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Healthy Play among Children

The manner in which a child plays has been a topic of interest for many disciplines for numerous years. Child development professionals study how play affects the domains of development. Educators theorize how play develops a child’s intellect. Mental health professionals are interested in how play assists in developing emotional health. Although many are interested in the outcomes of play, few question the fact that children use play for many things. Wilford (2005) reported that play serves as a learning mechanism for language, symbolic thinking, concentration and creative thinking, while McArdle (2001) suggests that play is central to personality development.

Due to the important effects of play, it is distressing to recognize that there are instances in which healthy play can be interrupted, possibly leading to difficulties in a child’s development process. For example, when a child experiences a traumatic experience, play patterns may shift and become more dysfunctional. Dysfunctional play implies that a child can become more aggressive or alternately, withdraw from normal play patterns. This research project was focused on the importance of play and how trauma can interrupt the healthy development of play. Although the project took place within the areas affected by Hurricane Katrina, the research focus would be on trauma in general not just that related to the devastating effects of the hurricane Katrina.

Statement of the Problem and Purpose

Many children, who experience trauma, including that of Hurricane Katrina, lack the ability to return to a level of healthy play, which can prevent the progression of normal child development. The problem addressed in this study is that children who experience trauma are not returning to a healthy level of play, which in turn, can impede important developmental milestones. Play is an opportunity for children to learn to express themselves and learn to navigate through the world. When children have experienced a traumatic event, play becomes a platform in which a child can work out unmanageable or threatening situations. Whereas adults can think and reason in a more abstract manner, children use play to “symbolically work through” frightening or uncontrollable circumstances (Kagen, 2007 p 11). In working with sexually traumatized children, Gil (2006) suggested that play therapy is an excellent approach for treating trauma. Gil also explains that traumatic memories are embedded in the right hemisphere of the brain, which is also the hemisphere that is known to be the “most receptive to nonverbal strategies such as symbolic play, creativity and pretend play” (p. 68). Symbolic play refers to role playing; while creativity play seeks enhance a child’s ability to come up with original ideas. Pretend play is almost synonymous with role playing.

Purpose of the Project

The major purpose of this dissertation was to determine whether implementing a play group, as a therapeutic approach to traumatized children, twice weekly for eight sessions, would increase the level of healthy play and decrease the symptoms of trauma in children. The project would allow the writer to research the effects of trauma on children’s play and explore the benefits of an organized, structured play group in ameliorating traumatic symptoms.

Childhood trauma is a difficult area to address, bearing in mind that different children respond in different ways to given traumatic experiences. Human behaviour is not like a scientific phenomenon that can be pinned down in a laboratory and standard specific principles, rules or procedures applied.  The Diagnostic and Statistical Manual of Mental Disorders (DSM) did not address childhood trauma until its third edition in 1980 (Ogawa, 2004). According to Vogel and Vernberg (1993), the first studies or recognition that trauma even had an effect on children were completed by Perry in 1956 on children who had been in a theatre during a tornado. It was not until 1991 that a solid definition for children with psychological trauma was provided. Such a relatively new field will require further research as traumatic experiences that affect children are steadily increasing, such as terrorism, war, abuse/neglect/rejection, and natural disasters. Professionals on the front lines will need effective strategies and interventions to prevent dysfunctional growth and development of children, especially those affected by trauma.

Background and Significance of the Problem

Children who have been affected by hurricanes, sexual abuse, neglect, violence, and/or poverty often exhibit symptoms that inhibit the ability to play. “They may lack the confidence, social development or emotional development to have successful play experiences (Gross, 2006, p. 4).”

This problem is being exhibited throughout the workplace of the writer. The writer is in private practice alongside two other therapists and one psychologist. Each practitioner has a full caseload, including clients with trauma related concerns. During office meetings, a theme of trauma and its effect on play had been identified. Some of the specific effects mentioned included a radical difference in the manner in which a child plays, such as aggression and/or withdrawal.

Although the practice is located in an area highly affected by Hurricane Katrina both directly and indirectly, it was not the intent of the writer to focus only on hurricane-related trauma. Many of the children seen in the practice have experienced other types of trauma, such as child abuse, neglect, domestic violence, or exposure to traumatic experiences. Children who have experienced any type of trauma were included in the recruitment efforts and invited to participate in the project.

The researcher is a Licensed Clinical Social Worker in private practice. She is both a Certified Parent Educator and a Certified Trauma and Loss Specialist. The focus of the writer’s practice is trauma and its impact on children. She is a lifelong resident in South Mississippi and continues to be active in the community. The researcher is a member of the local children’s advocacy team, which serves as a multidisciplinary network of professionals who meet to develop strategies to better serve the children within the community.

The researcher is a member of the training team of Project Joy, an “organization that uses play to strengthen and heal children whose lives have been deeply impacted by trauma” (Gross, 2006, p. 1), and has been involved since the pilot training of professionals selected to train other professionals who work with children. The researcher is also employed as a consultant by the State University’s Early Childhood Institute. The major responsibilities of this position include training, supporting and mentoring those who have received the Project Joy Training.

This project fitted well within the researcher’s qualifications and responsibilities within Project Joy and also was easily integrated within her private practice. The researcher recommended a plan for this project, oversaw its implementation, analyzed the results, and also intended to pursue action steps toward facilitating change.

Definition of Terms

Play is considered the work of children, which is to say that they are those activities that children perform for the sake of self-amusement. These activities bring with them behavioral, psychomotor and social rewards. It is also a medium through which children express themselves and learn to gain control of their feelings, actions, thoughts and outlook on life. It provides freedom because it is the platform on which ego is developed (Alicia & Richard, 2010).

A working definition of trauma was necessary in order to move forward in this project. It was not until 1991 that Terr offered a solid definition of psychological trauma in children as being “the mental result of one sudden, external blow or a series of blows rendering the young person temporarily helpless of breaking past ordinary coping and defensive operations” (p. 11). At this time, Terr (1991) also divided childhood trauma into two categories: Type I and Type II. Type I trauma includes s single, sudden and unexpected stressor, such as a hurricane, flood, shooting, etc., while Type II describes trauma that is long term, such as repeated abuse and/or neglect (Terr, 1991). This project was offered to both Type I and Type II trauma victims.

A deeper study of trauma will also address the topic of secondary trauma. Secondary trauma is an indirect exposure, which can be a firsthand account or a narrative of a traumatic event (Zimering, Munroe and Gulliver, 2003). Secondary trauma can result from having a close contact with a victim of a traumatic event, which includes those who assist trauma victims (Figley, 1995).

Dysfunction play is also a term that will appear frequently and is used to refer to ‘abnormal engagement recreational activities that should under normal circumstances not be exhibited in a child during play. For example, a child may suddenly attack other children and cause them bodily harm, and yet show no regret for the action. This could probably triggered by a traumatizing event that occurred in the child’s life. This attack could probably be a clear signal that the child is still suffering from the effects of the trauma (Alicia & Richard, 2010).

REVIEW OF RELATED LITERATURE

In order to explore the effects of trauma on how a child plays, it is necessary to look back at previous research to create a foundation of support. Related literature is discussed in the following areas: a) the significance of play; b) the effects of trauma on play; c) intervention modalities; and lastly; d) assessment tool research.

Significance of Play

There is a common adage that goes- all work with no play makes Jack a dull boy. Play in children is a much needed activity and there is always more than meets the eye when a child is able to engage in play, whether it makes sense to an adult or not. Proper child development studies show that all children play. From the time one is born, play is a method used to connect with others, socialize, learn, and simply have fun. In other words, play contributes to the social, physical and emotional well being of children and youth (Jeana & Emily, 2007). More importantly, through play, parents can be able to utilize the moment to connect with their children. This also has been recognized by the United Nations High Commission for human rights, which recognizes play as a right for each and every child on planet earth. Unfortunately, children are being raised in an increasingly hurried and pressured lifestyle that they are left with no time for play and relaxation. Play is therapeutic, not only for children but for adults as well. It is through play that one is able to detect any malfunctions and a digression from the normal course of development that may otherwise not be easy to detect in seemingly normal children not engaged in play. Children are born with an innate urge to learn new things, explore and utilize some innate talent that is within them (Jeana & Emily 2007).For example, it is evident in many children that at the time they learn how to start walking, they in many cases resist being carried around, as they want to explore the new ‘discovery.’ Play is also the building block through which children are able to develop skills that will be essential in the latter stages of his or her life development. Just to elaborate on this, it is not uncommon to find children engaging in play and games in which they imitate people who are way beyond their age. They play pretending to be doctors, engineers, teachers, surgeons, and teachers, name it!

Children of all ages play in various methods and play is exhibited in a number of ways in children of different ages. In other words, progressive play forms the benchmark on which the development milestone of a child can be measured. Play is a very powerful tool for the healthy growth and development of children (Wilford, 2003). Through play children form relationships and attachments, explore their environment, and develop a sense of competence and self-worth (Gross, 2006). Outdoor games, especially, help a great deal to nurture the sensory-motor development of a child. Sensory motor development of a child refers to ability to coordinate between the muscles of the various body parts and the five common senses of touch, taste, smell, sight and hearing. In short, it is the interaction between sensation and movement. It is this development that facilitates a jerk when one is stung or pricked by a sharp object, for example. It is the development that causes a child to kick and toss when there is pain in his tummy. This is because, the senses are at work, and they send a message to the brain, which then sends a message to muscles in the body parts to cause the movement or reaction. How then does play promote this sensory-motor development? During play, when a child gets physically hurt, the most natural reaction would be for him or her to give out a loud cry in order to attract attention. This means that there is an interconnection between the sensory organs and the rest of the body, which would otherwise be hard to develop when a child is idle and inactive. Sensory-motor development can also be gauged through a child’s ability to walk, move up and down a stair case, move around a room, play on the playground, feed themselves properly when they are of age and sit on their own and maintain balance. When defects are noted as the child plays, then it becomes possible to administer the proper intervention strategies. A child whose sensory-motor development is not well coordinated is likely to exhibit signs like frequent and unpredicted loss of balance, inability to keep up with others in play activities or even in class, difficulty in getting dressed, fear of movement, under reaction to painful or uncomfortable touch experiences (Kenneth, 2007).  

Wilford (2003) states that play is young children’s natural learning mechanism because it can extend language, expand symbolic thinking, enhance negotiation skills and life or survival skills like defense mechanism and also support concentration and flexibility.

Learning theories in relation to play

To support the importance of play in learning for children, several scholars and theorists have come up with theories that attempt to explain the concept. Learning has been defined as a process that attempts to merge environmental/social, cognitive/mental and emotional influences and experiences in order to influence the way in which one thinks and view the world. Explanations as to what happens during the learning process are what constitute the learning theories. Learning is a very complex process, as people learn differently and interpret their learning experiences differently. Learning theories have two main aims, one of which is to provide us with a conceptual framework and the language with which to attach meaning to the learning examples that come our way. The other purpose is to suggest where we can look for solutions to practical problems. In our case therefore, we shall be applying learning theories for the purpose of looking for a practical solution as to how play can influence learning in children. Learning theories fall under three major categories which are behaviorism, cognitive and constructivism. Behaviorism theories are those that focus on the observable aspects of learning, while cognitive dig a bit more to try and understand how the brain responds to learning. Constructivism theories look at learning as a process through which a person is able to build new concepts and implement them successfully. Among the behaviorism theories put forth are the classical conditioning theories and the operant conditioning, both in which it is assumed that learning is manifested in change in behavior, reinforcement is central to formulation of desired behavior and that the environment shapes behavior(Alicia and Richard, 2010). These theories were put forth by one B.F. Skinner and further developed by the likes of Pavlov, Hull and Thorndike.  In classical conditioning, behavior is seen to be a reflex response of a given stimulus. In play for example, children at the school going ages have learnt to associate a bell at a certain time of day with time for break, hence time for play. After the bell rings, the concentration levels of the children in class will most likely go down if they are held in class any longer instead of being let out to play.  It will be easy to detect a traumatized child from such a class setting, if they reach a point that they no longer show interest in the ring of the bell at break time (Danny, Ruth. & Julian, 2008).

In operant conditioning, behavior is reinforced or it diminishes depending on the rewards or punishment that the learner is exposed to when they behave in a certain way respectively. In play for example, a child will be motivated to engage in play activities even though they may not like it when they know that they are likely to be rewarded. In the same breath, a child will keep off from those activities they know will earn them a punishment. A traumatized child is likely to behave in a manner likely to suggest that neither rewards nor punishments move them, especially a traumatized child who exhibits the trauma through aggression (Kathleen, 2007).

The cognitive theory proposes that observation on learning should be looked at with an aim of establishing patterns rather than looking at isolated events and trying to formulate an explanation. Cognitive theories assume that the memory is a system that is organized as an active information processor and that prior knowledge of something facilitates speedy learning. Cognitive theorists emphasize on the physiological processes of sorting, coding, encoding ad decoding of information into the long and short term memory and believe that the learner is a more important factor in the learning process that the environment in which the learner is. If the cognitive abilities of a child are not developed to a certain level in a certain age, then it is a likely indicator that something is not all okay with the child and trauma could just be one of the problems (Kathleen, 2007).

Constructivism theories on the other hand look at the creativity levels of a learner and how they increase and build up as a result of learning. The theory supposes that knowledge is constructed when the learner(s) are engaged in social activities that aim at sharing problems or tasks. This is a theory that is very much applicable in the detection and intervention in a case of a traumatized child. This is because an observer of a traumatized child can look out for the impacts or lack of them of self-directed learning, situated cognition, experimental learning, transformational learning and reflective practice. The theory is an active learning theory, and any child not showing any interest in the process is a subject of closer analysis.

Learning theories play a great role in helping us explain why children behave the way they do in their developmental years, as well as help us establish any diversions from what should otherwise be the norm. However, we should remember that theories only give us a framework on which we can base our arguments and help us arrive at a conclusion, but they cannot be over generalized to all children because they are unique individuals. 

Play is designed to contribute to the preparation of children for adult life and adult responsibilities (McArdle, 2001). To begin with, it prepares children for school. As children grow, being engaged in play helps them to acquire and strengthen their listening, language and social skills, which are crucial in their school going years. Many play activities, if used properly, play a great role in balancing the multi-sensory abilities of a child by making a child able to learn, understand and recall things through touch, sight and sound. For example, play activities that involve rhythmic tunes and words sharpen a child’s memory and enhances his ability to learn a language and consequently learn to speak. Child development experts say that it is very necessary to help a child develop oral language skills, more that it is to help them develop cognitive skills. In other words, frequent talking to a child will enable them to pick a language fast than teaching them to recognize numbers and letter sounds. Play should not be undermined because as experts continue to say, it helps a child to master math skills and therefore, engaging children in play activities that involve counting numbers of objects, say in a sack. In addition, it is crucial that during play, parents and guardians teach their children the relationship between opposites like short and long, thick and thin, less and more because then, it is easier for them to memorize and form quick recognition abilities. The impact of repetitive play cannot be undermined. Gross (2006) provides a list of the functions of repetitive play: “leadership, connection, self-esteem, wonder, pride, strength, compassion, empowerment, teamwork, imagination, laughter, passion, and joy,”which are not easy to come by in children that do not engage in play (p 2).

These factors, which can be enhanced through play, can be explained by the Practice or Pre-existence theory by Saracho & Spodek, 1995. The theory proposes that play helps children to learn survival skills that will be crucial for survival in their adult years. This allows them to perfect the above mentioned skills like those of leadership, strength, empowerment and most importantly, teamwork. The Pre-existence theory of play states that if children are able to navigate their mental world through play and find meaning in it, this would do them more justice than when they sit in class to listen to a teacher and learn new concepts. What this theory emphasizes on is that children need the freedom to first explore the world and discover it in their own way, before they can be taught about it by anyone else. Self discovery, questioning and answering helps the child to grow at their own pace. This is what Spodec and Saracho refer to as modern concept of play as a medium for learning (Peter & Maggie 2006).

From another perspective that can be found in the encyclopedia of play, functions of play can be classified into physical, cognitive, emotional, social and moral development. Physical development has been discussed in greater detail in the sensory motor development of a child. As children play, they repeat certain body movements that build up muscles and help them develop body control, although children engage in these movements purely for pleasure and without giving much thought to it.  Emotional development can be enhanced through role playing, especially for children who are anxious and emotionally unstable, and this is where play therapy comes in for children who have suffered traumatic experiences. Through role playing, a child is able to escape into fantasy and to hence deal with emotional conflict. In addition, when a child shares a game or play activities with a parent, sibling or significant other, the child’s self esteem gets a boost and he learns the essence of self importance. Interactive play helps a child to develop a deeper outlook of the world and places him or herself in it. Play, in cognitive development, helps children to exercise their ability to think, reason, bring to memory and solve problems. They develop ability to test their beliefs about their environment and the world at large. Furthermore, it is through play that children are able to enhance their language skills through repetition of words, through song and sound recognition. They are also able to organize their thoughts and pass a message or simply communicate. Through solving games and puzzles, they strengthen their problem-solving skills. In social development, a child begins to identify with others around him and with objects and differentiates between self, others and objects. The child learns to relate with others and respond appropriately. As they grow older, they enjoy contact and play with others. They learn about boundaries, importance of sharing, teamwork, taking turns, competition and negotiation. In social development, they also develop virtues like patience and kindness and they learn to shun vices like selfishness and arrogance (Encyclopedia of Children's Health).

In moral development through play, a child is able to learn the behaviors that are acceptable in society and those that are not. They get used to the norms of society, learn to control aggressive behavior and identify with role models they admire. Parents and significant others can emphasize on moral implications through reading stories to these children, helping them identify the role models in the stories and emphasizing the importance of  upholding good morals. They learn to appreciate teamwork and respect other people’s feelings. Aggressive behavior is exhibited through kicking, biting, excessive screaming, uncontrollable anger, tantrums and bullying others. It is important for parents, teachers and significant others to realize that continued aggressive play could be an underlying symptom of deeper problems in the child psychologically or emotionally.The aggression becomes an avenue through which the child develops a coping mechanism for whatever it is that is bothering them. Aggressive play is caused by a number of factors, among them being trauma and others being a need for self defense, lack of adult supervision, exhaustion, extreme frustration or anger, lack of routine, stress, projection of other’s aggression or even inadequate speech development such that aggression remains to be the only avenue through which the child can express themselves (Peter & Maggie 2006). Among the ways in which parents and significant others can deal with aggressive play in children is by first teaching the child that aggression is wrong.

This is by talking to the child during a calm moment about aggression, and repeating it time and time again to the child. Remember that children learn through example. As such, it is important for parents not to scold children when they are correcting their aggressive behavior for aggression only begets aggression at its best. Train your child to use a verbal instead of a physical approach to dealing with feelings of anger, frustration or self defense.  Instead of hitting your child when they display aggression, it is better to walk up to them, help them find their voice and exercise diplomacy. Teach them to say no to what they do not want instead of turning physical. Help your child to practice other ways trough which they can diffuse their anger. As you do so, make sure that you do not raise your voice to your child; otherwise they may end up picking that negative aspect and use it on others.

Let them learn self control from you as a role model. As you try to correct the aggressive play, keep in mind your child’s limitations. For example, if his aggression targets a particular child during play, you could restrain him from going to the play group until he learns to control himself. However, intervention may not always work in the positive and the habit may only become worse. A pattern of continued deviance, disobedience and hostility towards a parent of figures of authority may be symptoms of a more chronic problem (Kathleen, 2007). They are characterized by frequent easy loss of temper, spite and vindicate, ongoing anger, constant arguments with adults, laying blame on others, chronically touchy and engage in annoying behavior knowingly. This may require professional attention. Aggressive behavior in play can more deeply be understood through the catharsis theory as put forth by Freud Sigmund. Catharsis refers to an emotional release that seeks to ‘cleanse, purify or purge’ ones emotions that have been tampered with. However, this in many cases happens without the conscious knowledge of the person releasing the emotions. A child who is not able to vent out feeling of frustrations, anger or stress verbally may do so physically without even realizing it. The effects are that the child expects to obtain mercy, attention or pity from anyone who cares enough to want to find out what could be wrong with the child. However, it has not fully been established what effects catharsis really has on a child’s ability to cope with a disturbing situation, although it is said to predict a decrease in the aggressive behavior (Richard, 2004).

Types of play

There are several ways that children play. As development occurs, children learn different ways to play. For example, some children play by themselves while others play in groups. At some point in normal development, parallel play occurs, which is when one child plays alongside another without engaging each other, other psychologists argue that this occurs in rare circumstances (Luckey and Fabes, 2005). Parallel play is common in very young children and in it, each child engages in a separate independent activity; don’t worry that they may be in a group. However, this sort of play is considered normal, up to the age when the children are fully toilet trained. If the continue to exhibit symptoms of parallel play, it may be a strong indicator of some play dysfunction, according to child psychologists. These diverse types of play facilitate different learning environments. During non social play, a child can learn imagination, creativity and independence. Non-social play on the other hand refers to play patterns that exhibit repulsion towards other children. It is different from parallel play in that, while in parallel play a child may sit in a group with others and actually perform the same activities with the rest but independently, in non-social play the child completely has nothing to do with others, probably because they want to discover things on their own and be creative without imitation, which may be present in parallel play. Then there is also the social play which is characterized by a lot of interactions among the children who play as a team with a common objective or goal.

One distinct difference between parallel play and social play is that during parallel play, social behavior is introduced as children observe each other, but do not engage or interact. Social play on the other hand teaches peer interaction and other social skills, such as cooperation, teamwork and problem solving. Non social play can be caused by a number of reasons that range from the sheer fact that there are some play tasks that are easy to achieve independently to more complex reasons like the need for solitary time for self-reflection and self-regulation. Yet still, there are some children that are just not able to engage others in play (Richard, 2004). 

One thing that scholars in the field of child development have found to be crucial is that play should be child-oriented, as often and much as possible. This means that a child should be able to initiate the kind of play or game that they want to engage in. this in itself enhances creativity in a child, helps them to develop leadership skills, boost his self confidence and feel appreciated, especially when the game or play activity is received well by others involved. This is especially so when each individual child comes up with his or her own idea, instead of the whole group as one. However, there are times that play will be initiated by a significant other, say a teacher or a parent to the child. This kind of play arrangement is mostly common in situations where there is need for the person initiating the play to monitor a given factor. In such cases, the play is normally pre-planned and this is the kind of play that is used in therapeutic sessions, say for example for children who have gone through traumatic experiences. Some schools have adopted this structured learning environment characterized by play, in which the teacher is able to work on the weak areas in the children (Jeana & Emily 2007).

Characteristics of play behavior for children across all ages, domains, and cultures

It becomes relatively easy to distinguish healthy play from unhealthy play when there is knowledge of what play constitutes and how children ought to respond to play activities regardless of where they come from or their culture. Play here has been used to refer to all leisure activities that children engage in for fun. Some of the features that accompany play are; play is intrinsically motivated and self-initiated, is non-literal and pleasurable, exploratory and active, is process oriented and  rule-governed, especially when in occurs in a groups These features make play both a process and a product. As a process, play provides a conceptual framework in which the child learns and gains an individual understanding of skills, concepts, and dispositions. Play as a product on the other hand, provides a platform on which children can demonstrate their understanding of skills, concepts, and dispositions (Fromberg, 1998, 2002). 

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