-value
IDADI-Fine motor skills	Appropriate AR	Delay	0.035
IDADI-Fine motor skills	N(%)	N(%)
Typical	3 (60)	26 (78)
Delay alert	1 (20)	2 (6)
Delay	1 (20)	0 (0)
Significant delay	0 (0)	5 (15)
IDADI-Cognition			0.63
Typical	2 (40)	12 (36)
Delay alert	2 (40)	8 (24)
Delay	1 (20)	5 (15)
Significant delay	0 (0)	8 (24)
IDADI-Socioemotional			0.19
Typical	2 (40)	18 (54)
Delay alert	3 (60)	6 (18)
Delay	0 (0)	6 (18)
Significant delay	0 (0)	3 (9)
IDADI-Receptive communication and language			0.19
Typical	4 (80)	11 (33)
Delay alert	0 (0)	7 (21)
Delay	1 (20)	7 (21)
Significant delay	0 (0)	8 (24)
IDADI-Communication and expressive language			0.56
Typical	0(0)	1(3)
Delay alert	0(0)	5(15)
Delay	0(0)	4(12)
Significant delay	5 (100)	23 (69)
IDADI – Gross motor skills			0.61
Typical	5 (100)	24 (72)
Delay alert	0 (0)	4 (12)
Delay	0 (0)	3 (9)
Significant delay	0 (0)	2 (6)
IDADI – Adaptive behavior			0.91
Typical	3 (60)	19 (57)
Delay alert	1 (20)	6 (18)
Delay	1 (20)	5 (15)
Significant delay	0 (0)	3 (9)

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[1] Source: Pondé et al.(¹⁴)