Play and Disability

Monash University, Australia

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Introduction and Subject

This article identifies the main groups of disabilities present in early childhood and considers how those disabilities affect children’s development and engagement in play.

Disabilities refer to impairments, limitations or restrictions to one or more of children’s physical, cognitive, sensory, language, speech, communication, behavioural and/or social functions.1,2,3 Disabilities can be mild to severe, according to how much core mobility, communication and self-care activities are affected.1 Between 3.65% and 4% of 0- to 5-year-old children in developed countries are disabled, with higher prevalence among boys.1,2,3

Typically developing children engage in solitary and social play and find play pleasurable.4,5 Play has different forms – locomotor, object, language, pretence and sociodramatic5 – readily recognised by children and adults.6 For some children, disabilities affect how often and what they play or whether they play at all.

Studying play in disabled children is challenging, because of existing debates in play and disability research.7 In play research, debate focuses on potential developmental functions of different play forms.6 In disability research, inconsistencies exist in classifying disabilities, and in recruiting disabled research participants.7,8 Studying play in multiply disabled children is especially challenging, because of difficulty in understanding the unique or interactive affect each disability has on children’s play. Knowledge of disabled children’s play has accrued incidentally from studying other aspects of disabled children’s behaviour.9

Research Context and Results

Disabilities in language, speech and communication disorders are the most common types of disabilities in early childhood.10 This is not surprising given that language, speech and communication delays are often cormorbid with other disabilities.11,12 Some language, speech or communication disabilities result from acquired brain injuries to language, speech and communication regions.13 Insights into the effects of injuries to these areas suggest that, the more severe the injury, the more delayed children’s play, especially pretence and sociodramatic play.10

Autism Spectrum Disorder (ASD) is one of the most widely investigated disabilities to affect children’s language, speech and communication. ASD children, besides language and communication delays, have significant impairments to social functioning and many have repetitive and stereotyped behaviours. Others have anomalies in posture and gait.14 Symptoms, skill deficits and impairment severity vary enormously among ASD children.14

Posture and gait anomalies in ASD children impair locomotor play.14 Restricted and repetitive behaviours, either self-focussed (e.g., finger flipping) or with a preferred object (e.g. stroking a favourite toy), affect most functionality in all or most play forms: locomotor, object, language and even pretend play.14 ASD children have significant delays in eye gaze, facial expression, gesture, imitation and turn taking, which form the substratum of sociability and facilitate sociodramatic play. When observed in social classroom settings, ASD children are more often unoccupied onlookers and engage less in pretend and sociodramatic play than typically developing peers.15

Children with physical disabilities, for example, cerebral palsy (CP), have mild-severe motor delays affecting mobility, posture and strength16 needed for locomotion and exploration of their surroundings. Locomotion helps to develop spatial understanding.11 Severely disabled children with CP need assistance with mobility, restricting exploration16 and affecting the development of locomotor and object play. Many children with CP also have impairments in sensory and language functions,16 restricting social play. For some of them, opportunities to play are restricted to playful contexts set up and controlled by adults for instruction.9 Their opportunities to develop play skills are incidental to learning in these interventions. Children with CP are usually time poor, because of time spent in adult-structured activities that preclude opportunity for play or leisure activities.16 Severe forms of CP affect children’s development of gestures and emotional expression, limiting or even precluding pretence and sociodramatic play.17

Children with intellectual disabilities (ID) have delays in intellectual functioning (learning, reasoning, problem solving) and adaptive behaviours needed for everyday living.12 Such children develop play forms more slowly than typically developing children, and spend less time playing with others,18 perhaps because many of them have language delays and/or sensory impairments.12 When adults modelled play, children with ID engaged less in locomotor play, less toy play and less play with children than typically developing children.7 However, when given opportunities to initiate their own play without adults, they played more with other children, used more complex language and engaged more in pretend and sociodramatic play than when adults structured activities.7

Visually impaired and blind children have concomitant delays in motor development, which impact upon mobility and spatial understanding.19 Looking, reaching for and grasping objects promotes exploration and object play and contributes to spatial development.19 Visually impaired children use tactile and auditory cues to locate, reach for and grasp objects. This develops later in visually impaired children, resulting in locomotor, object and social play delays.19 Motion sensors that emit audible signals in response to sensors attached to children have been adapted to assist blind children to navigate their environments safely and develop spatial awareness.20 Visually impaired children may develop idiosyncratic gesture and facial expressions, because they cannot observe the gestures and expressions that others use in communication.21 It has been asserted that visually impaired children have delays in pretence and social play comparable to play delays of autistic children.21 Yet there is evidence that blind children’s level of symbol play can be comparable to age and IQ matched non-handicapped peers.21 Social skills of children, not vision, predicted the level of symbolic play.21

Hearing impaired and deaf children experience delayed language acquisition, if their hearing impairment remains undetected and there is no intervention to teach oral or sign language.22 Hearing impaired children maintain joint attention and lip read to sustain social play with playmates using oral language, which are challenging tasks for young children.22 Deaf children can have delays in gesture and vocalisations compared with hearing children, because they do not hear oral cues that place the gestures in its social context.22 Signing and oral language used proficiently by young bilingual deaf children enabled conversations with others and led to Theory of Mind (ToM) performance comparable to hearing children.23 Implications of these findings for the role of ToM in hearing impaired children’s play development is speculative, because we do not yet understand the role of ToM in play, especially pretend and sociodramatic play.24

Research Gaps

There are inconsistencies in classification of the same disability in different studies affecting generalisability of research findings. Diagnostic criteria of different categories of disability (e.g., CP, ASD, ID) encompass broad symptoms of varying severity. Many children thus classified have additional delays characteristic of other disabilities. There is a need to develop rigorous classification of disability in early childhood.8

Many children have multiple disabilities making it difficult for play researchers to design research that informs them about how each disability uniquely or interactively affects children’s play. Disabled children can have similar delays in play, associated with distinct disabilities that have different aetiologies and life courses.

Comparison studies within disability groups are needed, because individual differences, for example, in blind children’s social skilfulness,22 and ID children’s temperament,25,26 affect play behaviours but are rarely controlled for in disability and play research.

Information about disabled children’s play is often reported incidentally to main findings of adult modelled interventions designed to teach disabled children many different skills within playful contexts using toys.22,24 There is a need to focus on disabled children’s play behaviours per se to understand how disability affects play development.


There is evidence that even children with severe and multiple disabilities can engage in some or all play forms during early childhood. There are, however, conflicting findings about the level of play development achieved by children with different disabilities. Methodological shortfalls in both play and disability research have contributed to this uncertainty. Information about play elicited during training and intervention studies provide only incidental evidence about the effect of particular disability on children’s play development, yet have the potential to provide valuable insights into the role of play in development.


All signatory nations are obliged to ensure that all the rights of their children are protected, as enshrined in United Nations Convention of the Rights of the Child.27 Disabled children have the right to receive special care and support to ensure they reach their full developmental potential (Article 21) and all children have the right to play, rest, recreation and leisure (Article 31). The goal should be to foster self-initiated play in an adequately provisioned and physically safe environment for disabled children. It is important to encourage play while remaining realistic about limitations and restrictions of children’s disabilities. Children with multiple disabilities present special challenges when structuring environments appropriately and safely, selecting appropriate toys and adapting emerging technologies that might serve these goals. It is also important to make sure that adults are not overly controlling during play interventions to enable the development of self-expression and independence in disabled children’s play.


  1. Australian Institute of Health and Welfare, Disability updates: children with disabilities, Bulletin 42, 2009:1-14. Accessed June 3, 2013.
  2. Boyle CA, Boulet S, Schieve L, Cohen RA, Blumberg SJ, Yeargin-Allsopp M, Visser S, Kogan MD. Trends in the Prevalence of Developmental Disabilities in US Children, 1997–2008. Pediatrics 2011; 127:1034-1042.
  3. Blackburn CM, Spencer NJ, Read JM. Prevalence of childhood disability and the characteristics and circumstances of disabled children in the UK: secondary analysis of the Family Resources Survey. BMC Pediatrics 2010; 10:21.
  4. Jenvey VB. Children and their need to play. Journal of Royal Australasian Institute of Parks and Recreation 1992, 28: 1-6.
  5. Smith, PK, Pellegrini, A. Learning through play. In: Tremblay, RE, Bar, RG, Peters, Red, Boivin, M. eds. Encyclopedia on Early Childhood Development [online]. Montreal Quebec: Centre for Excellence for Early Childhood Development: 2012:1-6. Available at: http// Accessed 1/10/12.
  6. Turnbull J, Jenvey VB. Criteria used by adults and children to categorize subtypes of play. Early Child Development and Care 2006; 176: 539–551.
  7. Jenvey VB Jenvey HL. Modelled, free play and toy type: Association with sociability, play and language usage among intellectually disabled and typically developing children. In: M.T. Maher, ed. Special Education in the 21st Century. Hauppauge, NY: Nova Publishers; 2010:37-66.
  8. Jensen EC, Colver AF, Mackie, PC Jarvis SN. Development and validation of a tool to measure the impact of childhood disabilities on the lives of children and their families. Child: Care Health and Development 2003; 29:24-34.
  9. Pennington L, Golbart J, Marshall J. Interaction training for conversational partners for children with cerebral palsy: a systematic review. International Journal of Speech and Language Disorders 2004; 39:151-170.
  10. American Speech Language and Hearing Association. Incidence and prevalence of communication disorders and hearing loss in children. Washington: DC, ASLHA: 2008.
  11. Adolph KE, Berger, SE. Physical and motor development. In: Damon W, Lerner R, eds. and Kuhn D, Siegler R, vol. eds, Handbook of Child Psychology, Vol 2, Perceptual and cognitive development, 6th ed. NY; Wiley, 2006.
  12. Schalock R L, Coulter EM, Craig P, et al. Intellectual Disability: Definition, Classification, and Systems of Support. 11th ed. Washington, DC: American Association on Intellectual and Developmental Disabilities; 2010.
  13. La Pointe L, Murdoch B, Stierwalt J. (2010). Brain-based communication disorders: Essentials. San Diego: CA; Plural Publishing.
  14. Interagency Autism Coordinating Committee. IACC/OARC Autism Spectrum Disorder Publications Analysis: The Global Landscape of Autism Research, Washington, DC: Interagency Autism Coordinating Committee, U.S. Department of Health and Human Services 2012:July. Accessed June 3, 2013.
  15. Leekman S, Prior M, Uljarevic M. Restricted and repetitive behaviours in autism spectrum disorders: A review of research in the last decade. Psychological Bulletin 2011;137: 562-593.
  16. Raina P, O'Donnell M, Rosenbaum P. The health and well-being of caregivers of children with cerebral palsy. Pediatrics 2005; 115 e626-36.
  17. Missiuna C, Pollock N. Play deprivation in children with physical disabilities: the role of the occupational therapist. American Journal of Occupational Therapy 1999;45:881-888.
  18. Cicchetti D, Beeghly M, Weiss-Perry B. Symbolic development in children with Down syndrome and in children with autism: An organizational, developmental psychopathology perspective. In Slade A, Wolf D, eds. Children at play. New York, NY: Oxford University Press; 1994: 206-237.
  19. Hatton DD, Bailey DB, Burchinal MR, Ferrell KA. Developmental growth curves of preschool children with vision impairment. Child Development 1997; 68:788-806.
  20. Velázquez R, Wearable assistive devices for the blind. In: Lay-Ekuakille A, S.C.Mukhopadhyay, eds. Wearable and Autonomous Biomedical Devices and Systems for Smart Environment. Issues and Characterization, LNEE 75, Springer; 2010: 331-349.
  21. Bishop M, Hobson RP, Lee A. Symbolic play in congenitally blind children. Developmental Psychopathology 2005; 17:447-465.
  22. Goldin-Meadow S. Hearing gesture: How our hands help us think. Boston, MA: Havard University Press; 2005.
  23. Meristo M, Falkman KW, Hjelmquist E. Language access and theory of mind reasoning: Evidence from deaf children in bilingualist environments. Developmental Psychology 2007; 43: 1156-1169.
  24. Newton E, Jenvey VB. Play and theory of mind: associations with social competence in young children. Early Child Development and Care 2011; 181:761–773.25.
  25. Holmes RM, Procaccino JK. Autistic children’s play with objects, peers and adults in a classroom setting. In: Clark CD, ed. Transactions at play. Lanham: MD:University Press of America; 2009: 86-103.
  26. Zion E Jenvey VB. Temperament and social behaviour at home and school among typically developing children and children with an intellectually disability. Journal of Intellectual Disability Research 2006; 50: 445-456.
  27. UN General Assembly, Convention on the Rights of the Child, 20 November 1989, United Nations, Treaty Series, vol. 1577, p. 3, Available at: Accessed June 3, 2013

How to cite this article:

Jenvey VB. Play and Disability. In: Tremblay RE, Boivin M, Peters RDeV, eds. Smith PK, topic ed. Encyclopedia on Early Childhood Development [online]. Published: June 2013. Accessed June 13, 2024.

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