literature review on children's play

importance of play in early childhood

Curriculum Map

Introduction

Literature Review

NYS PreKindergarten Standards
Summative Assessments

Early childhood classrooms are a place for young children to learn, grow, build friendships and have fun. One way that children can do all of these things at once is through play. It is through play that children can learn about themselves, and their environment, as well as academic skills, such as math, science, reading, writing, and social studies. It is up to the teachers and other educators to set up the learning environment so that it is welcoming for the children to interact with one another while inquiring about the materials they are given. Through this process of hands-on play based learning, children can develop the skills necessary to succeed in school and their everyday lives if given the opportunities to explore.

Definition of Play

In terms of the early developmental aspects of children’s play, their social, emotional, cognitive, physical, language, and creative skills are all being developed through their play and exploration (Stegelin, 2005).Social interaction between children increases during constructive play. This type of play has several benefits for the children including; problem solving, using their imagination and creativity to learn, as well as cooperate with others (Stegelin, 2005).

The idea of children’s social play is an important aspect of learning in early childhood education. Through both solitary play and social play children develop self-control, problem solving strategies, language fluency in communication and cooperation, as well as an understanding of symbolic representation and social behavior (Stegelin, 2005). It is through play that children learn about their environment and themselves. They enhance their creativity and imagination and can even take on leadership roles. As children play, they learn how to get along with others, communicate with peers and how to solve problems. As a child interacts with other children their language skills develop and become stronger. Together they learn to explore, cooperate, take turns and share through play (Stegelin, 2005).

Ways Children Learn Through Play

When children play they are learning, imagining, and creating either on their own or with other children. The Social Play Continuum is put in place to support an assessment based on the observation and interaction among children (Broadhead, 2006). It also encourages educators to assess the child’s learning progression from social interaction to cooperation and at the same time linking developmental skills and cooperation.

Broadhead (2006) advocates educators to use observation, reflection and interaction among children to promote developmentally appropriate practice. The Social Play Continuum has four domains that show development from Associative Play meaning children playing by themselves but alongside other children, to Cooperative Play meaning children interacting and playing together (Broadhead, 2006). As these types of play amongst children increases, their language and actions become more complex as a result.

Sociodramatic play, also known as dramatic play, is a type of play that has been shown to develop necessary school readiness skills (Bredekamp, 2005). Some aspects of sociodramatic play include using creativity and imagination to invent games and involves using language and social interaction between children.

Benefits of Play for Young Children

Through the process of using “real” life experiences in their play, the children are coming to terms with their reality and making sense of life as they know it (Bhroin, 2007). Expressing this through art or play is important for the child’s emotional, cognitive and social development (Bhroin, 2007). This type of play also creates meaningful connections to the child’s life and gives them a way to express it. On an educational level the children are able to express experiences, thoughts, fears, dreams and ideas in a safe and fulfilling way, which in turn develops skills of self-expression and communication that will benefit them throughout their entire lives.

Most preschool curriculums include: letter, shape and sound recognition, forming patterns, and understanding how to put letters together to form words (Bredekamp, 2005). Studies have shown that dramatic play during the early years develops school readiness skills such as language and communication, cooperation, and literacy skills (Bredekamp, 2005).

Bredekamp (2005) discusses research that shows when children enter kindergarten with some prior knowledge about early literacy skills, like letter and sound recognition, they have an advantage over the other children who have not had any prior experiences learning literacy skills at learning to read. One way to include early literacy in play would be to turn a dramatic play center into a restaurant and include; menus, food signs, pads of paper and pencils so they children can “write” down the orders just like they see in real restaurants.

How to Incorporate Play in the Classroom

Warner (2008) said “Play changed from being activity-based to being more object-based.” Now instead of playing with toys that have multiple uses, such as building blocks, children now have computers, video games, and other toys that just make noise. Those types of toys are intended for a single purpose that includes no imagination or creativity for the child (Warner, 2008).

The educational toys or manipulatives that children play with should be chosen carefully depending on the age group. The toys should be able to challenge the children’s interests and abilities and should match the skill and ability level of the child without making them feel frustrated (Stegelin, 2005). Since both solitary and social play is important and necessary in a child’s development, toys should be able to foster both aspects of play. For example; a child can play alone with building blocks and in the process develop self-sufficiency and independence. At the same time, playing with the same building blocks with a group of children build social skills such as cooperation, sharing, and empathy for others (Stegelin, 2005).

By identifying how young children view play as a whole, it is important for us as educators to set up learning environments that encourage more meaningful play (Howard, Jenvey & Hill, 2006). Constructive play is a type of play that involves children using hands-on inquiry based learning, and exploring materials to invent and discover new ways of learning (Drew et al. 2008). Young children need a developmentally appropriate amount of time, and open-ended materials available to them to make this type of learning valuable to them (Drew et al. 2008). Constructive play should also be linked with other types of play in the classroom, such as dramatic play, and it should be connected to activities in the school’s curriculum for it to be more educational (Drew et al. 2008).

As educators, it is our job to provide children with opportunities to play with toys where they need to use their imaginations. That type of play is more beneficial than if children were to play with something that has only one purpose or meaning. A child learns best through their own interests and exploration of those interests. Educators need to find out the interests of their students and build a developmentally appropriate curriculum for that year around what the children are interested in.

Children need physical images of objects for them to be completely tuned into the activity. In order for children to be entirely engaged in learning they need some kinesthetic movement as well. From birth, children can benefit in many ways from movement. Along with movement, children need to have many opportunities with hands on learning through exploration and discovery. Young children also need to build communication skills and what better way to build these skills then to talk with other children in a dramatic play area. By doing this children learn one-to-one correspondence with objects and other children, and by communicating through play children gain social-emotional concepts that will follow them throughout their lives.

Bhroin, M. (2007). “A Slice of Life”: The Interrelationships among Art, Play and the “Real” Life of the Young Child. International Journal of Education & the Arts , 8 (16), 1-25.

Bredekamp, S. (2005). Play and School Readiness. Educational Perspectives , 38 (1), 18-26.

Broadhead, P. (2006). Developing an Understanding of Young Children’s Learning through Play: The Place of Observation, Interaction and Reflection. British Educational Research Journal , 32 (2), 191-207.

Drew, W. F., Christie, J., Johnson, J. E., Meckley, A. M., & Nell, M. L. (2008). Constructive Play: A Value-Added Strategy for Meeting Early Learning Standards. Young Children , 63 (4), 38-44.

Howard, J., Jenvey, V., & Hill, C. (2006). Children’s Categorisation of Play and Learning Based on Social Context. Early Child Development And Care , 176 (3-4), 379-393.

Stegelin, D. A. (2005). Making the Case for Play Policy: Research-Based Reasons to Support Play-Based Environments. Young Children , 60 (2), 76-85.

Warner, L. (2008). “You’re It!”: Thoughts on Play and Learning in Schools. Horace , 24 (2),

Literature Review on the Role of Outdoor Play in Children’s Learning

This literature view will disseminate the eminent viewpoints which surround outdoor play. A brief synopsis of the definition of outdoor play and its perceived importance in supporting children’s social development will be discussed parallel to a strong critical analysis of previous research. Other factors involved in the provision of outdoor play such as time and access to facilities, resources and employees’ perception and training in the outdoor environment will also be segmented according to their importance in outdoor play.

Recently, the government has placed an emphasis on outdoor play and its role in children’s learning with the formulation of the Early Years Foundation Stage (EYFS) (DfES, 2007) and more predominantly with the refinement of the EYFS (DfES,2012). Rivkin (1998) verbalises that one of the main advantages of using the outdoor environment is that it provides children with the space in which they can move without the constraints of internal environments and it has been described by some commentators as one of the most natural and powerful modes of learning for young children (Bilton, 2002). Bilton (2001) philsophises that children appear to love the outdoors, an phenomena which practitioners can sometimes overlook. This does seem to induce the question of whether practitioners’ perceptions have an effect on children’s experiences in the outdoors. Woonton (2006) expands on this sentiment as he claims that, if given the choice, children prefer to be outside for a large proportion of their time. The potential of the outdoor environment for supporting children’s learning is expressed in the current EYFS (DfES, 2012) which makes the point that in the outdoors childrens’ social relationships can be developed in an environment that offers scope for communication through the triad of action, movement and language. Furthermore, the deliberation in using the equipment and discussion and co-operation that comes through this puts children in certain situations where they can appreciate and respect the needs of others, which will help make them better people in the long term.

The authoritative Plowden Report (CACE, 1967) suggested that play is the main way of learning in the formative stage of a child’s life and that in play ‘…children gradually develop concepts of casual relationships, the power to discriminate, to make judgments, to analyse and to synthesise, to imagine and formulate’ (CACE, 1967, p193). Additionally, the Rumbold report (DfES,1990) makes the assertion that children need to talk, play and have primary, authentic learning experiences as these are all essential for a child’s progression in life and academic skills. All of these government reports seem to convey the need for outdoor play as vehicle to develop children holistically. Moyles (2005) identifies that children’s emotional and social understanding is facilitated through outdoor play in terms of the attributes that children display in it such as: confidence, co-operation, spirituality and solitude. Developing children’s confidence correlates to the diaspora of challenges which are provided in the outdoor environment that allow children to test themselves at their own level and make continuous progression. Vygotsky (1978) construes this as children working within the parameters of their Zone of Potential Development (ZPD) (Vygotsky, 1978). Furthermore, Wood and Attfield (2005) make a discursive analysis of the importance of the development of social skills and emotional literacy within play as it plays a part in developing children’s self-awareness, self-esteem and confidence all of which are facets which underpin effective learning (Roberts, 2002).

History of Outdoor play

Outdoor play is a key factor in a multitude of aspects of children’s basic development. Pioneers and proponents of nursery education such as Froebel (1887), MacMillian (1930) and Isaacs (1932) all argued that early years education should entail active engagement with the outdoors. Forbes (2004) defines the key contexts of play as physical, social and symbolic which help us to carry out observational and discourse analysis of children’s speech and actions. Piaget (1962) and Vygotsky (1978) viewed play as a way of amalgamating a child’s learning which helps them make sense of the world. Vygotsky (1978) emphasised the importance of social interaction with other participants engaged in play. The pertinence of movement and social interaction has been widely recognised by Vygotsky (1978), Wells (1987) and Trevarthen (1994) who see social interaction and communication in the foreground of a child’s development. These viewpoints concur Wood’s (1988) theory that children are novices and adults the experts, therefore children need the opportunity to experiment and discover new ideas. Bilton (1998)observes that the outdoor environment has the potential to offer life-size social interactions and dialogue where children can assume different roles and footings in conversations and establish appropriate tenors between themselves.

Forest schools

Forest Schools encourage children to go beyond the boundaries which they are normally faced with in a classroom environment (Doyle, 2006). Moyles (2007) extends this sentiment by advocating that practitioners still need to enhance their understanding of outdoor provision and that outdoor spaces still tend to be adult-built with lots of ‘stuff’ (Maynard and Waters, 2006). This illustrates the need for children to be actively involved in the planning and decision making processes of using the outdoors. Research on childrens’ play in kindergardens in Norway (Fjortoft, 2004) ascertained that children who experience wild and rough terrain with lots of undulated surfaces, with trees to climb and bushes to hide in, engaged more frequently in sustained collaborative play than in conventional play areas. This accurately summarises the ethos of forest schools of using the natural environment as a resource to facilitate a child’s development. Furthermore, the findings from Waller’s (2007) research, which examined the opportunities for social development when children were given the freedom to play in a natural environment, were in concordance with the sentiments expressed above.

Some researchers are of the disposition that the outdoor environment evokes a richer, more complex use of lexis within children. A primary function of playing with others is to develop language and interpersonal skills (Wood and Bennett, 1997) which collaborates with the concept of outdoor play as it allows children to play imaginatively with their peers. A study commissioned by the Foundation for Outdoor Adventure (Barrett and Greenway,1995) found that outdoor adventure experiences can enhance interpersonal relationships and improve socialisation as it facilities co-operation and group bonding among peers. An eminent report by OFSTED , Learning outside the classroom: How far should you go? (2008) evaluated the impact of learning outside found that when planned and implemented well, outdoor provision contributed significantly to improving pupils’ personal, social and emotional development. Furthermore, it is often the natural elements of the outdoors which are conductive to social development (Fjortoft, 2001) such as the slopes, vegetation and biodiversity.

Role of the Adult

With determining the role of the adult within the outdoor, Woods and Atfield (2005) suggest that it is to facilitate an environment which offers abundant opportunities for children to grow and progress. Ouvry (2003) argues that an adult should be as active as they are in an indoor environment to allow the children to harness as much as possible from the sessions. Others claim that to fully foster the use of the outdoors, children should be allowed to work autonomously in constructing things by choosing equipment from ‘sheds, baskets and boxes’ as ‘they will always use it more imaginatively than if we decide for them’ (Featherstone and Bayley, 2002). Bruce (1996) strongly indicates that both indoor and outdoor areas need to foster children’s creativity in developing their own play and that it should be set up for children to make their own decisions.

Moyles (2005) argues that the responsibility of the adult should be to provide real activities which children can perform in the outdoor environment that give them a chance to ask authentic questions, collaborate with their peers and the co-construction of ideas between children and adults. There are an innumerable amount of ways in which adults can model activities for children; such as contributing to the maintenance of the outdoor area. The role of the adult in modelling is fundamental to the Steiner method of education. One of the ideals of Steiner education is that the adult supports childrens’ positive social behaviours and their development of self-identity and self-esteem by involving children with the preservation and upkeep of the outdoor area (Oldfield, 2001). Some children become more confident outdoors, and express a willingness to play and interact with other children. Adults relate differently to children in the outdoor environment; Rivkin (1998) denotes that while inside children are expected to sit still and be quiet, whilst outside they have the freedom to engage in physical activity and express themselves. This means that they display overt behaviours without the risk of being disciplined (Bilton, 2002;Ouvry, 2003). Henniger (1985) studied pre-school childrens’ behavior in indoor and outdoor settings and found that the indoor environment may inhibit some children socially because of the limitation of space, floor covering and the limited noise levels.

Staff perception/training

Another notable variable which affects the use and implementation of the outdoor area is the personal educational philosophy of the Early years teacher, in particular their regard for the outdoor provision as a medium for learning and development. Moyles (2007) discusses why outdoor play may be limited in some early years settings, stating that it is due to fear of litigation and staff’s lack of expertise and experience of the outdoor environment (Maudsley, 2005). Moreover, a practitioner’s perception of the outdoors is very relevant to the experience which they will subsequently provide for children. Ouvry (2000) elaborates on this, suggesting that the desire and drive to make the changes necessary for children to go outside need to be present in order for children to fully experience the outdoors and many educators are unfortunately not enthusiastic about the merits of the outdoors. Furthermore, Waters (2006) describes some adults as bio-phobic, as they have an unnatural hate for the outdoors and will not entre it with pleasure. Moreover, this links to the adverse climatic conditions as it is the most unpredictable component of working in the outdoors, although children are used to the outside as a general learning environment and are less aware of the nuances than weather (Bilton, 1998). Therefore, it is only adults who are reticent in going outdoors in un-favourable weather. The forecasting of the weather can also be used as a highly effective learning tool for children to develop their geographical acumen (Bilton, 1998). Another extraneous variable, which has been proven to affect the experience children receive in the outdoor area is parents’ perception of using the outdoor environment. Parents need to see the tangible benefits and purpose of outdoor play, McMillan (1930) felt that if parents could watch their children engaging in outdoor play and if practitioners could interpret the play, explaining what their child is doing, then parents way be more agreeable towards outdoor provision (Bilton, 1998).

Throughout education, there is a varied and fragmented diaspora of play provision available within settings and the resources which are available for children to use. Dempsey and Frost (as cited in Pugh, 2001) highlight that materials and equipment which are provided for children strongly influence the type and quality of play they engage in, impacting further on children’s learning and development. This is in concordance with Whitbread (1996) who maintains the viewpoint that there needs to be a well-equipped environment to facilitate play. The current EYFS framework (DfES, 2012) argues that the outdoor environment is best when it is …’enhanced by an environment that is richly resourced with exciting play materials and open-ended flexible resources that can be adapted and used in different ways, according to the needs and interests of the individual children.’ (DfES, 2012, p3). Bruce and Meggitt (2002) extrapolate this having the duality of also meaning providing a well-resourced ‘outdoor’ area stating;’…the outdoor area needs to be available for most of the time…the outdoor area should complement the indoor, so that the children can spend all morning outside and have the same choices on offer.’ (Bruce and Meggitt, 2002, p.44).

Bilton (2001) points out that. even when provision of outdoor play is sufficiently resourced, the most engrossing indoor session will be abandoned by children mid session to seek stimuli outside; Bilton (2001) says this quantifies just how much children love the outdoors. Stephenson (2002) clearly agrees with this and further provides the justification for this is that practitioners are less restricted by routines in the outdoor environment, with fewer distractions; therefore to the child , the adult may appear more approachable.The way that the outdoor environment is equipped is essential, as it is central to the way in which play is allowed to propagate and flourish (Abbott and Nutbrown, 2001). Esbenson (1987) advises that the outdoor environment should be zoned to facilitate children’s diverse interests, some zones would contain climbing apparatus, others social interaction and sections for sensory or socio-dramatic play. Moyles (2007) suggests that there is a prevalent within the UK that we should ‘mirror the provision indoors to that outdoors’ which has led to books, puzzles, pencils and construction used abundant in the outdoors. This strongly supports Dowling (2010) who expresses the viewpoint that what is offered indoors should complement what is happening in the outdoors. However, it could be argued that these are outdoor materials and that outdoors should be disjoint from the indoor environment. Therefore, Moyles (2007) says that it is not enough just to go outside because many of the outdoor environments set up for children are synthetic and artificial. Warden (2007) discusses that some adults’ perception of resources is that materials which are designed by adults have a greater value, however, adults who are knowledgeable about the ways in which young children learn can see beyond this narrow viewpoint and see that many of these resources exude limited exploration and learning. This is consolidated by Bilton (2010) who states that it is not sufficient to move indoor resources outdoors as this does not constitute quality outdoor play. The outdoors offers children numerous. opportunities which are not possible inside Edgington (2004) suggests that in the outdoors children should be encouraged to work on a more active and louder scale. Therefore, resources need to be carefully accumulated in the outdoor environment and how effective they are at catering for children’s learning and development.

Health and Safety (Risky play)

Safety has become an overriding factor in activities, to the point that it is a hindrance. Moyles (2007) suggests that this culture is paradoxically unsafe as children are not involved in safety issues and do not learn how to keep themselves safe and be aware of imminent dangers. Bruce (2012) analyses the importance of risk taking and adventurous play in the outdoors and proffers the view that play outdoors motivates children to extend their own learning boundaries, to be adventurous, to explore a little further and to engage with risk in a supportive environment. Claxton (1999) firmly supports this, claiming that risk-taking is part of the toolkit for effective learners. In addition, Dowling (2010) states that practitioners should consider a risk benefit assessment approach where providers carefully consider some of the advantages of the risks for the children. There is shift in the way that risk is approached, The Better Regulation Commission’s report ‘ Risk, Responsibility and Regulation: Whose risk is it anyway? ’ argue that risk can be beneficial and that managing risk is a shared responsibility.

Within the EYFS (DfES, 2007), statements concerning risky and outdoor play can also be seen ‘ Through play children can…take risks and make mistakes’ (DfES, 2007,p8). Taking risks is part of the learning process and children being able to be outdoors allows them to explore things that they might not be able to in the classroom.

Time/Access

There is also a large variation in the time which is allocated to outdoor play which is in accordance with the argument articulated by Bruce (1987) that “frequent lack of attention to the external environment must come from some bizarre assumption that knowledge acquired indoor is superior to that gained outside’ (Bruce, 1987, p55).

Within indoor activities children will more inclined to concentrate and persevere if they have the time to pursue interests, the outdoors is not conductive to this as McAuley and Jackson (1992) suggest that interrupting ‘children’s’ absorbed activity’ can subvert learning almost as much as allowing overt, maladaptive behavior. Moyles (2007) discusses the culture of the current schooling system in that children only get a limited period of time outside and some schools have extensive woodland but have a very restricted opportunity to experience these. A guidance document from the National Strategies suggests that ‘settings that have prolonged periods of free access to a challenging outdoor environment report that generally children behave more co-operatively, particularly boys.’ (DfES, 2008). Large construction areas and resources which promote imaginative play including making dens in trees and bushes all foster collaborative play. Staff ratios also affects the amount of time given to outside provision as it influences the degree of involvement of adults with the outside activities. Settings who restrict time in outdoor provision to set times in the day need to recognise that if children had free access to the outdoor environment there will be no strain on resources which can create difficulties such as children sharing provision and adults allocating their time fairly (Dowling, 2010). Children need time to develop their ideas and should not be disrupted by adults, the EYFS (2008) argues that children need time to play and work, that practitioners need to be flexible in their planning, so that children can follow an interest and if necessary, enable children to return to an activity at a later time. In terms of outdoor play, this means children need to be able to use both areas freely through making sure they make effective use of both spaces and most importantly have uninterrupted time to pursue interests (Bilton, 2010).

Stevens (2003) found that practitioners found it difficult to understand what ‘equal access’ meant and concluded that ‘simultaneously’ was a better word meaning that at any time there was free play inside, the outside should be available alongside this. However, within schools there is also pressure for children to perform and be hit their targets so some practitioners may argue that the pressures of these SATS and other attainment targets affects their ability to plan for the indoor and outdoors simultaneously as many view indoor activities being more conductive to their learning.

A large outdoor area which allows for a variety of different perspectives from different heights provides opportunities for children to enhance and consolidate their spatial awareness and mental mapping skills through physical play (Moyles, 2005). Moyles (2005) suggests that space allows children to be away from adults if they want to be and offers more space for children to interact with their peers. Pollard (2008) argues we need to consider the organisation of space as this can impact on the kind of teaching, the attitudes of the learners and the quality of learning. Good use needs to be made of the outdoor area so children can work on a larger, more active scale than is possible indoors (DfCSF, 2008).

Dowling (2010) states that the aim of the outdoor space should complement what is available for children inside in order to allow for the flow and elaboration of ideas and to make it as accessible as possible. This sentiment is also discussed by Ouvry (2000) who states that this allows the outdoor experience to be on a much grander scale.

The themes which have been found in the literature and research studies have also been critically analysed such as time and access to the outdoor provision, resources and adult role and staff’s perception and training in the outdoor environment.

Bibliography

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Claxton, G. (1999) Wise Up: Challenge of Life-Long Learning . London: Bloomsbury

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Qualitative Research on Children’s Play A review of recent literature

This presentation is a review of the recent, English-language (mostly peer reviewed) qualitative research on children’s play. It focuses on the place play has in children’s experience and giving sense to the world. Thus, it will leave aside the large and important body of research on the effect or outcomes (benefits and possible harmful consequences) of play which however tells us little on why children like to play so much and in particular on why they play so intensively, on why they are so much absorbed by play. A much more elaborate version of the review will appear in the new edited ICCP book on children’s play. Here, I will focus on just some of the recent contributions and trends in the field; I will not consider methodologies, although the recent turn to visual methods (especially photography) as complementing the very diverse observational methods, should certainly be mentioned in this context (Burke, 2005; Kernan, 2005).

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Human Studies

Maxine Sheets-Johnstone

Play for a Change is a review of perspectives on play, policy and practice carried out for Play England by Stuart Lester and Wendy Russell of the University of Gloucestershire. The authors of drew on a range of academic disciplines, especially brain sciences, sociology and geography. While recognising the foundation that developmental psychology has given to theories about children and play, the focus of this review has largely been on alternative approaches. It considers three strands: • the policy context for supporting children’s play, including an analysis of the literature on approaches to policy-making and on children and childhood • the literature on the benefits of children’s play and on children’s play patterns • provision for play and working with children at play.

Play and the pandemic: a rapid review of the literature and promising steps forward

Posted on 17 December 2020

DOI: 10.13056/acamh.14323

The ongoing coronavirus (COVID-19) pandemic continues to be a health crisis among the global community. Children in virtually all countries have been impacted in terms of movement restrictions, school closures, playground and public park closures, and limited access to social and extended family networks. Though it appears that children are not the most medically at-risk group with regard to COVID-19 (Cruz & Zeichner, 2020), they remain a vulnerable population: large-scale health crises can have hidden, yet potentially profound and long-lasting, impacts on children’s health and education (Ramchandani, 2020). One of the many ways that children’s lives were impacted was a global and unprecedented shift in where, when, how, and with whom play occurs.

There is good reason to take changes to children’s play seriously. Emerging evidence suggests that school closure, home confinement, and social restriction during disease outbreaks could have serious consequences for children’s physical and mental health, highlighting the need for preventative support and early intervention (e.g. Brooks et al., 2020; Guan et al., 2020; Loades et al., 2020). Play may be one of the most essential ways to attend to children’s mental health, development, and learning, as it can be a way of coping with stress, anxiety, and trauma (Chatterjee, 2018) and provides stability, normalcy, and enjoyment (International Play Association, 2017).

Our team from the Play in Education, Development and Learning (PEDAL) Centre at the University of Cambridge sought out existing evidence that could help us understand what effects a global pandemic has on children’s play and what is the role of play in protecting children’s wellbeing amidst restrictive circumstances. We conducted a rapid review in March-April 2020 to synthesise the available literature, identify gaps, and hopefully inform the foundations of policies that affect children during moments of crisis.

What did we do?

We asked the following research questions:

1) How might quarantine and related restricted environments affect play in children and young people? 2) In what ways might play and related activities mitigate the impact of quarantine and restriction on children/young people’s health and education?

The full methodological protocol – including terminology definitions, search syntax, and inclusion criteria – can be found in our manuscript (Graber et al., in press).

As this review was conducted on a short timeline, we limited the databases searched (PsycInfo, ERIC, and PubMed) and abbreviated data extraction and synthesis strategies according to accepted parameters for streamlining traditional review methodologies (Ganann, Ciliska, & Thomas, 2010). Articles were title and abstract screened for eligibility. Where there was uncertainty about whether a paper met inclusion criteria, we discussed the content as a team and reached consensus. All articles selected for inclusion were also screened by at least one other author to ensure adherence to criteria.

What did we find?

Our search yielded 5,897 papers. Twelve met the inclusion criteria, and handsearching provided an additional three papers, totalling 15 studies. Study characteristics were extracted and key themes were identified via narrative synthesis. Detailed information about the breakdown of study methodologies, locations and settings, participants, and types of play engagement can be found in the full manuscript.

We first looked at how restrictive environments affect children’s play, and found some evidence that children’s access to play can be impacted by quarantine or isolation. In such situations, there can be barriers to play – such as unsafe spaces, scarcity of toys, lack of interaction with other children, and lack of time outdoors – and reports indicated that diminished opportunities for play were associated with inactivity and boredom (Kuntz et al., 1996; Mares, Newman, Dudley, & F., 2002; Veronese, Cavazzoni, & Antenucci, 2018). Overall, relatively few studies characterised changes in the nature of children’s play in restrictive environments.

Our second research question considered how play may mitigate negative impacts of restrictive circumstances. Studies alluded to mechanisms through which play might support children during quarantine or isolation (e.g. via coping, social connectivity, self-expression), though these were not explicitly evaluated. Most studies were qualitative, providing insights on perceived benefits of play in restrictive conditions and suggesting a role for play in attenuating negative effects of restrictions; however, further research is needed to test this hypothesis robustly. For example, one study looked at children in hospital isolation and, via drawings depicting play areas, friends, shared spaces, and playful technology, concluded that the children were expressing a desire for more social connectivity (Lambert, Coad, Hicks, & Glacken, 2014[6]). Research has shown that sociability is related to stress resilience in children (Zolkoski & Bullock, 2012), yet we require further study of play itself to understand whether it may serve as a protective factor for children in isolation. We also found that creative and arts-based activities were prominent in studies addressing this second research question, alluding to the notion that play affords opportunities for self-expression, and perhaps a mechanism for coping with restrictive circumstances.

Notably, none of the included studies directly examined the impact of restrictions on play due to infectious disease outbreak. This presented a challenge in generalising the findings to the unique affectations on children’s play in response to widespread health crisis-related restrictions.

Implications and Next Steps

This rapid review is the first to map literature on the impact of restrictions on children’s play experiences and play’s role in mitigating adverse effects of such restrictions. There remain significant gaps in understanding the effects on play and play’s subsequent influence on children’s health outcomes, especially during restrictive conditions due to an infectious disease outbreak.

Since we undertook and completed this rapid review in the Spring of 2020, many individuals (e.g. Moore et al., 2020) and organisations (e.g. EmergingMinds, PlayEngland) have reported on and advocated for the importance of children’s play throughout the pandemic response, and such pushes have resulted in exciting research initiatives. For example, the ESRC recently funded a project, led by Professor John Potter at the UCL Institute of Education, to explore how children have been playing and how games are emerging during the pandemic. Additionally, Dr. Helen Dodd at the University of Reading launched a Pandemic Play Archive project in collaboration with the Museum of English Rural Life in the hopes of exhibiting and preserving children’s unique play experiences that are being shaped by this health crisis.

In considering the implications of this review of the existing literature, the PEDAL Centre initiated a new study that puts both play and children’s voices at the forefront of the research. The Play in the Pandemic study, which I lead, focuses in on children’s own perspectives and experiences of playing during the pandemic and ways, if any, in which play is different. This work stems from principles of participatory qualitative research: children aged 3-10 were virtually interviewed and considered experts of their own experiences, especially regarding play – one of the most fundamental aspects of childhood.

As the pandemic endures, we can likely expect continued shifts in children’s play experiences, and new aspects within the content of their play that reflect the unprecedented, health-related circumstances surrounding them. Uncertain times can emerge as interesting moments of reflection and exploration – there is promising work being undertaken regarding children’s play during this health crisis that will enhance our collective understanding of the value of play, its meaningfulness to children’s health and wellbeing, and how play might help to support children coping with crisis.

Disclosure of interests

The PEDAL Centre receives philanthropic funding from the LEGO Foundation. The funder played no part in the direction or execution of this research.

Our full rapid review

Graber, K.M., Byrne, E.M., Goodacre, E.J., Kirby, N., Kulkarni, K., O’Farrelly, C. & Ramchandani, P.G. (in press). A rapid review of the impact of quarantine and restricted environments on children’s play and the role of play in children’s health. Child Care Health Dev.

Link to the pre-print on the Open Science Framework

Child-Centered Play Therapy for Youths Who Have Experienced Trauma: a Systematic Literature Review

Jaxon j. humble.

1 Department of Educational Psychology, University of Texas at San Antonio, 510 W. Cesar E. Chavez Blvd, San Antonio, TX 78207 USA

Nathan L. Summers

Victor villarreal, kara m. styck.

2 Present Address: Northern Illinois University, DeKalb, IL USA

Jeremy R. Sullivan

Joseph m. hechler, blaire s. warren.

This systematic review examines the literature on the effectiveness of child-centered play therapy (CCPT) for youths who have experienced traumatic events. Two independent reviewers conducted the search procedures, as well as all data extraction and coding. Seven peer-reviewed articles reporting treatment outcomes were included in the review. As the focus of the review was on CCPT, treatment methods were similar across the seven articles (e.g., use of similar materials). There was also some consistency in findings regarding outcomes related to internalizing problems, self-concept, and self-competence. However, there was significant variability in the outcome measures used to evaluate effects, as well as limitations regarding the study methods that impact the overall conclusions regarding the use of CCPT to treat children that have experienced traumatic events. Treatment recommendations and suggestions for future research are discussed.

Posttraumatic stress disorder (PTSD) is characterized by the development of characteristic symptoms following exposure to one or more traumatic events (e.g., threatened or actual physical assault, threatened or actual sexual assault, natural or human-made disasters, severe accidents). Symptoms associated with PTSD include intrusion symptoms associated with the traumatic event, avoidance of stimuli associated with the traumatic event, negative alterations in cognitions or mood associated with the traumatic event, and/or marked alterations in arousal reactivity associated with the traumatic event (American Psychiatric Association 2013 ).

Results from the National Comorbidity Study-Adolescent Supplement indicate that the lifetime prevalence of PTSD for children ages 13 to 18 years in the U.S. is 5.0%, with females having a higher prevalence than males (8.0% and 2.3%, respectively) (Merikangas et al. 2010 ). Twelve month and 30-day prevalence estimates are 3.9% and 1.6%, respectively (Kessler et al. 2012 ). There are no definitive studies on prevalence rates of PTSD in younger children. However, it is important to note that in the U.S., the youngest children are most vulnerable to maltreatment, which may represent traumatic events (U.S. Department of Health and Human Services 2018 ). PTSD is associated with significant comorbidity, and trauma and PTSD symptoms may influence long-term behavioral and emotional development (Nader and Fletcher 2014 ; Perfect et al. 2016 ). Thus, it is critical that children with PTSD receive effective treatment.

Trauma-focused therapies (i.e., those that specifically address the traumatic experience) have been recommended to treat PTSD (see American Academy of Child and Adolescent Psychiatry 2010 ). Among the trauma-focused therapies for children, trauma-focused cognitive behavior therapy has received the most empirical support and has been the subject of multiple systematic reviews and meta-analyses (e.g., Black et al. 2012 ; Cary and McMillen 2012 ; de Arrellano et al. 2014 ; Gutermann et al. 2016 ). Nonspecific or nondirective therapies (i.e., those that do not specifically address the traumatic experience) represent alternatives to trauma-focused therapies. Individuals in these types of therapies may not spontaneously mention or address their traumatic experience (Cohen et al. 2004 ). Rather, nondirective therapy refers to unstructured therapy that relies primarily on the interpersonal skills of the therapist in ways that encourage individuals to explore and express their experiences and emotions (Cuijpers et al. 2012 ). Nondirective therapy with children typically involves play, as play represents an effective method for children to explore and express their experiences (Ewing et al. 2014 ).

A survey of mental health providers of play therapy indicates that the majority use a child-centered approach in play therapy (Lambert et al. 2007 ). In child-centered play therapy (CCPT), therapists use a playroom with carefully selected toys. The toys utilized in play are used as a means to elicit communication of the child’s view of his or her experiences (Axline 1969 ; Ray et al. 2015 ). As summarized by Ray et al. ( 2015 ), during play the therapist may reflect the child’s feelings, reflect content, track behavior, facilitate decision-making, facilitate creativity, encourage the child, facilitate relationships, and set limits for the child. Although play is not directed or necessarily trauma focused, when CCPT is used to address experiences of trauma, it is posited that it allows children to relive the trauma experience in a safe environment, including allowing children to express and work through painful emotions and to relieve accompanying tensions (Reyes and Asbrand 2005 ; Scott et al. 2003 ).

Although CCPT may be a preferred approach within the larger modality of play therapy (Lambert et al. 2007 ), and although play therapy has been used for treating children who have experienced traumatic events, few published studies have examined the effectiveness of this approach with this population (Gutermann et al. 2016 ). Recent reviews of CCPT indicate overall moderate treatment effects (e.g., Lin and Bratton 2015 ; Ray et al. 2015 ), but criticism regarding the relative lack of research examining the effectiveness of CCPT in general (Phillips 2010 ) and for trauma and PTSD specifically (see Gutermann et al. 2016 ) has yet to be adequately addressed. Notably, this specific topic has not been subject to systematic reviews of the research literature. Thus, the present systematic literature review aims to highlight the existing research on CCPT for children who have experienced traumatic events.

Search Procedures

Keyword search and inclusion criteria.

Two graduate students independently retrieved scholarly journal articles from multiple online databases, including PsycINFO, Psychology Database, PsycARTICLES, SocINDEX, Psychology and Behavioral Sciences Collection, ERIC (EBSCO), and PubMed. The Boolean phrases used were: (“play therapy” OR “child-centered play therapy” OR “child centered play therapy” OR “non-directive play therapy” OR “therapeutic play” OR “play intervention” OR “sandtray” OR “person-centered play therapy” OR “humanistic play therapy”) AND (child* OR adolescent) AND (“traumatic event” OR “trauma” OR “stressful event” OR “psychological trauma” OR “maltreatment” OR “psychological maltreatment” OR “stress” OR “acute stress” OR “abuse”). Databases were searched up to June 2017, with no set limit on the start date.

To be included in the review, studies had to meet the following inclusion criteria: (a) the majority of the participants were 17 years of age or younger; (b) the treatment protocol (i.e., intervention) was systematically manipulated by the research team; (c) the study included a quantitative analysis of treatment effects; (d) the participants must have experienced exposure to actual or threatened death, serious injury, or sexual violence in one (or more) ways (based on the American Psychiatric Association 2013 criteria for PTSD); and (e) the researchers specified that therapy utilized in the study was based on CCPT. Studies were excluded if they did not meet the criteria listed above, were not per-reviewed, were literature reviews, were meta-analyses, were published in a language other than English, made use of therapies not identified as CCPT, or were uncontrolled or qualitative case studies that included anecdotal or interview data rather than quantitative data.

With the inclusion and exclusion criteria outlined, each graduate student independently identified 785 articles. After eliminating articles found on multiple databases (i.e., duplications) and articles that were not peer-reviewed, the number of articles was reduced to 635. The interrater reliability of the keyword search was assessed using the “irr” package (Gamer et al. 2012 ) in R Version 3.3.2 (R Core Team 2013 ). Results indicated an unweighted Cohen’s kappa of 0.98, which can be characterized as “almost perfect” interrater reliability per Landis and Koch ( 1977 ).

Title and Abstract Inspection

Next, titles and abstracts of all articles identified from the keyword search were independently examined for relevance. Articles were screened against the inclusion and exclusion criteria stated above. The interrater reliability results of the titles and abstract search between the graduate students indicated an unweighted Cohen’s kappa of 0.951, which can be characterized as “almost perfect” interrater reliability (Landis and Koch 1977 ). Following a meeting with the research team on article disagreements, the number of articles retained for full-text review was 172.

Full-Text Inspection

Inclusion and exclusion criteria remained the same. For articles that were not available through the university library, inter-library loan was utilized. The interrater reliability of the full-text review between the graduate students indicated an unweighted Cohen’s kappa of 0.942, which can be characterized as “almost perfect” interrater reliability (Landis and Koch 1977 ). Following a meeting with the research team on article disagreement, the number of articles retained for data extraction was seven.

Extended Search Procedures

The titles and abstracts of the references for each of the seven remaining articles were analyzed against the same inclusion and exclusion criteria. Of the references reviewed, zero met the criteria to be included in the final review and data extraction of articles. The interrater reliability results for this extended search indicated an unweighted Cohen’s kappa of 1.0, which can be characterized as “perfect” interrater reliability (Landis and Koch 1977 ). See Fig. 1 for a summary of the search procedure.

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Flowchart depicting search procedures

Data Extraction

For each study remaining after the extended search procedures were completed, data were extracted pertaining to the following broad categories: (a) description of treatment programs, (b) description of research method, and (c) description of treatment outcomes. Regarding the treatment programs, information pertaining to treatment duration, treatment delivery, and treatment aims was extracted. Regarding the research method, information regarding the subjects (including age, sex, and trauma experiences) and study design was extracted. Regarding treatment outcomes, information regarding the outcome measures, specific outcomes, and effects was extracted. This information was coded by two researchers. All disagreements were resolved via review and discussion with the research team, resulting in 100% agreement.

Description of Treatment Programs

Duration and delivery.

The duration of treatment ranged from 12 days to 9 months. The number of individual sessions attended by children ranged from 10 to 36 sessions. In three of the studies, children attended one CCPT session per week; in four of the studies, children attended multiple sessions per week (with one study utilizing daily sessions over the course of 12 days). Most studies reported the typical length of each session; the range for reported session length was 30 to 50 min.

Treatment was delivered by various mental health professionals, including counselors (four studies), social workers (three studies), therapists (not further defined; three studies), and psychologists (one study). Most of the studies specifically indicated that the therapists had received some sort of training (e.g., coursework, practicum) in CCPT (Kot et al. 1998 ; Schottelkorb et al. 2012 ; Scott et al. 2003 ; Shen 2002 ; Tyndall-Lind et al. 2001 ). Notably, Schottelkorb et al. ( 2012 ), the most recently published article, indicated that therapists utilized a manual to implement CCPT.

Based on information provided, there was some overlap in materials used in the studies. Three of the studies noted that the play settings (including toys and materials) used in therapy were based on those suggested by Landreth ( 1991 , 2002 ). Two studies provided a general description of the toys and materials used in therapy. Two studies referenced play settings, but did not specify the types of toys or materials that were used. Notably, concurrent family therapy was available in one of the studies (Reyes and Asbrand 2005 ), and one study used sibling groups (Tyndall-Lind et al. 2001 ).

Treatment Goals

The treatment aims in the studies reviewed varied but there was some overlap. The most common goals involved improvement in self-concept and reduction in internalizing symptoms (three studies). Other common goals involved reduction in behavior problems (two studies) and positive changes in trauma-related symptoms (two studies). Improvement in positive play behavior, reduction in coercive family behaviors, improvement in social competence, and improvement in life adjustment were also targeted in the various studies. See Table Table1 1 for a summary of each article’s treatment aims and aspects of treatment delivery.

Descriptive information and components of treatment

Description of Research

The number of participants in treatment groups across the studies ranged from 10 to 38 (mean = 23.4). There were more girls than boys in five of the six studies that reported this information. In the treatment groups, the age of children ranged from 0 years to 16 years. The mean age of children, based on the average of studies reporting mean age, was 7.3 years. Children and families in the studies were recruited from various settings. In three studies, children were referred from child and family protective service agencies. In two studies, children were recruited from women’s shelters. In one study each, children were recruited based on geographic proximity to a natural disaster, based on refugee status and previous diagnosis with PTSD, and based on referrals from non-specified community agencies. The type of traumatic event(s) experienced by participants varied considerably. Two studies each included children that had been exposed to parental (domestic) violence or had been sexually abused. Other types of traumatic experiences (included in one study each) were physical abuse, persistent coercive family relationships, exposure to war, and exposure to a natural disaster.

Study Designs

Each of the seven studies used a pre-post treatment design. Three of the studies also used a control group. Shen ( 2002 ) used random assignment of participants to treatment conditions. Tyndall-Lind et al. ( 2001 ) used a waitlist control group, but did not specify how children were assigned to each condition. Kot et al. ( 1998 ) used a no treatment control group that was assigned after the experimental group had completed treatment. Two of the studies utilized comparative treatments (i.e., CCPT was compared to another treatment). Nicol et al. ( 1988 ) compared a focused casework approach (based on social support and behavior modification principles) to a CCPT approach. Schottelkorb et al. ( 2012 ) used random assignment to compare trauma-focused cognitive behavioral therapy to CCPT. See Table Table2 2 for a summary of the sample and research design characteristics.

Sample and design of research

Tx treatment, Cx control or comparison, F female, M male, Pre pre-treatment assessment, Post post-treatment assessment

Treatment Outcomes

Overall, the results across studies suggested that participation in CCPT led to improvements in self-concept and competence (four studies), internalizing problems (three studies), externalizing problems (two studies), and post-traumatic stress-related problems (two studies). Notably, non-significant effects for CCPT were also found in the majority of studies for various outcomes. Table Table3 3 summarizes the results of each study, including indication of the significant effects found.

Results of research

Tx treatment, Cx control or comparison, FU follow-up, Pre pre-treatment assessment, Post post-treatment assessment

+ = statistically significant positive change in outcomes between treatment-control or pre-post assessment; − = statistically significant negative change in outcomes between pre-post assessment; 0 = no statistically significant change

Kot et al. ( 1998 ), Tyndall-Lind et al. ( 2001 ), and Scott et al. ( 2003 ) reported significant differences between CCPT and control groups, as well as pre- and post-test differences in the CCPT group, for outcomes related to self-concept and competence. Results indicate that children who had witnessed parent (domestic) violence (Kot et al. 1998 ; Tyndall-Lind et al. 2001 ) and had experienced sexual abuse (Scott et al. 2003 ) felt empowered after receiving CCPT treatment. Relatedly, Shen ( 2002 ) reported significant pre- and post-test differences on a measure of life adjustment for children receiving CCPT after a natural disaster; however, there were no significant differences on this scale between the CCPT and no treatment control groups.

Reyes and Asbrand ( 2005 ) and Shen ( 2002 ) reported significant pre- and post-test differences in the CCPT group for outcomes related to internalizing problems. Tyndall-Lind et al. ( 2001 ) reported significant differences between CCPT and control groups, as well as pre- and post-test differences in the CCPT group, for depression and anxiety. Overall, results indicated that children who had a history of sexual abuse (Reyes and Asbrand 2005 ), had experienced a natural disaster (Shen 2002 ), and had witnessed parent (domestic) violence reported fewer symptoms of anxiety and depression after receiving CCPT. However, Kot et al. ( 1998 ) found no significant differences (including pre-post difference for the CCPT, and between the CCPT and control group) for internalizing problems in children who had witnessed parental (domestic) abuse. In addition, results regarding comparisons of the CCPT and control groups in Shen ( 2002 ) were mixed, with one measure (Revised Children’s Manifest Anxiety Scale) indicating that CCPT was superior to no treatment, and another measure (Multiscore Depression Inventory for Children) indicating that CCPT was not superior to no treatment.

Kot et al. ( 1998 ) and Tyndall-Lind et al. ( 2001 ) reported significant differences between the CCPT and control groups, as well as pre- and post-test differences in the CCPT group, for outcomes related to externalizing problems. This was based on reports of behavior of children who had a history of witnessing parental (domestic) abuse. Shen ( 2002 ) specifically reported significant pre- and post-test differences on a scale of defiance for children who had experienced a natural disaster, with children receiving CCPT reporting fewer related problems. However, Tyndall-Lind et al. ( 2001 ) did not report improvements for specific problems such as delinquent behaviors or attention problems.

In terms of post-traumatic stress-related problems, Reyes and Asbrand ( 2005 ) reported significant pre- and post-test differences in the CCPT group. Results indicated that children who had a history of sexual abuse and received CCPT reported fewer symptoms of overall post-traumatic stress. However, no pre- and post-test differences were found for specific difficulties sometimes associated with PTSD (e.g., dissociation, fantasy, sexual distress). Schottelkorb et al. ( 2012 ) also found significant pre- and post-test differences regarding overall post-traumatic stress; this was true for both parent- and self-reports for children who had been exposed to war. However, there were no significant differences when comparing CCPT to trauma-focused cognitive behavior therapy.

Notably, Nicol et al. ( 1988 ) reported no significant pre- and post-test differences in the CCPT group regarding coercive behaviors for children who had been physically abused and that had experienced coercive family relationships. Significance was found for positive behaviors; however, pre- and post-test scores indicated that fathers engaged in less positive behaviors after CCPT. In addition, the comparative treatment (based on social support and behavior modification principles) was found to be superior to CCPT.

Few studies examined any moderating effects or ways in which treatment differed based on participant characteristics. Nicol et al. ( 1988 ) reported results based on participant status (i.e., mother, father, or child) and Reyes and Asbrand ( 2005 ) evaluated the effects of factors related to the trauma (e.g., severity of abuse, duration of abuse), but the majority of studies did not evaluate the effects of participant characteristics. Also lacking from the statistical analyses of the majority of studies were analyses of effect size. It is becoming standard to report information on the amount of between-group differences (i.e., effect size) in addition to results of statistical significance testing. Shen ( 2002 ) and Reyes and Asbrand ( 2005 ) reported partial eta squared, and Schottelkorb et al. ( 2012 ) reported eta squared, but effect sizes were not reported in the other studies. Ranges of effect sizes were as follows: Shen ( 2002 ) = .019 to .274; Reyes and Asbrand ( 2005 ) = .33 to .43; Schottelkorb et al. ( 2012 ) = .43 to .57.

Given the prevalence and wide-ranging effects of traumatic experiences and PTSD during childhood, mental health professionals clearly need evidence-based treatments (Nader and Fletcher 2014 ; Perfect et al. 2016 ). Although CCPT appears to be a popular treatment approach, there have been relatively few studies regarding its effectiveness on treating children exposed to traumatic events, and there is no overall consensus regarding its utility with this population (Gutermann et al. 2016 ). Thus, in this systematic review we examined the available research on the effectiveness of CCPT for children who have had traumatic experiences as defined by the American Psychiatric Association ( 2013 ). Only seven studies ultimately met criteria for inclusion in this review; these studies were published between 1988 and 2012. Overall, there was some consistency, but not complete uniformity, in the materials (e.g., toys) used in CCPT. There was also some consistency in findings regarding outcomes related to internalizing problems, self-concept, and self-competence. However, there was significant variability in the outcome measures used to evaluate effects, as well as limitations regarding the study methods that impact the overall conclusions regarding the use of CCPT to treat children that have experienced traumatic events.

Treatment Considerations

Based on the characteristics and components of the treatments described in Table Table1, 1 , CCPT has been implemented in many diverse ways across different studies. All of the studies are based on CCPT, and there is some consistency in materials and treatment method. At the same time, most studies did not describe specific components of the treatment and only one (Schottelkorb et al. 2012 ) indicated that therapists used a manual to structure treatment delivery. Similarly, with the exception of Schottelkorb et al. ( 2012 ), the studies did not seem to report methods to assess treatment fidelity, and generally did not report if participants engaged in trauma-focused play (vs play that did not refer to the traumatic event).

We observed a wide range in treatment duration, which could have an impact on outcomes. For example, a child participating in daily therapy sessions for 12 consecutive days might have a very different experience and outcome compared to a child participating in weekly sessions for 9 months. Of course, this variability in implementation will be an issue when using an unstructured treatment approach. Interestingly, some studies focused on outcome variables other than, or in addition to, PTSD symptoms, such as self-concept, social competence, and behavior problems. It is possible that larger treatment effects may have been found if dependent variables were limited to the PTSD symptoms targeted by treatment. Overall, the existing research does not provide specific implications for play therapy for various types of trauma.

Research Considerations

Unfortunately, many articles identified in the initial search were excluded because they were uncontrolled case studies and/or did not present quantitative data analysis. Since only a few articles were left after the article search and selection process, we do not have an established “critical mass” of literature to allow us to make a general statement about effectiveness of CCPT with this population. We can, however, describe some of the characteristics of the studies included in this review. One characteristic that must be noted is the high attrition rate observed across studies (several in the 40–50% range). Treatment outcomes might have been more positive if more participants had actually completed treatment or attended more sessions. Perhaps the high attrition rates were related to the nature of the samples (i.e., youths who had experienced traumatic events) and treatment (i.e., treatment for traumatic experiences, which may have exacerbated feelings of distress or discomfort).

Another notable finding is the wide variety of dependent variables, or outcome variables, and a commensurate variety in how these variables were measured in the different studies. This lack of consistency, both in constructs measured and in how they were measured, may partially explain the inconsistent results across studies. That is, some studies found positive outcomes both when compared to a control group and when compared to pre-treatment functioning, but other studies (or other dependent variables within the same study) did not find significant differences or treatment effects. Further, some results suggest positive outcomes when comparing pre- to post-test data, but not when comparing outcome scores between treatment and control/comparison groups. There also was quite a variety in the samples used in the seven studies, with some studies including youth who had experienced natural disasters (i.e., an earthquake), others with children who had witnessed violence or war, and others with youth who had experienced physical or sexual abuse. Unfortunately, these inconsistencies prevent us from identifying patterns in the research or exploring whether CCPT may be more effective for some types of trauma than others. Only three of the seven studies reported effect sizes (either eta squared or partial eta squared), and those effect sizes were generally in the moderate to large range. This certainly provides preliminary support for the potential effectiveness of CCPT, and points to the importance and merit of further research in this area.

Limitations of Present Review

The current findings highlight important considerations for CCPT for youths that have experienced traumatic events, but the results must be interpreted in light of the review’s limitations. One limitation is the methodological rigor of our inclusion and exclusion criteria. In particular, we chose to exclude studies that did not include a quantitative data analysis of treatment effects. Although we did this to focus on articles that used more rigorous methodology and analyses, a consequence was that it significantly limited the number of articles we reviewed. Although other articles may have used less rigorous methods (e.g., uncontrolled case studies, narrative descriptions of the treatment process and outcomes), it may nonetheless be beneficial to glean evidence from these studies, especially given the relatively few studies of CCPT for trauma that utilize more rigorous methods. In addition, the majority of studies did not report effect sizes. This limited the ability to conduct additional evaluation of overall treatment outcomes, such as meta-analyses of outcome data and the potential impact of moderator variables on treatment outcomes. Although this reflects a limitation of the existing research, it nonetheless constrained our ability to further evaluate the data.

The seven identified studies included samples who experienced a range of traumatic events, used a variety of outcome measures, and found inconsistent pre-post and between-group differences. Perhaps the most striking conclusion to be drawn from this systematic review is the fact that, despite the popularity of CCPT approaches, there is very little research to support this popularity, at least when considering studies using a sufficiently rigorous design with youths who have experienced trauma. Even though we cannot make firm recommendations or conclusions regarding the effectiveness of CCPT, we can make several recommendations for future research in this area. First, researchers should explore ways to reduce attrition rates in these studies (and, most likely, in these treatment programs more generally). That is, how can we encourage participants to remain in treatment and help them work through initial feelings of distress that may accompany re-experiencing or processing traumatic events? Second, researchers might consider identifying and using common outcome measures so that results can be more easily compared across studies. Third, more rigorous research designs must be used to enable the field to establish stronger evidence for the effectiveness of CCPT with this population. Uncontrolled case studies may be helpful in the initial stages of developing and describing treatment approaches, but more rigorous designs are necessary to more precisely identify what treatments work best, for whom, and under what conditions.

In terms of methodology, in many ways the Schottelkorb et al. ( 2012 ) study should be viewed as an exemplar that future research studies on CCPT should follow, as those researchers used a comparison group, randomization, well-developed instruments, treatment manuals, and a treatment fidelity checklist. Fourth, researchers should routinely report effect sizes as part of their data analyses. Cohen’s d may be most appropriate when comparing outcomes for treatment group vs. control group, but any measure of effect size is better than nothing. Reporting effect sizes would also facilitate the application of meta-analytic techniques to quantitatively examine trends in effectiveness across studies. Lastly, we encourage researchers to describe play materials and content/components of sessions more thoroughly and operationally, so practitioners and other researchers will have a better understanding of what the treatment looked like. This is important for replication of results, and for practitioners who want to implement these treatments in their own practices.

Compliance with Ethical Standards

This study did not involve human participants.

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Publisher’s Note

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Parents’ awareness, knowledge, and experiences of play and its benefits in child development: A systematic review protocol

Roles Conceptualization, Investigation, Methodology, Project administration, Writing – original draft

* E-mail: [email protected]

Affiliation Department of Occupational Therapy, Hamad Medical Corporation, Doha, Qatar

Roles Conceptualization, Investigation, Project administration, Writing – review & editing

Roles Investigation, Project administration, Writing – review & editing

Roles Conceptualization, Methodology, Writing – review & editing

Affiliation Collaborative Learning and Capacity Building Theme, NIHR ARC NWL, London, United Kingdom

Brightlin Nithis Dhas,
Shoba Mary Chacko,
Vince Soloman David Solomon,
Vimal Sriram

Published: September 9, 2022
https://doi.org/10.1371/journal.pone.0274238
Peer Review
Reader Comments

Play is an important childhood occupation and a medium for development. Parents’ attitudes towards play, knowledge about play and its benefits, and their experiences in facilitating effective play are key factors that determine the experiences of play in children. These factors related to parent’s understanding and experiences of play gain additional significance when the child has a disability. The aim of this systematic review is to synthesize the available evidence on awareness, knowledge, and experience of play among parents and to summarise the findings.

MEDLINE, CINAHL, APA PsycINFO, Psychology Database, Sociological Abstracts, EMBASE, and Cochrane Collection Plus will be searched for studies of any design that investigate awareness, knowledge, and experience of play among parents and its benefits to child development. Manual searches from reference lists of relevant papers will also be completed. The primary outcomes are parents’ knowledge (what constitutes play), experiences (what parents feel about play) and awareness (benefits of play) about play. Three independent reviewers will screen identified papers with pre-defined eligibility criteria and extract data using a customized extraction form. Discrepancies will be resolved in discussion with a fourth reviewer. A synthesis of eligible studies and summary will be provided.

A systematic review of quantitative and qualitative research evidence of parents’ awareness, knowledge, and experiences in play will be carried out. This will highlight parents’ own views on play among their children, current theories/domains related to parents’ awareness, knowledge, and experience in play, and outcome measures that have been used. In addition, comparison among views of parents of children with disabilities and parents of typically developing children will be made. The results will be presented as a summary of key findings under the themes of awareness, knowledge, and experience of parents in play.

Citation: Dhas BN, Chacko SM, David Solomon VS, Sriram V (2022) Parents’ awareness, knowledge, and experiences of play and its benefits in child development: A systematic review protocol. PLoS ONE 17(9): e0274238. https://doi.org/10.1371/journal.pone.0274238

Editor: Emily Freeman, The University of Newcastle College of Engineering Science and Environment, AUSTRALIA

Received: August 9, 2021; Accepted: July 15, 2022; Published: September 9, 2022

Copyright: © 2022 Dhas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data from this study will be made available upon study completion.

Funding: Hamad Medical Corporation provided support in the form of salaries for authors BND, SMC and VSDS. The specific roles of these authors are articulated in the 'author contributions' section. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have read the journal’s policy and have the following competing interests: BND, SMC and VSDS are paid employees of Hamad Medical Corporation and VS is a paid employee of NIHR Applied Research Collaboration. The authors declare that this article presents independent research commissioned by the National Institute for Health Research (NIHR) under the Applied Health Research (ARC) programme for Northwest London. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare.

Abbreviations: CINAHL, Cumulative Index of Nursing and Allied Health Literature; COSMIN, Consensus-based Standards for the selection of health Measurement Instruments; PRISMA–P, Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols; PROSPERO, International Prospective Register of Systematic Reviews

Introduction

Play has tremendous growth promoting potential in a range of developmental domains including cognition, language, social integration, social communication, and emotional regulation [ 1 , 2 ]. Children have an innate desire to play and through play they develop many life skills without even realizing it [ 3 ]. Everyone acknowledges that play is an important aspect of child development. However, there are considerable differences among parent and professional conceptualisations of play and its value to child development [ 4 ]. In their study, Fisher et al. [ 4 ] found that mothers consider both structured activities (goal-oriented activities consisting of a sequence of events/actions) and unstructured activities (highly varied activities involving imagination/creativity) as highly playful, whereas, professionals’ rate structured activities to be less playful. With regards to its developmental value, mothers felt unstructured activities contribute less to child development compared to professionals, while both parents and professionals ascribed high developmental value to structured activities.

There are many factors that influence play, among them, family is an important factor [ 5 , 6 ]. Parental beliefs about play are found to affect the play experiences of their children [ 7 ]. Parents are considered to have a "gatekeeper" role in determining which activities children do and therefore their awareness towards the importance of play in child development can have an impact on children’s play opportunities. Parents who value the importance of play devote more time for play [ 3 ] and encourage the type of play they deem to be important [ 8 ]. For example, parents who place importance on physical activities tend to provide more opportunities for physical play while those who place importance on intellectual activities tend to provide more opportunities for intellectual play [ 3 ].

Knowledge regarding play among parents is another factor in determining play experiences of their children. For example, what toys to buy based on the developmental level of the child is important as this could determine if the child derives enjoyment from playing with them or the child feels frustrated because they cannot play with it [ 3 ]. Children whose parents had better knowledge about play were likely to engage in higher level of play [ 9 ]. Certain disabling conditions impose specific limitations on playing skills for children with these conditions [ 10 ]. For example, play participation in children with Cerebral Palsy was linked to their motor skills [ 11 ] while for children with Autism, certain play skills are impaired [ 12 ]. Knowledge about overcoming these obstacles through changes or adaptations to toys and or environment would make a difference in play participation for their children [ 13 ]. Even if parents were aware and knowledgeable about play and its benefits, it does not translate into them being competent enough to play with their children effectively [ 14 ]. Therefore, it is suggested that parents need some training on how to play with their children in order to make their play interactions rewarding and already some positive results has been observed on interventions targeting teaching play skills to parents [ 15 ].

Studies on parental experiences while playing with their children that explore questions related to “how, what, when, where and why” parents play with their child provide valuable insight on the level and type of parental engagement in their children’s play [ 16 ]. The amount of time parents play with their children, the type of engagement during play and the toys/play materials they buy and use with their children depends on their viewpoints about play [ 17 ].

Play does not exist equally for all children but determined by biological factors such as gender and developmental transitions, socio-cultural factors, and specific context such as presence of an illness or disability [ 18 ]. Therefore, there could be variations in the awareness, knowledge, and experiences among parents of children with different developmental levels, culture, and children with physical, social and intellectual disabilities. For this review, we will examine studies reporting parent’s awareness, knowledge, and experience with play among children and describe the variations in terms of age groups and disability status of the children, gender of parents, and the cultural context (where reported).

Rationale for the review

Parents are an integral part of their children’s play and the play experiences are closely associated with the choices that parents make [ 19 , 20 ]. Therefore, parents’ understanding of the importance or nature of play is essential in creating nurturing play experiences for children. Particularly for children with disabilities whose engagement in play occupations could be limited due to impairments in play skills, environmental barriers, or both. Parent knowledge on developmental aspects of play and adapting play could thus make a difference. Currently, there are several studies exploring the positive benefits of play in child development and interventions to improve play performance on children [ 21 , 22 ]. However, little is known about how parents feel about play and if they perceive that they have enough knowledge and competence in structuring play experiences for their children. This review aims to appraise the literature on play from parents’ perspective in order to synthesize the available evidence in this important field of enquiry.

Review aims and questions

This review will aim to:

Synthesize qualitative, quantitative, and mixed methods research related to awareness, knowledge, and experience in play among parents of typically developing children.
Synthesize qualitative, quantitative, and mixed methods research related to awareness, knowledge, and experience in play among parents of children with disabilities.
Compare 1 and 2 to identify similarities and differences in conceptualization of play by parents of typically developing children and those having children with disabilities.

The following information will also be collected and reported: Details of the participants in the reviewed studies; surveys/observational methods/standardized tools used in understanding parents’ awareness, knowledge and experience in play and interventions targeting knowledge and competence of parents in play.

Methods/Design

This protocol has been prepared following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines for systematic review protocols [ 23 ]. (The PRISMA-P checklist is included as S1 File ). The review protocol has been registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42021259601).

Inclusion/Exclusion criteria

Types of participants..

Studies that include parents, of typically developing children or children who have any type of disabilities will be included. There will be no restrictions regarding sex, medical condition of the child or ethnic background. Studies that report on parents whose children have reached adolescence (above 11 years of age) will be excluded.

Types of studies.

Studies that focus on exploring or improving parents’ understanding of play will be included. Both quantitative and qualitative study designs are required to answer the review questions. Hence no restrictions will be placed on study design. The full-text article of the study needs to be available (i.e. abstracts will be excluded). We will not be including other reviews; however, we will check references within identified existing reviews on parents’ awareness, knowledge, and experiences of children’s play to ensure that all relevant studies have been located. Non peer-reviewed publications including letters to the editor, abstract and conference proceedings, magazine articles, and book reviews will not be included. Study protocols and theses/dissertations will also be excluded.

Types of play.

Since there is no universal definition of play, we will use a broad definition and all research articles that consider play in general (not specific play types such as digital play, pretend play, etc.), done with the purpose of enjoyment and not for competition (sports), achievement (physical activity or fitness), or therapeutic purpose (play therapy) will be included. The focus of many studies is on improving play skills among children or using play as a therapeutic media. However, this review’s focus is on parent perceptions of play and interventions directed towards parents to address their concerns. We will report on the common definitions and interpretations of their children’s play from the perspectives of parents.

Comparator(s).

Perspectives of parents of typically developing children will be compared to the experiences of parents of children with disabilities.

Outcome measures.

The primary outcomes will be the level of parents’ awareness, knowledge, and experiences of play. Awareness refers to the level of importance parents’ attach to play in the development of the child. Knowledge covers understandings of the concept of play, its types, and the developmental stages of play. Experience relates to how, what, when, where and why parents play with their children and how they organize their schedules, objects, and environments to facilitate play.

Secondary outcomes will be to identify any survey/measures or instruments developed for assessing parents’ awareness, knowledge, and experience in relation to their children’s play. We will also identify and report on any changes in trends of how parents’ awareness, knowledge and experience of children’s play has changed over time.

Search strategy

Searches will be carried out on:

1. Databases

In order to carry out a comprehensive review, we will search for relevant studies in more than one database. The databases of CINAHL (EBSCO) from 1937 to present, MEDLINE (EBSCO) from 1946 to present; APA PsycINFO (ProQuest) from 1806 to present; Psychology Database (ProQuest) from inception to present; Sociological Abstracts (ProQuest) EMBASE from 1974 to present; and Cochrane Collection Plus (EBSCO).

2. Manual searches

Manual searches of reference lists and included articles in any previous reviews or metanalyses will also be conducted to identify relevant research studies.

Searches will not be limited by quantitative or qualitative filters or date limits. However, the search will be limited to articles in English language due to funding constraints.

The search strategy for the search in Medline (EBSCO) is provided ( S2 File ).

The web based Covidence software platform ( https://www.covidence.org/ ) will be used for the review. Search results from the databases will be downloaded into Covidence software. Covidence will be used to identify and remove duplicates. Authors BND, VSDS and SMC will screen all titles and abstracts independently based on the inclusion/exclusion criteria. Any disagreement will be resolved by discussion and in consensus with VS. Full text review will then be conducted for all studies marked for inclusion. An audit trail will be maintained for exclusion of any studies at this stage by adding notes in Covidence.

Data extraction

A bespoke form ( S3 File ) developed by the authors will be used for data extraction. The sub-headings in the form were taken from relevant sections from the STROBE checklist (The Strengthening the Reporting of Observational Studies in Epidemiology) [ 24 ] and the COREQ checklist (Consolidated criteria for reporting qualitative research) [ 25 ]. This form will be piloted on a sample of studies initially and modified if needed. BND, SMC and VSDS will extract the data.

Risk of bias (quality) assessment

The Mixed Methods Appraisal Tool [Version 18] [ 26 ] for assessing bias in both quantitative and qualitative studies will be used. The COSMIN Study Design checklist for Patient-reported outcome measurement instruments [version July 2019] [ 27 ] will be used for assessing any surveys developed to assess parents’ understanding of play. The selected studies will be critically evaluated by BND, VSDS and SMC and any discrepancies resolved in discussion with VS.

Data synthesis

A descriptive summary of included studies will be created with a meta-analysis if the included studies are sufficiently homogenous [ 28 ]. If the studies are not homogenous a narrative synthesis will be used. An applied thematic analysis approach [ 29 ] will be used to synthesize findings from qualitative studies. Where data is available, a subgroup analysis based on parents of typically developing children and parents of children with disabilities will be conducted.

Potential limitations

Certain limitations are anticipated. Since there are numerous terminologies used to describe play and parents’ understanding of it some relevant studies could potentially be missed and heterogeneity in the included studies could be expected. Restricting the searches to limited databases and limiting to only English language peer-reviewed articles is another limitation as some important articles could be missed. However, we are confident that our comprehensive search strategy, searches in multiple databases, manual search among reference lists and using a broad definition of play will provide a comprehensive review in this important topic area.

The aim of this review is to understand the level of awareness, knowledge, and experience of play among parents. The results are expected to summarize parents’ perceptions of various dimensions of play including importance of play, attitudes towards play, and experience in supporting play. Existing theoretical perspectives of play could be compared with the parent perspectives derived from the review. This systematic review would also help to identify any lack of awareness or negative attitudes towards play from the part of parents that needs to be addressed as parental views about play affects actual play among children which in turn has the potential to affect child development [ 7 , 19 , 20 ]. Gaps in the literature, if any in the understanding of parental concerns and competence in playing with their children, particularly children with disabilities could be identified from the review. Moreover, comparisons of viewpoints of parents who have children with disabilities and those of typically developing children could provide insights regarding the complexities, hardships if any, and unique experiences parents of children with disabilities face while playing with their children. In addition, the review will also identify methods used in the literature to identify parental perceptions about play and any standardized questionnaires developed in this regard. This would be useful to identify existing outcome measures in this area. The inclusion of quantitative and qualitative study designs will be helpful to thoroughly explore the available literature related to the aim of this review. It is anticipated that the findings will be useful to develop insights regarding empowering parents to nurture growth of their children through play. Furthermore, areas that require further investigation and research could be identified.

Supporting information

S1 file. prisma-p checklist..

https://doi.org/10.1371/journal.pone.0274238.s001

S2 File. Search strategy.

https://doi.org/10.1371/journal.pone.0274238.s002

S3 File. Data extraction forms.

https://doi.org/10.1371/journal.pone.0274238.s003

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Recommended Citation McGinn, Amy, "Play-based early childhood classrooms and the effect on pre-kindergarten social and academic achievement" (2017). Graduate Research Papers. 229. https://scholarworks.uni.edu/grp/229 This Open Access Graduate Research Paper is brought to you for free and open access by the Student Work at UNI ScholarWorks.
Qualitative Research on Children's Play A review of recent literature
Published 2008. Psychology. This presentation is a review of the recent, English-language (mostly peer reviewed) qualitative research on children's play. It focuses on the place play has in children's experience and giving sense to the world. Thus, it will leave aside the large and important body of research on the effect or outcomes ...
Qualitative Research on Children's Play A review of recent literature
This presentation is a review of the recent, English-language (mostly peer reviewed) qualitative research on children's play. It focuses on the place play has in children's experience and giving sense to the world.
Free play in early childhood: a literature review
File size: 2.4 MB. Download. This literature review, focusing on free play (children choosing what they want to do, how they want to do it and when to stop and try something else) in early childhood, was commissioned by Play England.The review draws on a range of viewpoints, including observational studies, the work of pioneers and well ...
Play and the pandemic: a rapid review of the literature and ...
Play may be one of the most essential ways to attend to children's mental health, development, and learning, as it can be a way of coping with stress, anxiety, and trauma (Chatterjee, 2018) and provides stability, normalcy, and enjoyment (International Play Association, 2017).
Children's literature criticism
The term children's literature criticism includes both generalist discussions of the relationship between children's literature and literary theory and literary analyses of a specific works of children's literature. Some academics consider young adult literature to be included under the rubric of 'children's literature.'. Nearly every school of theoretical thought has been applied to children ...
Neighbourhood Factors in Children's Outdoor Play: A Systematic
This review provides insight into the urban neighbourhood factors that influence children's outdoor play. While that context clearly matters, studies differ on which elements matter most. Regarding physical factors, the quantitative studies highlight the importance of traffic safety (88% found at least one positive association), followed by the ...
PDF The impact of play on child development
impact of play on child development - a literature review, European Early Childhood Education ... to be matched with children's age, type of play, research method, and learning outcome.
PDF Literature Review: Nature-Based Play and Learning
The literature that substantiates the benefits of nature-based play and learning draws from a broad range of related topics such as general exposure to nature, green spaces, and naturalized settings; active participation in outdoor activities; and garden-based learning.
Children's Literature Review
Children's Literature Review covers more than 750 authors, and includes entries on individual titles and topics in children's and young adult literature such as picture books, folklore and graphic novels. Entries are compiled by professional literature researchers and other subject experts who also write the introductions. Each entry includes ...
Literature review on early childhood education and care for children
Abstract This literature review provides an up-to-date comprehensive overview of what is known about process quality in early childhood education and care (ECEC) provision for children under age 3. It builds on empirical studies published in peer-reviewed journals between 2010 and 2019.
PDF Submitted to the Jessie Ball duPont Fund
access to play is changing, it has become a focal point for parents, researchers and educators alike. This literature review explores the benefits of structured and unstructured play and impediments to play from a multidisciplinary perspective. Environmental factors out of the child' s control may present as impediments or barriers to play.
Child-Centered Play Therapy for Youths Who Have Experienced Trauma: a
Results from the National Comorbidity Study-Adolescent Supplement indicate that the lifetime prevalence of PTSD for children ages 13 to 18 years in the U.S. is 5.0%, with females having a higher prevalence than males (8.0% and 2.3%, respectively) (Merikangas et al. 2010 ).
Parents' awareness, knowledge, and experiences of play and its ...
Play is an important childhood occupation and a medium for development. Parents' attitudes towards play, knowledge about play and its benefits, and their experiences in facilitating effective play are key factors that determine the experiences of play in children.
Early Childhood Literature Review Examples That Really Inspire
The Importance of Play to Children's Learning and Development in Early Childhood Program "Playing to Learn/Learning Literature 1. The Role of Pretend Play in Children's Cognitive Development by Doris Bergen; Miami University. ... This paper presents a literature review on the effects of autism in early childhood development. Autism is a ...
The Impact of Play-based Learning
with their peers. The play is facilitated by adults (Roden & Szabo, 2017). Play fosters and develops children's curiosity in the world. Through play, children are able to explore different types of materials. Through play, children learn life-long skills that will help them in the rest of their schooling and their adult life.
PDF The Benefits of Children's Engagement with Nature: A ...
children's healthy development, well-being and positive environmental attitudes and values. It also points to the value of more playful engagement styles. The findings are relevant to the development of educational and planning policy and practice, and to advocacy work. Keywords: children, nature, outdoor play, literature review, children's

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Literature Review on the Role of Outdoor Play in Children’s Learning

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Qualitative Research on Children’s Play A review of recent literature

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