Do you want to build a snowman?

The role of outdoor play in pediatric occupational therapy.

Presented by:Kimberly Wilkinson, PhD, OTR/LDepartment of Occupational TherapyIthaca College

Theories/Theorists of Play Surplus Energy Theory Recreation Theory Recapitulation Theory Modern Theories Psychodynamic Social Learning Cognitive Postmodern Piaget Vygotsky Bruner Brian Sutton Smith

Play as Occupation• Play is the primary occupation of children (AOTA,

2008).

• Play can be defined as an unstructured activity that is pleasurable intrinsically motivated, inspires imagination and is concerned with process rather than outcome (Alexander et al, 2014).

• As OT’s we have an obligation to be educated and well-informed regarding the different types of play children engage in and why this play is important or beneficial in relation to treatment or intervention.

Benefits of Play Through play children develop their motor, creativity,

physical, cognitive, and social skills (Goldstein, 2012).

Children learn to interact with the world around them

(Ginsburg, 2007).

Play that is child driven allows for them to move at

their own pace, develop interests, and practice decision

making skills (Ginsburg, 2007)

Benefits Cont.Enhances muscle growth and supports vital functions

(Clements, 2004)

Cognitive skills-development of abstract thinking,

practice generalization of knowledge to new

environments

Mental Health?

International Play Association

UN Article 31 Child’s Right to Play

https://www.youtube.com/watch?v=5tjRPWPhIfA

Outdoor Play-Benefits

Kids playing outdoors are more activePhysical benefits of activityPlay in natural areas sparks more interest than typical playground equipmentProvides endless variation

Historical Aspects

Literature-Clear evidence that children play outside less than previous generations.

Play is more structured and more frequently supervised by adults.

“Screen time” is increasing.

Changes in Children’s Play: A Global Concern

Trend toward lifestyles that lead to increases in non-communicable disease.

Childhood obesity and inactivity increasing in prevalence

Proportion of children meeting physical activity guidelines is very low and likely declining

“The decreased opportunity for, and prioritization of, childhood healthy active living and active outdoor play has been positioned as a child rights concern.” (Trembly et al., 2015)

WHO Commission on Ending Childhood Obesity

OT needs to be part of these conversations

Media/Current Cultural Climate Safety concerns and fear of injury are popular topics seen in

the media in North America (Staempfli, 2008).

Legal and litigation issues are making parents afraid of letting their children play freely (Staempfli, 2008)

“How to parent like a German” (Zaske, 2014)

Parenting blogs: Timbernook Blog: Balanced and Barefoot-“Why Children Fidget and What You Can Do About It” (2014)

Public Discussion-OT

Timbernook Blog and Book by Angela Hanscom, MOT, OTR/Lhttp://www.balancedandbarefoot.com/blog/why-kids-are-getting-more-aggressive-on-the-playground

International Journal of Environmental Research and Public Health—Position Statement 2015

“Access to active play in nature and outdoors—with its risks– is essential for healthy child development. We recommend increasing children’s opportunities for self-directed play outdoors in all settings—at home, at school, in child care, the community and nature.” (Tremblay et al., 2015)

Position Statement

“With its risks…”Public and parental worries for all kidsStranger abductionChild elopementAccidents and Injuries--Falls-broken limbs Concussions and TBIshttps://www.health.ny.gov/prevention/injury_prevention/children/toolkits/childhood_fall/child_development_and_falls.htm

Weather exposure—rain, snow, sun

Risk vs. Danger vs. Hazard

Risk-e.g. climbing a tree

thrilling and exciting

challenges to ability (may fail)

Kids may need support to learn to take risks

DangerCarries significant risk of long-term damageMost injuries from outdoor play are minor

Hazard-e. g. rusty nailEnvironmental Kids need to be protected from to the best of our ability

Are kids safer indoors?

Risks from internet exposure-Cyber-Bullying, Predators, etc. Exposure to advertisementsReduced physical activityIndoor falls and accidentsHazards of indoor air

Research Problem

There is significant literature claiming benefits from unstructured play (Goldstein, 2012; Ginsburg, 2007; Bodroya & Leong, 1996; Clements, 2004; Blaut, 1970) and detailing why unstructured play may not be occurring in the current cultural climate (Staempfli, 2008; Valentine & McKendrink, 1997; Zaske, 2014).

However, there is very little literature that specifically describes what children are currently doing when engaged in unstructured play time and what the benefits of current play practices might be.

Purpose

The purpose of this study was to explore and document the play of selected 4-6 year old children with a particular focus on unstructured play time. Of particular interest is where opportunities for this kind of play occur and how this play supports developmental skill of the children involved.

Rationale and Significance

Examples of play in different environments

OT lens: Links to sensory experiences and

developmental gains

Treatment planning

Typical playground

Natural environment

Home environment

Playgrounds and Play Spaces

Methodology We used ethnographic methods to collect

focused, naturalistic observations of children at play. (Angrosino & Rosenberg, 2011)

Careful, systematic observations of daily life

Cultural world of children

Narratives of children and their parents

Methodology Participants: 3 families with a child between the ages of 4-6 Recruitment: Flyers and posts in online forums Data collection: Video recordings

30 minutes of playNatural play environment

Data Analysis Field notes during and after the video sessions Transcribed verbatim speech of the first video Transcribed action of all videos Transcribed verbatim speech of parent interview Narrative analysis (chaptering) Thematic analysis Created rich descriptions of children's play and analyzed for: types of

play scene, motor aspects, learning what children play with, who they play with, what their parents role is in play, sensory aspects of play, what play looks like in different environments, social emotional implications of free unstructured play

Example of Transcript and Action Analysis

Family 1

Focal Child: MadiAge: 4 Play Partner: Olive-twin sister

Family 2

Focal Child: BraelynAge: 6Play partner: Nina-older sister

Family 3

Focal Child: KeeganAge: 5Play Partner:

Noah-Younger brotherXena- CousinKelly- Mother

ResultsThree initial themes:1. Learning (the work of play)2. Snow Play3. Risky Play

Learning (the work of play)Subthemes

Motor Skill

Body mapping/motor planning

Social Experimentation

Cognitive Skills

Affordances of a snowy play environmentSafetyCushioningCreativityExperiment

Increased demands of a snowy play environment Postural

Control

Praxis and Motor Planning

Movement in bulky clothing

Sensory

Resistance

Risky Play Exhilaration

Overcoming fears

Rough and Tumble

Social Experimentation

Long term benefits of dealing with fears, anxieties, risks of life

Benefits of “Risky Play”Builds confidenceAutonomyResilienceFrustration toleranceProblem solvingSelf awarenessTrust of self and abilities

Discussion Unstructured play continues to be an important

occupation for children. Outdoor play provides a rich sensory experience. The benefits of free play and risky play are easily

related to OT goals. Snow play affords many opportunities for OT. Helping children with special needs access these

benefits should be paramount to OT practice as it will create ongoing opportunity for development.

General Recommendations for OT

Knowledge and research about play should help guide intervention planning Facilitating unstructured free play during therapy

both in and outdoors can be an appropriate role for OT’s. Advocate for more play spaces to be built that allow

unstructured free play We must advocate for children with disabilities to

have greater opportunities to engage in free play in a variety of play environments.

Strategies—Early Intervention•Take kids outdoors

•Model activities that work on children’s goals in a natural outdoor space

•Support parents in finding time and places to play outside

•Share benefits with parents and child-care workers

•Discuss risk and its benefits

•Work with child-care centers to increase outdoor time and create spaces that allow for free play in natural spaces.

•Advocate for outdoor play even in “inclement” weather. Help parents learn to dress kids (and themselves) appropriately for weather conditions.

Strategies for Pre-schoolTake kids outdoorsModel facilitation of outdoor play for kids of all levels of abilityWork with teachers and administrators to create natural play spacesOffer inservices on benefits of free play, loose parts play, adventure-play, Share resources with teachers, parents, and administrators. Consider a “pop-up adventure playground” day or a “Loose Parts Play Week” so parents and professionals can see the benefits for themselves.Advocate for mess and risk.

Strategies—School Aged KidsTake kids outdoors

Go to recess, talk to the workers responsible for supervising recess time.

Offer trainings to teachers, aids, administrators that focus on the benefits of play, allowing risk vs. danger.

Partner with parks and nature-related organizations to bring “nature” to the school or take advantage of the nature that’s already there.

Advocate for opportunities for children to participate in the creation of their own play places.

AdvocacyJoin play organizations International Society for Play US Play Coalition http://usplaycoalition.org/play-conference:2016

Go to conferences

Talk about play to anyone who will listen. This is important stuff and we owe it to the kids we work with.

AOTAhttp://www.aota.org/practice/children-youth/play.aspx

Benefits of play

Recess advocacy

Limitations of the Study

Lack of diversity of subjects/locations Issues with scheduling and family

availability Observer effects Weather Short time-frame

Special Thanks to…

The three focal children and their wonderful families Former IC graduate students, Chris McCloskey,

Jules Doliscar, and Nicole Readie who collected data and did preliminary analysis. Current IC graduate student Stacy Ward for

help with preparation of this presentation.

References and Resources1. NEW ARTICLE PUBLISHED DAY AFTER PRESENTATION: Recess is Not a Privilege http://www.huffingtonpost.com/laura-hanby-hudgens/recess-is-not-a-privilege_b_8505720.html

2. Position Statement on Active Outdoor Play-Great resource! http://www.participaction.com/wp-content/uploads/2015/03/EN-Active-Outdoor-Play-Position-Statement-FINAL-DESIGN.pdf

3. AOTA Resources: ◦ a. PowerPoint Presentation for Consumers - Role of OT in Recess: An

Important School Routine http://www.aota.org/-/media/Corporate/Files/Secure/Practice/Children/PowerPoint%20Role%20of%20OT%20in%20Recess.pdf

◦ b. Recess Promotion Fact Sheet http://www.aota.org/-/media/Corporate/Files/Practice/Children/SchoolMHToolkit/Recess%20Promotion.pdf