Assessment of play and leisure delineation of the problem

1. Assessment of Play and
Leisure: Delineation of
the Problem
Anita C. Bundy
Key Words: human activities and occupations
• leisure activities. play development. play
and playthings (leisure)
This paper discusses current perspectlues on pia)' and
leisure and proposes that ifplay and leisure are /0 be
accepted as uiable occupations, then (a) ualid and re-
liable measures ofplay must be developed, (b) intel"-
ventions must he examined for inclusion ofthe ele-
ments ofplay, and (c) the promotion ofplay and
leisure must be an explicit goal ofoccupational ther-
apy intervention. £'dsting tools used by occupatiol1al
therapists to assess clients' play and leisure are eualll-
atedfor the aspects ofplay and leisure they address
and the aspects thejifail to address. An argument is
presentedfor the need for an assessment ofplay/ii/-
ness, rather than ofplay or leisure actiuities A pre-
liminary model for the deuelopment ofsuch an CJssess-
men! is proposed.
Anita C. Bundy, SeD. OTR~ .. FAurA. is Associate Professor, Ocp"rt-
mcnr of Occupational Therapy. College of Applied Human
Sciences, Colorado State Univet-sity, 200 Occupational Ther-
apv Building, Fort Collins, Colorado 80523.
This article I(I(IS aeeepredj'ur pub/iearion October 20. /992.
'(he American jO/.lln(1! o/Occupatiuna/ Therapy
I
n many ways, play and leisure are different from the
other major occupations with which occupational
therapists have been concerned. Unlike work and
self-care, play is a tripartite phenomenon. First, play is a
transaction or actiuity in which we engage only because
we want to, not because we feel we must (Neulinger,
1974; Neumann, 1971). Because we freely choose them,
our play and leisure activities may be some of the purest
expreSSions of who we are as persons.
Further, unlike work and self-care, play and leisure
are determined by the player. Cnder certain circum-
stances, such diverse activities as golf, running, building
with blocks, playing computer games, and pretending to
be superheroes all can be considered play or leisure.
Cnder different circumstances, each of those activities
might be considered work. Finally, unlike work and self-
care, in play, the player is in control. He or she becomes
totallv absorbed in an activity that presents the just right
challenge. The concerns of real life are suspended (Csiks-
zentlllihalyi, J975; Csikszentmihalyi & Csikszentmihalyi,
1988)
Second, play is a primary medium for intervention.
Through play and related media such as humor (which
really amounts to verbal and cognitive play), we engage
clients in activities in which the consequences are some-
how diminished. [fthe client drops the spoon, falls off the
SWing, or spills the paint in therapy, the consequences are
not as great as if those things happened in a restaurant,
on the playground, or at school. In fact, when those situa-
tions are handled skillfully, they sometimes turn into
powerful therapeutic interactions (Vandenberg & K(el-
hafner, 1982). They may result in clients trying, and mas-
tering, activities they never would have tricd alone or in
rcaI life. Plav as a Illcans of suspending the consequences
of real life is an important concept. Clients come to us
asking, although rarely in so many words, for us to "play"
'-'vith them so they can develop skills that more nearly
march those required for their real lives.
Finally, play is a s~vle we use when we approach
problems and situations in a flexible manner. When pl3y
is described as a style, the term playfulness is generally
applied. Few situations in life must be 3pproached as
matters of life or death. If one approach or solution does
not work, there is bound to be another that does. The
person who approaches problems in a flexible, playful
fashior. is much more likely to find a solution than is the
person who thinks there is only one right approach. Play-
fulness is so important that ultimately we may find that a
person's approach to an activity is more important than
any play or leisure activity in itself. In other words, a
playful approach to life may be much more important
than whether one engages in golf, running, bUilding with
blocks, playing computer games, or pretending to be a
superhero. Clearly, playfulness is intimately related to
plav as a transaction and as a medium for intervention.
Without playfulness, all activities become work.
217
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2. Playas Paradox
Play is also different from other occupations because it is
not considered serious or real; it is not thought of as
productive. Because play is not considered important
(Schwartzman, 1991), it is not a respectable medium for
intervention, a respectable goal for intervention, or a re-
spectable approach to life. Comments such as "Insurance
will never pay for her to learn to play; I don't dare write
goals about pJay- it's not educational" and "No wonder
he likes to come here. You just play with him," are perva-
sive when occupational therapists, who claim playas one
of three major occupations, are asked to examine the
practical implications of incorporating and promoting
play in their interventions, that is, of taking play seriously.
We are caught in a vicious cycle. If we cannot think seri-
ously about play, we cannot be serious about assessing,
implementing, or promoting it. If we cannot assess, im-
plement, and promote play, we do not take it seriously.
On the one hand, we acknowledge the rower and
importance of play. On the other hand, we slip it under
the rug. Bateson (1972) and other well-known theorists
have commented on the paradoxes of play. Perhaps our
attitude is another of those paradoxes. We recognize that
play is a powerful tool through which we can diminish the
consequences of real life and promote our clients' abili-
ties to express themselves, yet we fear the repercussions
of being thought less than serious about the real-life difFi-
culties confronting our c1iems. We want to take play seri-
ously, but if we do, we may not be taken seriously our-
selves. The use and promotion of play presents us with a
paradox.
We have gone to great lengths to give play credibility
Slogans such as "play is the work of children" somehow
make our interventions and outcomes sound more im-
portant. I suggest that, rather than likening play to work,
we should strive to liken work to play. We should not
strive to be better at working; we should strive to make
our productive endeavors more like play. If we want to
take play seriously, we must routinely and systematically
assess our clients' playfulness and their abilities and op-
portunities to play. Further, we must routinely and sys-
tematically assess the intervention transactions in which
we engage our clients, examining them for the presence
of the elements of play. Finally, we must actively and
systematically promote play and leisure in our clients'
lives and in our intervention sessions (Bundy, 1991).
Evaluating Play and Leisure: A Critique of
Existing Tools
But what if occupational therapists were to decide to
evaluate each client's play and playfulness systematical-
ly and to examine each intervention session for the
presence of the elements of play' To what sources and
tools would we turn to accomplish these worthwhile
endeavors?
If we wished to assess children's play, we might turn
to instruments such as the Preschool Play Scale (Bledsoe
& Shepherd, 1982; Knox, 1974) or the Play History (Ta-
kata, 1974). Ifwe worked with adults, we might use tools
such as the Interest Check List (Matsutsuyu, 1969). What
would we learn about a client's play and playfulness by
using those tools' Perhaps more important, what would
we not learn?
In administering the Preschool Play Scale (Bledsoe &
Shepherd, 1982; Knox 1974) or other similar evaluation
tools, a therapist learns what developmental skills a
young child uses in play. Granted, this is important infor-
mation. To be able to play well, a child must have the skills
to meet the challenges presented by playmates and by the
physical environment (Csikszentmihalyi, 1975; Csikszent-
mihalyi & Csikszentmihalyi, 1988). Because our society
has a propensity for grouping children together by chron-
ological age, it is important to know whether or not chil-
dren's skills are adequate to meet the challenges present-
ed in play. However, interpreting the results of these
assessments is difficult. What do we know if we discover
that a child plays more like a younger child than like his or
her peers' Does that child have a play dysfunction? Cer-
tainly, that child's play is not typical, but in a study of boys
with sensory integrative dysfunction, O'Brien (formerly
Clifford) anJ I (Clifford & Bundy, 11.)89) concluded that it
is far more important for children to be good at what they
want to do than to have a play age that is equivalent to
their chronological age.
In contrast, when a therapist uses a tool such as the
Play History (Takata, 1974) or the Interest Check List
(Matsutsuyu, 1969), the therapist learns what the client
Joes in play or leisure and what he or she had done in the
past. With a child, the therapist uses this information to
piece together a developmental history (which can be
compared with normative guidelines drawn from the lit-
erature) and a picture of the ways in which the environ-
ment supports or prevents the child from playing. For an
adult, assessments such as the Interest Check List enable
the therapist to learn about the ways in which illness or
injuly have affected the client's leisure activities and roles.
Evaluation tools like the Play History and the Interest
Check List provide us with information that is closer than
that gained from the Preschool Play Scale (Bledsoe &
Shepherd, 1982; Knox, 1974) to an assessment of playas
an occupation. But, again, these results are difficult to
interpret. Neither tool is a measure, in the true sense of
the word (A. G. Fisher, in press). The normative guide-
lines contained in the Play History were drawn from theo-
retical rather than empirical data. The Interest Check List
is simply a checklist. Should one have a lot of interests or
only a few' How many is too many? How few is too few'
When we examine play and leisure we need to know
a number of things, including (a) in what activities the
March 1993. Volum.e 47, Number 3218
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3. client becomes totally absorbed; (b) what the client gets
from those activities; (c) whether or not the client en-
gages routinely in activities in which he or she feels free to
vary the process, product, and outcome in whatever way
he or she sees fit; (e) whether or not the client has the
capacity, permission, and support to do what he or she
chooses to do; and (f) whether or not the client is capable
of giving and interpreting messages that "this is play; this
is how you should interact with me now."
Currently occupational therapists have developed
no formal assessments that allow them to examine the
factors that may be some of the most important aspects
of, and influences on, play and leisure. Although a few
members of other professions have developed some of
these tools (eg., Barnett, 1991; Wolfgang & Phelps, 1983)
and have formulated methodologies that might be used
or adapted by occupational therapists seeking informa-
tion about play and leisure (e.g., Csikszentmihalyi, 1975;
Csikszentmihalyi & Larson, 1987), it is telling that we,
who claim that play and leisure are a primary lifelong
human occupation and who make it our business to as-
sess occupation, have contributed so little to the existing
theoretical and practical knowledge base of play.
Further, occupational therapists rarely use even the
existing evaluations of play, whether drawn from OUI' own
literature or that of other professionals. In three surveys
of pediatric therapists (Kielhofner, Knecht, & Bundy,
1987; Lawlor & Henderson, 1989; StOne, 1991), respon-
dents indicated that they formally assessed play in only
one survey (Stone, 1991). Stone's results suggested that
when occupational therapists incorporated play into a
child's assessment, it was primarily as a vehicle for ob-
serving other developmental skills rather than as an occu-
pation. Because play is the primary occupation of young
children, I can only assume that therapists who intervene
with adults are even less likely to assess play and leisUI-e
than were the pediatl'ic therapists who responded to
Stone's survey.
To be fair, however, the respondents to both Stonc's
(1991) and Lawlor and Henderson's (1989) surveys ex-
pressed some frustration with their inability to assess play
adequately. Some indicated that they were not awal'e that
fOl'mal assessments of play existed.
Using Playas a Medium for Intervention
Although the therapists l'esponding to Stone's (1991) SUl'-
vel' acknowledged that their assessments of playas occu-
pation were less than adequate, they indicated that they
felt relatively better about theil' abilities to use playas a
medium for intervention. However, once again, few
guidelines exist to enable therapists to evaluate their in-
tervention sessions for the presence of the elements of
play. Those that do exist (Bundy, 1991) have been pub-
lished in a textbook (Fisher, Murray, & Bundy, 1991)
written primarily for pediatric therapists. However, the
The American journal ol Occupalional Therapy
use of playas a powerful medium is not, and should not
be, confined to pediatrics,
My experience supervising and instructing students
and therapists suggests that many pediatric therapists are
intuitive about using play in intervention. (Mattingly
[1989] made similar observations of occupational thera-
pists' use of humor in their interventions with adult cli-
ents.) However, when a session does not feel right (that
is, when there is something not playful enough about it),
therapists have no systematic means for reflecting on
what went wrong and changing the course of their
interactions.
Play and Leisure: A Challenge to Occupational
Therapists
Occupational therapists' failure to develop and imple-
ment adequate assessments of playas an occupation, a
style of approaching tasks, or a treatment medium, in the
face of claims that play is an important domain in their
practice, suggests a need for the profession as a whole to
reexamine its priorities. Clearly, assessments of play and
plavfulness al'e needed; however, their development will
not be easy Further, I believe that occupational thera-
pists have a unique perspective to offer to play research
and theory and a unique contribution to make to their
clients' lives through the promotion and use of play. We
will not be able to demonstrate our knowledge or contri-
butions by using tools developed by members of other
professions, because most of those persons have been
interested in playas a reflection of some other skill or trait
(e.g., cognition, social development), They have not been
interested in playas an occupation. Thus we will need to
develop our own assessments.
Toward that end, I offer three preliminary pieces of
work. The first of these I recently piloted with my col-
lcagues (Morrison, Bundy, & Fisher, 1991)(see Figure 1).
It represents a model that may form the basis for evaluat-
ing playfulness in clients and assessing specific interven-
tion sessions for the presence of the elements of play.
Neumann (1971) and other play theorists have proposed
that play transactions have three elements: intrinsic moti-
vation, internal control, and the freedom to suspend reali-
ty. These are the traits of people as well as of play transac-
tions It is not possible (and probably not desirable) for a
person to feel totally intrinsically motivated, internally
controlled, and free to suspend all aspeCts of reality. Nei-
ther is it possible or desirable to design therapeutic trans-
actions in which these three elements are present to the
fullest extent. These three elements can each be ex-
pressed best as continua. It is the sum contribution of
these three elements that tips the balance toward play or
nonplay, playfulness or nonpJayfulness,
The next step in developing these preliminary ideas
into psychometrically sound and clinically useful assess-
ments of playfulness or playas a transaction is to oper-
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4. Figure 1. The play-nonplay continuum: A balance be-
tween perception of control, source of motivation, and sus-
pension of reality. Reprinted by permission from Bundy, A.
C. (1991). Play theory and sensory integration. In A. G.
Fisher, E. A. Murray, & A. C. Bundy (Eds.), Sensory integra-
tion: Theory and practice (pp. 46-68). Philadelphia: F. A.
Davis.
ationally define the ways in which persons behave when
they are intrinsically motivated, internally controlled, and
free to sLispend aspects of reality. Those operational
statements can then be transformed into test items that
can be evaluated for their ability to be calibrated as mea-
sures with acceptable reliability and validity.
Because intrinsic motivation, internal control, and
the freedom to suspend aspects of reality are broad and
abstract concepts, it is likely that before they can be oper-
ationally defined, they must be broken down intO compo-
nent parts (see Figure 2). The next step will be to observe
people in play and to interview them and their caregivers
to determine how components such as absorption and
the just-right challenge are manifest in ordinary play and
Initial Interview Questions Play Elements
Are there some things that you do each
day or week that you do only because
you want to, not because you feel you
must'
Intrinsic
motivation
Are there some things you do each day
or week in which you become totally
absorbed - when you can forget
about everything else going on around
vou and the time seems to fly'
Freedom to
suspend reality
Intrinsic
motivation
Are there some things you do each
day or week when you feel the free-
dom to make the activity or product
come out just the way you want it to
come OUI'
Internal control
Figure 2. Suggested initial interview questions for the eval-
uation of playas an occupation. (Each question can be
adapted for use with caregivers by replacing "you" with
"your child," "your husband," etc.)
leisure activities. How do we know these imponant com-
ponents when we see them Clearly these elements are
'
not mutually exclusive, bm together, they form a single
unidimensional construct of playfulness. As Fisher (W. P.
Fisher, in press) indicated, this construct must be tested.
Not all of the information we need to colleer about
our clients' play and leisure requires measurement. The
nature of some of this information will require qualitative
inquiry. If play is the purest expression of who we are as
persons, then people who have lost their ability to play in
the ways they choose have lost important pieces of them-
selves. In our assessments, we must seek to learn not so
much what persons do as what the activity says about
them and what they value about that actiVity. Is it social
interactionl The feeling of having solved a difficult prob-
lem The sense of having created something meaningful
'
(Csikszentmihalyi, 1975)1 Only when we know what the
benefits of panicular leisure activities are to the client can
we help that person recapture those same benefits in a
different activity. A set of preliminary questions (see Fig-
ure 3) can be used as the basis for interview of clients or
their caregivers and may ultimately form the basis of an
assessment of playas meaningful occupation. These
questions also reflect the model depicted in Figure 1.
Other questions might be used to help clients or care-
givers elaborate on their answers to the initial questions
(see Figure 4)
IINITIAL QUESTION I
WHAT PREVENTS THAT' WHAT ARE I
FROM HAPPENING? THOSE THINGS? I
IS IT POSSIBLE HOW OFTEN DO
TO ELIMINATE YOU DO THEM?
THE OBSTACLE?
~I
WHAT
OTHER Ho'w?1
ACTIVITIES
COULD BE
SUBSTITUTED
THAT WOULD
PROVIDE THE
SAME BENEFITS
& NOT BE
SUBJECT TO THE
OBSTACLES?
Figure 3. Potential follow-up questions for use in the eval-
uation of playas occupation.
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5. PLAY ELEMENTS
INTERNAL CONThOL FREEDOM TO INThINSIC
SUSPEND REALITY MOTIVATION
Figure 4. Preliminary representation of the elements of play.
Conclusion
If we want to use playas a powerful medium and to
promote play and playfulness in our clients, we must take
play seriously. We must develop measures and means to
examine play and playfulness systematically, to reflect on
and revise the course of our interactions, and to learn
about the benefits of play from the perspective of the
player. Like all the other professionals who have grappled
with play and leisure, we have never successfully defined
them. The assessments we develop will become our defi-
nitions of play and leisure (Rubin, Fein, & Vandenberg,
1983). Further, we must develop assessments that define
play and leisure from the perspective of occupational
therapists....
Acknowledgments
This manuscript is based on a paper presented at the Sl'mpo-
shlln on Measurement and Assessmenl: Directions for Re-
search in Occupational Therapl' at the University of Illinois at
Chicago, October 16-18, 1991. The symposium was jointil'
sponsmecl b)' the American Occupational TherapI' Association,
the American Occupational Thel-apy Foundation. and the Occu-
pational Therapv Center for Research and Measurement at the
Universitv of JIIinois at Chicago.
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