Inclusion of Children with Disabilities in Free Risky Play

Original Editor - Andrea Sturm Top Contributors - Special Contributors/ Inclusion of Children with Disabilities in Free Risky Play

Original Editor - Andrea Sturm
Top Contributors - {{Special:Contributors/Template:Inclusion of Children with Disabilities in Free Risky Play}}

A child’s right to play is enshrined by article 31 of the United Nations Convention on the Rights of the Child, however, this right is not always met appropriately by institutions, governments and policymakers. Play also includes physical activity, which is crucial for children to maintaining their healthy social, physical and psychological development. About 80% of the children around the globe do not meet the recommendations of the WHO for 60 minutes of moderate to vigorous physical activity per day. But it is not just the intensity that is relevant for health benefits of physical activity for health, especially in children with disabilities. The importance of global psychosocial experiences such as satisfaction, enjoyment and perceptions of inclusion have been highlighted as well. Ross et al. (2016) define participation of children with disabilities in physical activity as follows:

“Physical activity participation describes “experiences in physically demanding movement, sport, game, or recreational play that results in energy expenditure and perceptions of communal involvement.”

Physical activity participation of children with disabilities can be qualified by:

1. Level: the frequency of attendance and intensity of physical exertion
2. Quality of experience: self-perceived feelings of social inclusion, enjoyment, self-efficacy, and satisfaction
3. Overall profile: the extent to which a child’s level of participation matches their expectation for a quality experience

Especially for a child with disabilities, the definition of participation in physical activity cannot be restricted to health and physical outcomes. Physical activity of children with disabilities is rather a broader health experience, situated within a dynamic child-environment interaction, which acknowledges the aspects of the quality of the experience. Underestimating the abilities of a child with disabilities in taking part in physical activity and play can result in lower expectations and fewer opportunities, and reduce their engagement in health-promoting behaviours. When children with disabilities engage in moderate to high intensity physical activity during their childhood, it can reduce their predisposed risk for the development of secondary health conditions such as non-communicable diseases. Enjoyable physical activities will foster childhood experiences that nourish the psychosocial development of children’s interpersonal skills, their self-confidence and self-efficacy. To increase their children’s participation in physical activity has been described as a primary goal of both parents and professionals in childhood disability.

In general, children strive to perform thrilling and exciting play activities that involve some kind of risk such as climbing or jumping at great heights, swinging, playing or engaging in rough and tumble play. Free risky play offers opportunities to master age-adequate challenges, manage fears and to learn life skills. Reasonable risk taking in play is a fundamental factor in emotional development, and the development of gross motor and cognitive functions. Children’s opportunities to engage in free outdoor risky play is limited by social and environmental factors, and adult’s concerns, which compromises their overall health and wellbeing. To engage in free and risky play is even more crucial for children with disabilities than for their peers without disabilities. A lack of accessible playgrounds or overprotective attitude of caregivers are major barriers, preventing them from fully benefiting from this kind of play experience. Social exclusion of people with impairments has been supported by applying a medical model of disability, which located disability within individuals and their bodies. Based on this model, health interventions, including physiotherapy, aimed (and sometimes still aim) to eliminate or ameliorate individual characteristics of children’s impairment. This kind of thinking minimizes any consideration of disabling environmental and social influences. Sometimes impairment is considered to be a biomechanical, physiological or cognitive condition. Consequently, disability is the experience of impairment as it is structured into a society, and is socially created. Using able-bodied children as a frame of reference contributes to an attitude of wanting children with disabilities ‘to do things normally’ rather than to accept the ‘normality of doing things differently’. Indigenous children with disability are considered to have a ‘triple disadvantage’ because of additional limitations that they experience.

Children with disabilities need the opportunity to express themselves, including in education and health service contexts. It is important that children with disabilities can experience enjoyment and be able to exercise appropriate control over their lives and activities. Not surprising, children with disabilities experience therapy more positively when it is fun, pleasurable and/or engaging. They also perceive the repetition of particular aspects of therapy sometimes as dull and boring. Of course, such interventions are promoted to prevent changes at structural, functional or activity levels through regular repetition. Nonetheless, besides being boring, such interventions may be uncomfortable, painful or limit children’s opportunities for participation in other activities or roles. Families reported tensions and parental stress of imposing sometimes painful exercises on their children. Parents struggle with situations where home programmes may be addressing long-term rehabilitation outcomes, but potentially harming children in socioemotional ways.

So, why do health professionals not make use of the benefits of outdoor activities (for both children with disabilities and their caregivers) and risky play? The Australian Physiotherapy Association explicitly recommended that children should actively engage in risky play to counterbalance the negative trends of physical inactivity due to the COVID-19 pandemic. Research suggests that physiotherapists should develop processes and practices for children with disabilities that are fun, engaging and affirming to each individual child in every moment of interaction. This suggestion applies also to the construction of home programs, which could be based on an understanding of participation in outdoor physical activity that includes also the quality of the experience, as suggested by Ross et al. (2016). This could counterbalance that opportunities for children with disabilities to spend time in natural environments with their families are less than for able-bodied children. Different commitments of family members and organizing therapies occupy a great deal of caregivers’ time, leaving little chance for outdoor recreation. Combining physiotherapy or occupational therapy and outdoor activities either in the therapy-setting or when creating home programs can contribute to pleasurable, positive relationships and achievements which are valued by children with disabilities.

Playing freely outdoors and having access to natural environments is particularly important for children with (multiple) impairments. Sensory exploration of smells, textures and sounds of outdoor spaces can enhance children’s awareness and appreciation of natural environments, and contribute to their happiness, wellbeing and overall health. Outdoor play provides opportunities for exploring boundaries and to engage with the unknown or unexpected. This, in turn, improves levels of confidence and self-esteem. For example, for some children with disabilities putting their hands or feet outside into water, mud, sand or even snow might be perceived as a risk by them, just because it is an entirely new experience. Someone might have never touched a tree’s bark or a rock before and could be overwhelmed by this feeling. A form of risk-taking, in that sense, could also be to make an environment accessible (with sensitive facilitation by a caregiver or therapist) for someone who has difficulties in accessing it on their own. Therefore, what is a risk, may be understood differently by different persons in different situations. Furthermore, offering choices of how to master a risky situation, also helps to facilitate the child’s decision-making and to develop self-efficacy. In children with disabilities, the understanding of risk-taking and risky outdoor play is wider and more inclusive. Facilitating the process of risk-taking and risky play activities of children with disabilities does not contradict the original intention of the concept of risky play as being unstructured, child-driven activities.

Most parents would appreciate that their children could be able to play outside unsupervised, but their anxieties including ‘stranger danger’ and concerns about road safety prevent them from providing much freedom to their children. Due to a range of social and environmental barriers, children with disabilities are restricted from this freedom to a greater extent than their able-bodied peers. Children, and children with disabilities in particular, are often viewed as being dependent and vulnerable rather than being competent and able to actively make choices and participate in decision-making. It has been reported that children who are deaf and children with communication impairments, autism or multiple health requirements are those most isolated and the least likely to be asked and heard.

Also, other factors can hinder children with disabilities to fully participate in risky play. For instance, motor and sensory limitations can hamper their free movement and exploration of the environment. For example, children with sight impairments sometimes feel less able to carry out tasks than their peers, to take part in physical activities, to make strolls on foot on their own outside of school, or with other children, which leads to higher inactivity. Furthermore, intellectual limitations can make it difficult for the child to assess and deal with risks. Often children with disabilities depend on the presence of a caregiver, and require a higher level of adult supervision; for example children with Autistic Spectrum Disorders as they are prone to run away. The degree of acceptable risk for risky play activities in a child with disabilities must be assessed according to their individual traits. Sometimes certain activities must be avoided, such as tree climbing by children who suffer from epilepsy.

Sometimes it is not easy for caregivers to find a balance between taking risks and maintaining health and safety for children with disabilities, and results sometimes in limited play opportunities for these children. Additionally, and unfortunately, children with disabilities are disproportionately susceptible to bullying, when children who do not reflect dominant cultural norms are excluded within particular play spaces. Also, playgrounds can be sites where young people define and legitimize repressive social hierarchies. Such discriminating experiences prevent children with disabilities to use outdoor play spaces even more. Places which exclude children with disabilities are rarely natural constructs, but rather results of dominant relations, policy and poor planning, which allows able-bodied children to benefit at the expense of children with disabilities. Furthermore, children with disabilities are more likely to grow up in families with low incomes than children who are able-bodied, which may restrict traveling together to participate in outdoor leisure activities. Therefore, to improve access to inclusive outdoor play the cooperation of multiple agencies is required, including the involvement of children and young people with disabilities and their families.

This video by Voice America discusses a special playground for children with special needs:

Resources

• Characteristics and Categories of Risky Play
• Health Benefits of Outdoor Time
• Outdoor Activities Now and Then