Inclusion of Children with Disabilities in Free Risky Play

Original Editor - Andrea Sturm
Top Contributors - Top Contributors - Jess Bell, Robin Tacchetti, Aminat Abolade, Tarina van der Stockt and Kim Jackson

Introduction

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 maintain 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, especially in children with disabilities. The importance of global psychosocial experiences such as satisfaction, enjoyment and perceptions of inclusion have been highlighted as well.

Physical Activity Participation of Children with Disabilities

Ross et al. 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."'

The participation in physical activity by 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

The definition of participation in physical activity for children with disabilities extends beyond mere health and physical outcomes. It encompasses a broader health experience that takes into account the dynamic interaction between the child and their environment, while also considering the quality of the experience. Underestimating the abilities of children with disabilities in engaging in physical activity and play can lead to diminished expectations, limited opportunities, and reduced engagement in health-promoting behaviours. Encouraging children with disabilities to participate in moderate- to high-intensity physical activity during their childhood can help reduce their predisposition to develop secondary health conditions, such as non-communicable diseases. Engaging in enjoyable physical activities fosters childhood experiences that support psychosocial development, including the development of interpersonal skills, self-confidence, and self-efficacy. Increasing children's participation in physical activity is viewed as a primary goal by both parents and professionals working with children with disabilities.

Free Risky Play for Children with 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 are limited by social and environmental factors, and the concerns of adults. These can compromise the child's 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 attitudes of caregivers are major barriers, preventing children with disabilities from fully benefiting from this kind of play experience.

The social exclusion of individuals with impairments has been perpetuated through the application of a medical model of disability, which primarily focuses on locating disability within individuals and their physical conditions. Within this model, health interventions such as physiotherapy have historically aimed to eliminate or improve individual characteristics related to the impairment. However, this approach overlooks the significant impact of environmental and social factors that contribute to disability. By disregarding the disabling influences of the environment and society, the consideration of these crucial factors is minimised. 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 non-disabled 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.

It is crucial to provide children with disabilities the chance to express themselves, both within educational and healthcare settings. Allowing children with disabilities to experience enjoyment and maintain a sense of control over their lives and activities is of utmost importance. It comes as no surprise that therapy is better received by children with disabilities when it is enjoyable, pleasurable, and engaging for them. 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 a child's opportunities for participation in other activities or roles. Families reported tension and parental stress when having to impose 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.

Considering the numerous benefits of outdoor activities and risky play for both children with disabilities and their caregivers, it begs the question as to why health professionals have not fully embraced these opportunities. The Australian Physiotherapy Association, in fact, explicitly recommended that children actively participate in risky play as a means to counteract the negative effects of physical inactivity resulting from the COVID-19 pandemic. Research indicates that physiotherapists should focus on developing processes and practices that prioritise fun, engagement, and affirmation for each individual child throughout every interaction, particularly for children with disabilities. This suggestion also applies to the construction of home programmes - i.e. we should consider both participation in outdoor physical activity and the quality of the experience. This approach could help to counterbalance the fact that opportunities for children with disabilities to spend time in natural environments with their families are less than for non-disabled children. Different commitments of family members and organising therapies occupy a great deal of a caregiver's time, leaving little chance for outdoor recreation. Combining physiotherapy or occupational therapy and outdoor activities either in the therapy-setting or when creating home programmes 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 non-disabled 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.

Other factors can also affect the ability of 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 take 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 (e.g. children with Autism 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 have epilepsy.

It might not always be easy for caregivers to find a balance between taking risks and maintaining health and safety for children with disabilities, which could result 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 legitimise repressive social hierarchies. Such discriminating experiences prevent children with disabilities from using outdoor play spaces even more. Places which exclude children with disabilities are rarely natural constructs, but rather the result of dominant relations, policy and poor planning, which allow non-disabled 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 non-disabled, which may restrict a family's ability to travel 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