Risky play and mental health

Introduction 

There is growing concern about the mental health of children and young people. Parents and those teaching and caring for children increasingly recognise that a significant proportion are experiencing difficulties, including high levels of anxiety, low mood and challenging behaviour. The foundations of good mental health are laid during early childhood. It is therefore important to consider what factors during early childhood can help lay positive foundations that foster good mental health. It is intuitive that rich, diverse play experiences are important for supporting healthy development. Increasingly it is recognised that risky play, in particular, might play a role in preventing mental health problems.

Subject

Risky play is included in the early years curriculum in many countries^1,2 but it can be challenging for practitioners and parents to support risky play. Facilitating risky play requires a balance between prevention of serious injury and giving children space to explore and learn³. It can be anxiety-provoking for adults to support children’s risky play, due to worries about injury, incompatible policies, lack of understanding regarding potential benefits, and absence of appropriate space and equipment^3,4.

Problems

A significant proportion of children and young people have difficulties with their mental health. Before the Covid-19 pandemic, it was estimated that around 1 in 8 living in high income countries had a mental health problem at any given point in time⁵. The pandemic negatively impacted mental health and, it is now estimated that rates are as high as 1 in 5.^6,7 

Western societies have become increasingly risk averse which has had the effect of decreasing children’s opportunities for taking risks in their play, and for independence (e.g., walking to a friend’s house)⁸.

Research Context

It has been proposed that decreasing opportunities for risky play are having a negative impact on children and young people’s mental health. This is a difficult proposal to assess rigorously because measurement of risky play is challenging; the extent to which any play activity is risky varies from one child to another. In addition, the impact of risky play on mental health may only be seen over a long period of time, or in certain circumstances. Nevertheless, some initial research provides some support for a link between risky play and mental health in children.

Key Research Questions

To what extent is the decline in risky play related to the increase in children’s mental health problems?
If children’s opportunities for risky play increase, does this decrease their risk for mental health problems?

Recent Research Results

A number of researchers have proposed that risky play might help to prevent mental health problems. For example, Sanseter & Kennair explained how risky play might help children to overcome phobias such as a fear of heights⁹. More recently, Dodd & Lester drew on an understanding of the cognitive and behavioural processes involved in anxiety to explain how risky play may help prevent the development of anxiety¹⁰. Specifically, they argue that risky play supports children’s learning about uncertainty, physiological arousal and effective coping. Peter Gray has also written extensively about the links between rising rates of mental health problems and the decline in children’s play¹¹.

Despite the theoretical interest, research evaluating links between risky play and mental health is relatively rare, especially in young children. One recent exception is a study that focused on preschoolers in the UK, which found that children aged 2 to 4 years who spend more time engaged in risky play have lower levels of internalising problems such as anxiety and depression, and higher positive mood¹². This mirrors findings from research carried out with school-aged children, although for the older children no link with externalising problems was found¹³. These studies have used large, national samples, but rely on parent-report questionnaires. Complementing this approach, a study by Imai and colleagues used observation of preschoolers’ risky play in Japanese preschools¹⁴. They found that observed risky play behaviours were associated with better prosocial behaviour, after other characteristics of the child were taken into consideration¹⁴.

Rough and tumble play is a specific type of risky play that has been studied in a little more detail, although often in the relatively narrow context of father-child play. Findings are mixed regarding links with mental health. For example, some research has shown that more rough and tumble play is associated with better emotional expressiveness and emotion regulation one year later in preschool-aged children¹⁵. In contrast, other studies have found that rough and tumble play is linked to more physical aggression and emotion dysregulation in 4-6 year olds¹⁶. Whilst the reasons for these inconsistencies are not yet clear, it is possible that the effect of rough and tumble play varies depending on other developmental and relational difficulties that the child may be experiencing.

Although not all outdoor play is risky play, playing outdoors facilitates risky play. It is relevant therefore that there is growing evidence that more time spent playing outdoors is associated with better mental health. For example, Piccininni and colleagues found that outdoor play was associated with fewer psychosomatic symptoms in teenage girls¹⁷, and Flouri and colleagues found associations between park and playground use and both internalising and externalising symptoms¹⁸.

Research Gaps

There is a lot of scope for more research investigating the links between risky play and mental health. Longitudinal research measuring risky play and mental health symptoms over time would help to disentangle cause and effect. The best design for evaluating whether risky play can help to decrease risk for mental health problems would be to increase opportunities for risky play, within a randomised controlled trial (RCT) design, and assess what the impact is on mental health. Some work is underway taking this approach within schools¹⁹.

The vast majority of risky play theory and research comes from Western contexts and focuses on children growing up in relatively safe environments. Risky play may have different effects and may look different in different contexts. Where children live with high levels of risk in their environments, risky play may not have the same impact, and could have a negative impact²⁰. Research in different contexts is therefore vital.  

Conclusions

There are good theoretical reasons for thinking that opportunities for risky play early in childhood might help support the development of good mental health, in particular in relation to anxiety. There is emerging research supporting this link; more risky play is linked to lower anxiety and depression symptoms in preschool-aged children and school-aged children. Nevertheless, there remain significant gaps in the research. It will be important for future research to use longitudinal methods and experimental designs to better clarify cause and effect. It is also vital that we consider in future work a wider range of cultures and contexts within which children grow-up. This will require a significant expansion of research outside of western countries and relatively safe contexts. There is a growing evidence base around how to create environments within early years settings and in community spaces to support risky play, so an important next step is to evaluate the impacts on mental health when this guidance is put into practice.

Implications for Parents, Services and Policy

For parents and for early years practitioners it can be challenging to give children opportunity to take risks in their play. Parents and practitioners tell us that they worry about a child getting hurt. Where possible to do so, resist the temptation to jump in and help or to ask a child to stop immediately, if you think they might be able to resolve something for themselves. Every time we jump in and help when a child could work something out for themselves, we deny them a learning opportunity.

Services may benefit from adopting benefit-risk analysis, rather than traditional risk assessments, which focus on minimising all risk. Benefit-risk analysis allows practitioners to consider what the benefits of an activity are for children, as well as what the risks are, and to take a balanced approach²¹. Where the benefits are assessed as being greater than the risk, then the activity can go ahead even if there is some risk present. An example would be a child using a hammer and nail: there are risks in terms of the child getting hurt by the hammer or the nail, but letting them try helps to develop their hand-eye coordination and concentration, and gives them an opportunity to impact their environment.

Having clear policies for early years settings about the use of benefit-risk analysis and accompanying support on how to carry out this type of assessment is useful and gives practitioners a clear steer on what is expected. Broader government level policy about expectations in terms of providing sufficient opportunities for risky play, whilst preventing serious injuries, would be helpful in guiding settings to create aligned policies.

References:    

1. GOV.UK. Early years foundation stage. https://www.gov.uk/early-years-foundation-stage. Accessed August 9, 2024
2. Makovichuk L, Hewes J, Lirette P, Thomas N. Play, participation, and possibilities: an early learning and child care curriculum framework for Alberta; 2014. https://education.alberta.ca/media/482257/play-participation-and-possibilities-reduced.pdf. Accessed August 9, 2024.
3. Harper NJ, Obee P. Articulating outdoor risky play in early childhood education: voices of forest and nature school practitioners. Journal of Adventure Education and Outdoor Learning. 2021;21(2):184-194. doi:10.3390/children8080681
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17. Piccininni C, Michaelson V, Janssen I, Pickett W. Outdoor play and nature connectedness as potential correlates of internalized mental health symptoms among Canadian adolescents. Preventive Medicine. 2018 Jul;112:168-175. doi:10.1016/j.ypmed.2018.04.020
18. Flouri E, Midouhas E, Joshi H. The role of urban neighbourhood green space in children's emotional and behavioural resilience. Journal of Environmental Psychology. 2014;40:179-186. doi:10.1016/j.jenvp.2014.06.007
19. Dodd HF. Project Playtime: Evaluation of the Outdoor Play and Learning (OPAL) programme on the wellbeing of primary-aged children in England; 2024. doi:10.1186/ISRCTN55659573
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21. UK Play Safety Forum. Resources. https://playsafetyforum.wordpress.com/resources/