Play and Playfulness in Older Children With Visual Impairments: A Mixed-Methods Study

RESEARCH QUESTIONS: For older children and adolescents with visual impairments:

1. In which play activities do they participate?

2. What play companions do they prefer?

3. How do they perceive their skill level when participating in various play activities?

4. What is their level of playfulness?

5. What factors predict playfulness? and

6. What does play look like for them?

RATIONALE: The Occupational Therapy Practice Framework: Domain and Process recognizes that play is a primary occupation of childhood. Playfulness refers to the stylistic manner in which one approaches play, work, or new situations. Little research exists on play or playfulness in older children and adolescents with visual impairment (VI). A study revealed that preschool children with VI showed significantly lower play and playfulness skills than typically developing children. This study expanded the line of research to evaluate whether these same delays also occur in older children and adolescents with VI.

DESIGN: Mixed-methods descriptive study: quantitative; cross-sectional; qualitative: phenomenological

SETTING: A Midwestern state school for the blind or in the homes of nonresident participants.

PARTICIPANTS: Twenty-one children with a primary VI, ages 8–20 yr. Participants also had other physical and cognitive disabilities.

MEASURES: Test of Playfulness (ToP), Play Interest Profiles (Kid Play Profile, Pre-Teen Profile, or Adolescent Leisure Inventory, depending on the participant’s age), Qualitative Play Form, and a demographic survey.

ANALYSIS: Quantitative: IBM SPSS Statistics Version 21—Multiway analysis of variance tests, measures of central tendency, frequency statistics, and multiple regression analyses

Qualitative: Video analysis with qualitative form followed by thematic analysis with audit trails.

RESULTS: Older children and adolescents with VI showed the following:

• Question 1: a preference for indoor and socializing activities most and lessons and classes least

• Question 2: a preference to perform play activities with friends over family as age increased

• Question 3: a perception of strongest play skills in creativity and socializing for preteens and community club and relaxation for adolescents

• Question 4: an average level of playfulness of –3.64 (standard deviation = 0.87) compared with an average ToP score of –.33 for children with atypical development, indicating significantly lower playfulness skills

• Question 5: a significant decrease in playfulness scores occurred as severity level of disability increased

• Question 6: nine overall qualitative themes emerged: (1) typical play activities were adapted; (2) play was highly influenced by developmental level; (3) adults have a strong impact on play, both positive and negative; (4) sensory exploration was predominant; (5) everyday technology was commonplace; (6) gross motor outdoor play was less common than fine motor indoor play; (7) supportive language and validation among peers was commonplace; (8) play displayed a process rather than product orientation; and (9) persistence to play despite barriers

CONCLUSION: Older children and adolescents with VI are able to play and exude playfulness but in a different manner than typically developing children, according to developmental theories.

IMPACT STATEMENT: This study illustrates how older children and adolescents with VI play and exude playfulness. Because occupational therapists work with children with VI, it is important to understand how this population plays and how occupational therapy interventions can be developed to target deficit areas in order to increase participation in the vital occupation of play for older children and adolescents with VI.