November 2002

Play Time

By Ruth Segal, PhD, OTR; Angela Mandich, PhD, OT (reg); Helene Polatajko, PhD, OT (reg); and Joanne Valiant cook, PhD, OT (reg)

Schoolchildren with special needs often receive help through the public school system and, as a result, the interventions are often focused around the children’s academic needs. This focus on academic needs may come at the expense of other important aspects of children’s lives, in particular, their social lives.

SOCIAL EFFECTS OF DEVELOPMENTAL DELAY

Developmental coordination disorder (DCD) affects about 6% of children between the ages of 5 and 11.¹ The symptoms include marked delays in achieving milestones of motor development, dropping things, clumsiness, poor performance in sports, or poor handwriting. If any of these symptoms interfere with a child’s performance of daily activities, a diagnosis is warranted.¹ Observations of school-aged children with DCD during organized and free play show that they spend less time in formal and informal team play than children without this disorder.²

Physical activity play, both free and team play, is important for the social life of children.^3-5 Pellegrini⁵ indicates that exercise play (ie, gross locomotor movement in the context of play) seems to increase in the late preschool years and peak during primary school years.

In his longitudinal qualitative and quantitative study of British children’s experiences during break time, Blatchford³ describes how friendships develop in conjunction with physical activity play when children begin their first year in school at the age of 7. He states that at the beginning of the year, students play during break time with different groups of children and in various physical play activities. However, as the year progresses, the play groups become more stable in the games played and in the children who belong to the groups. Blatchford³ concludes that “games are a main medium through which groups come together and friendships are formed.” Additionally, rough and tumble seems to have the social function of establishing and maintaining dominance relationships among boys.^4-6

PHYSICAL PLAY=SOCIAL LIFE

Physical activity play is important for the social life of children in terms of acquiring and maintaining friends and belonging to peer groups.³ Such activities may be difficult for children with motor coordination problems to master and this difficulty appears to reduce their participation.²

In our study, parents of children with DCD explained that their children’s inability to participate in physical activity play contributed to their social isolation. One mother said that her son’s social group was much smaller compared to the social groups of his typically developing siblings. Other mothers described how their children could be identified on the playground from a distance because they were never moving or playing on any of the equipment. Rather, their children were usually just sitting in the sand. Several more mothers described how peers excluded their children from physical activity games during recess because they knew that the children with DCD are unable to perform these activities.

The new International Classification of Functioning, Disability and Health⁷ presents a framework for organizing and describing human functioning and its restrictions. The current final draft of this framework consists of two parts: functioning and disability and contextual factors. Each of these parts consists of two components.

Functioning and disability consists of (a) body functions and structures, and (b) activities and participation. Contextual factors consist of (a) environmental factors and (b) personal factors. This framework is based on the concept that impairment, which is defined as problems in body function or structure, may impact an individual’s ability to perform activities and to fully participate in life.⁷ The manner and the extent of the impact on an individual’s activities and participation depend on the impairment, individual characteristics, and social context.

Parents’ descriptions of the social impact of their children’s DCD indicate that children’s impaired performance of physical activities in the context of play in middle childhood may lead to participation restriction. These restrictions are the results of interactions between impaired function (impaired motor performance), the physical features of the environment (physical activity play), and the social and attitudinal world (the way social groups and friendship evolve in middle childhood).

Accepting peer groups (ie, social environment) and skill enhancement were factors parents identified as mitigating the restrictions on participation. One mother shared a story where peers wanted the child with DCD to join their tag game during recess. The child’s inability to run fast enough was mitigated by a friend who could run very fast and liked being “it” (the one being chased) in the game. Whenever the child with DCD was caught and became “it,” this friend would come close to him and run slowly enough to be caught.

OT INTERVENTIONS

Perhaps the most significant findings of this study related to the occupational therapy interventions. In the clinic, the children set their own goals, eg, they chose the occupation or the activity that they wanted to work on in the therapy. The children usually selected physical activities or occupations such as throwing a ball, going down the fire pole, or riding bicycles. Children with DCD who had the opportunity to master the performance of a desired activity or occupation in a safe environment took advantage of this opportunity. Parents reported that the effects of mastering such new activities and occupations were an increase in the size of the children’s social group and they became more adventurous in going to visit friends while riding their bicycles.

These findings indicate an important direction for further research in the area of the effectiveness of occupational therapy interventions. Research needs to evaluate whether and how interventions are effective in the natural environment of therapy recipients, and, in particular, how and to what extent they increase their social inclusion in peer groups. That is, rather than directing interventions at “fine and/or gross motor skills” in a molecular sense, we need to intervene at the level of children’s occupations.

In particular, for certain age groups, we need to focus on physical play activities in a holistic manner. Then we can assess efficacy in terms of questions like: Does mastering bicycle riding increase a child’s social circle and lead to increased participation in other play activities? In summary, it seems necessary to focus less on a particular impairment per se, and much more on occupation and participation within social contexts.

ACKNOWLEDGMENT

The findings on which this article is based were originally published in: Segal R, Mandich A, Polatajko H, Cook JV. Stigma and its management: a pilot study of parental perceptions of the experiences of children with developmental coordination disorder. Am J Occup Ther. 2002;56:422-428.

References

1. The Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994.
2. Smyth MM, Anderson HI. Coping with clumsiness in the school playground: social and physical play in children with coordination impairments. British Journal of Developmental Psychology. 2000;18:389B413.
3. Blatchford P. Social Life in School: Pupils’ Experience of Breaktime and Recess from 7 to 16 Years. Bristol, Pa: The Palmer Press; 1998:82.
4. Humphreys AP, Smith PK. Rough-and-tumble play, friendship, and dominance in school children: evidence of continuity and change with age. Child Development. 1987;58:201-212.
5. Pellegrini AD. School Recess and Playground Behavior: Educational and Developmental Role. Albany, NY: State University of New York Press; 1995.
6. Pellegrini AD, Smith PK. Physical activity play: the nature and function of a neglected aspect of play. Child Development. 1998;69:577–598.
7. World Health Organization. International Classification of Functioning, Disability and Health. Available at: www3.who.int/icf/icftemplate.cfm. Accessed September 26, 2002.

Ruth Segal, PhD, OTR, is assistant professor in the Department of Occupational Therapy, New York University, New York.

Angela Mandich, PhD, OT (reg), is assistant professor, School of Occupational Therapy, University of Western Ontario, London, Canada.

Helene Polatajko, PhD, OT (reg), is professor and chair, Department of Occupational Therapy, University of Toronto.

Joanne Valiant Cook, PhD, OT (reg), is associate professor, School of Occupational Therapy, University of Western Ontario.

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