We’re back! Finally…after a very busy February and March at work, we are back. I want to speak on something that I think about often, which is the route we as pediatric occupational therapists could be taking our practices. The title “untapped” potential is a little misleading, since I do know of OTs who are making some efforts in this, and that is our potential to make “play” more of a specialty and a priority in our OT practice, and in turn affecting important areas of society…and in turn….likely preventing a lot of the issues we treat. Here’s to creating a preventive rather than reactive medical system…

Here’s what I’ve seen so far in pediatric OT that is really disappointing to me: We claim to be occupation-centered. We then claim that play is a child’s primary occupation. We then claim to use play as a means of accomplishing OT goals. From what I’ve observed in typical OT sessions across a few different locations, we don’t seem to have any true understanding of the occupation we claim to be experts on. 

Here’s what I mean. 

I’ve followed a lot of Peter Gray’s research. For those of you who are unfamiliar, Peter Gray is a researcher at Boston College in the areas of psychology, anthropology, education, and the importance of play and its role in education. He wrote a fantastic book called “Free to Learn” that everyone should read and that I will likely speak on more at a later date. In following some of his research, I’ve learned that most children do not consider any adult-led or adult-involved activity play (now I’d argue that children raised in certain cultures that may not have been included in this research would consider household work alongside adults as a form of play…but that is a different topic for a different day, and I’m mostly speaking on the children in Western cultures, especially English-speaking cultures). 

THIS MEANS, that when we say we are using “play” or “playful activities”, chances are the child does not truly experience this as play. They may have some fun with it, but play in its truest form looks very different than what we often come up with and label as “play”, and I think our peds courses in OT school should’ve delved much further into the intricacies of play, because it should drive everything that we do. 

And plenty of times I’ve seen therapists skip any sort of attempt at the play thing altogether and go straight to calling their sessions “work”. 

“First work, then __(name any preferred activity including “play”)” 

I already feel that we use bottom-up, non-functional approaches way too often for being in a profession that claims to be occupation-centered in everything, but now we’re not even attempting to place those bottom-up approaches into some sort of attempted functional “play” context. Now we’re just straight up putting kids to work in OT! Very therapeutic! 

While some bottom-up approaches may have a time and a place, I think we’ve got our priorities a little off kilter. For example, I think we often become overly consumed by a child’s ability to follow adult-directed tasks, and be able to sit still when we want them to, and make sure their sensory systems are regulated (another rabbit hole for a different day…), and make sure they can do their pre writing strokes and use a tripod grasp and balance on one foot and complete obstacle courses and, and, and….do anything but be a child and PLAY!!! How often during evaluations do we ask questions like:

“How do they like to play?”

“What do they like to play with?”

“Where do they like to play?”

“Do they seem satisfied in their play?” (are we missing the reality that they may be perfectly content in play schemes that we don’t deem good enough, and be approaching certain age-appropriate play experiences at their own pace, which is in fact a fantastic form of self-regulation) 

“How often do they play outside?”

“What is your attitude toward risky play?” 

“How much screen time do your kids engage in, and with whom?” 

Versus the amount of time we spend testing reflexes, spinning them on a swing, filling out sensory profiles, taking ROM measurements, etc. etc. the list goes on. 

Again, a time and a place for those things, as well as non-play occupations such as completing ADLs (which could be argued as play if approached the right way). But how often do we think to ourselves, “is this child engaging in tons of outdoor play everyday weather permitting, and what factors are affecting their ability to engage in this most important occupation?” 

Our evaluations and treatments should largely be centered around helping kids engage in PLAY, because it is through PLAY that they do their best learning and development!!! 

Have a client with cerebral palsy? Don’t be the umpteenth therapist concerned about their ROM…DOES THE KID PLAY?! Does the kid get to just be a kid?! Or are we just another one of their many indoor appointments they’re shuffled around to? We as OTs have so much potential to ADVOCATE for every child’s right and ability to play, and we don’t!! Or we think we do. We do cutesy activities labeled as “play” to secretly work on our ROM agendas (or whatever agenda you have for your particular client), but who’s making sure that they’re getting outside or engaging in functional play/leisure activities like every other child would/should be doing??! 

I think it all comes back to returning to the basics. We come up with all these fancy-sounding things like Zones of Regulation and obstacle courses and tweezer activities and crafts that teachers can also implement…but we don’t stop and realize that kids are overbooked, addicted to technology, overprotected, and just not spending the hours they need engaging in play, which carries a lot of the burden in making sure a child develops. Sure, some kids will need a little extra help, but if they’re not even getting that basic need, what are we even doing? Do we not even know just how much time a child should be spending in active free play? At least a couple hours daily. How many hours does the average American child get instead? Not hours…minutes. Approximately 7 minutes I think is where the number is at right now. And even if it’s more, consider how much of it is in front of a screen. 

It’s like returning to the basics of eating good food, getting good sleep, having good parenting practices…contributing to the household…being connected and grounded in nature (something the majority of children enjoyed for the vast majority of history)…playing…………….

Even if you’re an OT who hates nature, too bad. Our kids absolutely need time to be grounded outside, engaging in independent and mixed age free play. If we learned more about this need and its huge effects on development in OT school, I think a lot of us would be doing things differently and taking not only a preventive approach, but also incorporating this more into our therapy. We could have a serious impact on the ridiculous increase in families seeking OT services. Especially for regulation issues, which currently is the majority of new intakes at my work!! Let’s advocate for returning to the basics instead of always trying to put fancy-looking bandaids on issues. 

I have thoughts on all this relating to our role in the school system, but that is for a different day, as this post is now approaching 4 pages in my Google Doc. 

Until next time,

The Inquisitive OT 

🙂