This blog explores techniques and ideas that come from the Positive Behaviour Support Framework which you can read more about here
But why is play more challenging for children with disabilities and what can we do to help?
I will begin by briefly defining developmental disability. Developmental disability is an umbrella term that includes a diverse range of diagnoses which arise from an impairment of the central nervous system (Statewide Child and Youth Clinical Network, 2013).
Some of the common types of development disabilities include Intellectual disability, Down syndrome, Seizure disorder, Cerebral palsy, Fragile X syndrome, Deafblindness, Autism Spectrum Disorder, Global developmental delay and other genetic syndromes/disorders.
Having a disability can affect how a child plays, the kinds of play the child participates in and the learning that the child takes from the play activity.
Depending on the type of disability a child has, one or more areas of development may be affected. It is important to be aware of individual differences in the development and use of play skills as each child will have unique play abilities.
Hence, careful observation of children's interactions with objects and with people will provide a better picture of how a child's disability affects their play.
Following is a summary of some of the reasons why playing is so difficult for children with disabilities. This section discusses some of the difficulties that can arise in the acquisition of play skills when a child has one or more of the following disabilities:
- Physical Disability
- Communication Disability
- Intellectual Disability
- Sensory Integration Disability
- Sensory Disability
- Emotional, Behavioural and Social Difficulty
Physical Disability and Play
A physical disability is any condition that permanently prevents normal body movement and/or control. There are many different types of physical disabilities. Some of the main ones include Muscular Dystrophy, Acquired brain and spinal injuries, Spina Bifida and Cerebral Palsy.
The challenges faced by children with physical disabilities are often very practical ones and depends largely on how limited the child’s movement is by their disability.
The child may experience any or all of these difficulties:
- Difficulty holding things. For example, holding toys or pieces of a game or puzzle may not be easy, therefore, playing with those things becomes much harder if not impossible.
- Difficulty manipulating objects. For example, the child may not be able to dress a doll or stack building blocks without assistance. If this can’t be achieved, the play is disrupted.
- Difficulty in moving to or around a play area. For example, a child with a physical disability that limits their ability to walk will have difficultly travelling to a play area or play equipment even if it is relatively near, i.e. across the garden.
- Difficulty accessing play equipment. A child with balance or co-ordination problems may have particular difficulty accessing equipment such as a slide or rocking horse safely or at all without help.
- John’s wheelchair enables him to move around the play area,
- John uses a prone wedge to help him read his book,
- A plastic corner seat provides John with support so he can sit up and play with his toys,
- A walking frame with wheels enables John to move around the play area more easily and on foot rather than sitting in a wheelchair,
- John’s toy robot has been modified with a momentary button so that John can make the robot move by pressing the button where his physical disability would otherwise limit John’s ability to manipulate the robot’s movements by hand.
Communication Impairment and Play
A communication imprairment encompasses a wide variety of problems in language, speech and hearing. Individuals with Intellectual disability, Cerebral palsy, Down’s syndrome, Autism often have a communication impairment. Below are some examples of difficulties experienced by children with a communication impairment and how it impacts on their play skills:
- Knowledge and use of the structure of language e.g. statements, questions, instructions, comments etc,
- Comprehension i.e. understanding of what is said to them,
- Understanding and using a range of vocabulary,
- Clarity of speech.
Communication impairment can limit how a child interacts with other children during play:
- Difficulty joining in with other children’s games,
- Difficulty initiating play with other children,
- Difficulty in discussing or explaining their own play,
- Difficulty in discussing or explaining play of others.
During play sessions the child may have trouble being understood by other children and adults. This can limit their ability to express desire for certain play materials and equipment, express dislike of a play activity and connect with the other children and adults.
Intellectual Disability and play
Intellectual disability is the result of a multiplicity of causal factors such as faulty chromosomes or genes, exposure to toxins etc. However, many of the causes are unknown and unidentified. It has important effects on a child’s development and ability to independently participate in activities of daily living.
Intellectual disability can affect the child’s communication ability, attention span, thinking and play skills.
Children with an intellectual disability are unique, as all children develop at different rates.
Jon is 5 years old with a mild intellectual disability and uses his senses to become familiar with his toy dog and its physical features. He explores its visual, auditory and tactile qualities.
Shauna is a 5 year old girl with a mild intellectual disability. She lets the toy guide her to discover ways to use it and its pieces; for example, where to touch, turn or twist it, where to put things in or take them out.
Leonie is also 5 years old with a mild intellectual disability. She uses imagination and creativity to discover a number of ways to interact with her toy bear such as taking him for a walk, having tea with the bear and dressing the bear.
Sensory Integration Disorder and play
Children with a sensory integration disorder have difficulties with understanding and responding to sensory stimuli. Sensory stimuli includes: touch, taste, smell, sound, sight, movement and body position.
Sensory integration is a process of analysing, organising and connecting the sensory stimuli received by the child, to make sense of the world around them and produce a meaningful response to the stimuli. It takes place in the central nervous system, which consists of the spinal cord and the brain.
When a child has a sensory integration disorder they have inefficient processing of the sensory stimuli. This means that the central nervous system cannot analyse, organise and connect – or integrate the sensory stimuli.
Hence, the sensory integration disorder impacts on how a child perceives and reacts to sensory stimuli. A child may be under or over sensitive to one or more stimuli.
When a child is under-sensitive to touch, they may not feel heat when wearing warm clothes on a hot day. A child may also not be aware of mess on themselves and their clothes such as mud.
When a child is over-sensitive, they often dislike getting messy and dislike being touched by others.
Children that are under-sensitive to visual stimuli often have excessive interest in complex patterns or geometric drawings. Children may also be obsessed with bright lights whereas children that are over-sensitive to visual stimuli prefer to be in darkened rooms with much less to look at.
Under-sensitive children will always want to make lots of noise and be fascinated with loud banging. For example, clashing saucepan lids together.
Over-sensitive children are very often distressed by loud noises and will place their hands over their ears when loud noises are going on.
Taste and Smell
Under-sensitive children will often taste or lick their toys before and during playing with them.
Over-sensitive children might refuse to play with a particular toy because of the way it smells.
Movement and Body Position
If a child is under-sensitive to movement and body position, they will likely actively seek physical activities and even engage in more risky behaviours such as climbing on furniture.
Over-sensitive children will simply avoid physical activities where possible such as sports and physical games.
Sensory (Vision and/or Hearing) Disabilities and Play
Children with sensory disabilities have a vision or a hearing impairment. This results in difficulties with how they receive and express a message. Below are some examples of difficulties experienced by children with a sensory disability and how it impacts on their play skills.
Difficulties for a child with limited vision
- Difficulty with orientating to the play area and materials,
- Difficulty in exploring materials,
- Difficulty copying/mimicking others,
- May have to explore toys by putting them into their mouth.
Difficulties for a child with limited hearing
- Difficult with language and speech skills,
- Cannot respond adequately to other children’s play invitations,
- May be seen as not wanting to play by others,
- Limited opportunities for social play as they appear to be unresponsive.
Keisha is a three year old girl with a severe vision impairment. She is unable to see other children at a distance. She is dependent on others to let her know who is present and guide her to join in the play.
Lucy is a five year old who has a hearing impairment. She can’t hear explanations and so is extremely fearful of new things.
Emotional and Behavioural Disorders
Emotional and Behaviour Disorders are are more than just naughty behaviour. They are related to how the child copes with life stressors which lead to disruptive behaviour, emotional and social problems. Below are some examples of difficulties experienced by children with an emotional, behavioural and social disability and how it impacts on their play skills.
A child may not be able to participate fully when engaging in play because of:
- Poor motivation and low confidence,
- Poor social skills which disrupt interactive play,
- Aggressiveness which can lead to destruction of equipment and hurting others,
- Inability to use toys appropriately.
Aileen is a three year old girl with cerebral palsy and finds it difficult to reach and grasp things with her hands unless they have large handles or knobs to grasp.
She found playing with small puzzles very frustrating as she was unable to take the pieces out. This affected her confidence and resulted in her refusing to play with puzzles.
To increase her self confidence her mum found wooden puzzles that had extra-large knobs. This made it easier for her to get the pieces in and out independently.
Vygot is a four year old with Down Syndrome who finds it difficult to follow through with challenging activities and attempt new activities independently.
To motivate him his mother attempts to offer him a choice of new vs. old and easy vs. challenging play opportunities. She provides him with extra support when he is engaging in new and challenging play activities.
Shaun is a five year old boy with Lesch - Nyhan disease. He becomes aggressive following positive play interactions with others, if the child or adult person gets too close physically. Shaun will pinch or hit the other child or adult.
Being reluctant to share
Jason is a four year old with an intellectual disability. He has difficulties with sharing his toys and making joint decisions with others.
Being unwilling to take turns
Shauna is a five year old girl with Rett’s syndrome who loves to have a lot of space and to play with toys by herself. When other children want to take turns in playing with her toys she will bite her hand in frustration.
Inability to give and read non verbal signals
Nula is a five year old with Autism Spectrum Disorder and has difficulties with expressing and understanding non verbal communication. Nula appears to be aloof, displaying almost complete indifference to other children who are playing with her because of this lack of understanding. Hence, she doesn’t pick up when they are bored or frustrated or excited.
Play is an essential part of growing up. The benefits of play influence all aspects of development. This article highlights some of the areas that caregivers, educators and professionals can focus on to help children with disabilities develop these critical skills.