Full text of DOI:10.1002/oti.127

Occupational Therapy International, 7(4), 259–276, 2000 © Whurr Publishers Ltd
259
The impact of child abuse on
children’s play: A conceptual model
RODNEY J. COOPER University of Queensland, Brisbane, Queensland,
Australia
ABSTRACT: The purpose of this article is to examine critically the impact of child
abuse on children’s play, using a descriptive model of children’s play as a conceptual
framework for this review of the literature. Play is recognized as a primary occupa-
tion of childhood by occupational therapists. When a child is exposed to an abusive
or neglectful care environment his or her play development may be disrupted.
Although the detrimental effects of physical, sexual or emotional abuse and neglect
are well documented, relatively few studies have investigated the play of abused chil-
dren. Reported effects suggest that abused or neglected children are more likely to
show developmentally delayed play skills, decreased playfulness and behavioural dis-
turbance in their play, which may place them at greater risk for learning and social
problems. Occupational therapists often use play, including play therapy, to assess
and treat abused children. This analysis highlights the need for occupational thera-
pists to evaluate how play-based therapeutic approaches can best meet the develop-
mental and emotional needs of abused and neglected children. Recommendations are
made for occupational therapists to be more knowledgeable about child abuse and to
address the need for research into the specific effects of child abuse on children’s play.
Key words: child abuse and neglect, children’s play, play model, occupational
therapy.
Introduction
The importance of play for children is widely recognized (Parham and
Primeau, 1997). As a developmental and mastery process, play is considered
instrumental in children’s socialization, creativity, language development,
problem-solving abilities and sensorimotor skills (Rubin et al., 1983). Play

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provides children with limitless opportunities to explore, experiment and
practise new skills and, in doing so, gain a sense of mastery over themselves
and their environment (Piaget, 1962; Reilly, 1974). Play is also the child’s
natural medium of self-expression through which he or she can express feel-
ings, thoughts, fears and conflicts as well as develop self-awareness, self-esteem
and a flexible attitude (Garvey, 1991).
Central to an understanding of children’s play is the Western cultural
expectation of childhood being a period of innocence and special rights. It is
assumed that a child will be protected, nurtured and kept safe by his or her
parents or caregivers (Garbarino et al., 1992). When a child feels safe at home
and in the community, he or she is able to play and learn and develop into a
competent individual. Child abuse challenges these expectations about child-
hood and assumptions about normal childhood development. Unfortunately,
when a child is exposed to a chronically abusive or neglectful care environ-
ment, his or her opportunities for play development and play experiences are
more than likely to be disrupted. Consequently, the effects of child abuse may
manifest in a child’s developmental, cognitive and social organization of play
behaviour (Alessandri, 1991).
Although there is no universally accepted definition, child abuse is gener-
ally defined as any act of commission or, in the case of neglect, omission that
endangers or impairs a child’s physical, developmental and emotional well-
being (Portwood, 1998). Child abuse can include physical abuse, sexual abuse,
emotional abuse or neglect. Moreover, the child’s experience of maltreatment
frequently involves multiple forms of abuse, thus making it difficult to distin-
guish between various types of abuse (Ney et al., 1994). Emotional abuse, for
example, is increasingly being recognized as inherent in all forms of physical
and sexual abuse and neglect (O’Hagan, 1995).
International recognition of child abuse as a complex, multifaceted prob-
lem that affects children across all socioeconomic and ethnic groups has
increased over the past few decades. Although the problem of child abuse
exists in both developed and developing countries, it is often hidden or
ignored for social and cultural reasons. Consequently, the extent of child
abuse is difficult to determine, with increased reporting closely reflecting
growing public awareness and societal concern (Cicchetti and Toth, 1995).
An expanding body of research identifies abused children as being at risk of
delayed development, as well as short- and long-term social and psychological
maladjustment (Mullen et al., 1996). Younger children, because of their size,
developmental needs and dependency on parental care, are particularly vul-
nerable to intra-familial abuse or neglect. Clearly, early identification and
intervention is needed to reduce the negative impact as well as break the
intergenerational cycle of abuse (Esdaile, 1996).
Increasingly, occupational therapists are seeing children who are at risk, or
who have experienced abuse or neglect (Davidson, 1998). This involvement

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includes both direct referrals and secondary prevention programmes which
support at-risk children and their families (Wright, 1994; Esdaile, 1996). Fur-
thermore, there is also an increased risk of child abuse occurring in families
with a ‘high needs’, disabled or developmentally delayed child (Davidson,
1995). These more vulnerable groups of children often make up a sizeable
proportion of the paediatric occupational therapy caseload. Therefore, the
scenario of a clinician being alerted by a child’s verbal disclosure, behaviour
or physical signs to the possibility of child abuse is very real. How effectively a
clinician responds to suspected abuse depends on his or her training, ability to
recognize the behavioural warning signs of child abuse and discernment of the
legal, professional and ethical rules that apply to occupational therapy prac-
tice in the jurisdiction where the clinician works.
In the treatment of abused children, play-based therapies are widely used,
with play therapy being one of the most recognized interventions used by
clinicians (Gil, 1991). Play therapy approaches, based on Axline’s (1947) use
of a non-directive, nurturing play environment and a therapeutic relationship
to help the child to ‘play out’ emotional trauma, have been adopted by many
occupational therapists working with emotionally damaged children (Reade
et al., 1999). In other play-based interventions, the therapist may structure
the play environment to enable the child to develop new play skills, a playful
attitude and to improve weaker developmental skills which impede play per-
formance (Morrison et al., 1996).
Play assessment can also provide the therapist with important information
about the abused child’s developmental and emotional functioning (Wright,
1994). Clearly, conducting assessments in a play context with traumatized
children is much less intrusive than formalized testing or interviewing
(Kendall-Tackett, 1992). Play observations are often included in occupational
therapy assessment reports, which, in turn, can be subpoenaed as expert evi-
dence in child protection cases. However, the validity of interpretations made
from clinical play observations is questionable, given the subjective nature
and limited psychometric properties of most clinical play assessments and
inadequate research knowledge about play deficits (Kielhofner and Barris,
1984; Everson and Boat, 1994).
The effects of child abuse on children’s play have received little attention
in the research literature to date. This is surprising, given the widespread
recognition of the importance of play in childhood, and the extensive use of
play in both educational and therapeutic settings. The current paucity of
research data on how child abuse affects children’s play has important clinical
implications for how therapists use play in the assessment and treatment of
abused children. Since the therapist may be one of the most significant adults,
outside the family, involved with the child, there comes with this responsibili-
ty the need for a greater understanding of child abuse and its effects on chil-
dren’s development of play.

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Defining children’s play
Play research continues to be hampered by problems of definition and inade-
quate measurement. Researchers agree on the value of play as a facilitator and
indicator of children’s developmental maturation, but do not agree on a uni-
versal definition of play (Kagan, 1990). Lack of consensus could be due to the
wide range of behaviours that can be regarded as play. Similarly, since both
the external environment and the child’s personality traits influence play, it is
difficult to predict what type of play behaviour can be expected in any one sit-
uation (Kielhofner and Barris, 1984).
In contemporary occupational therapy practice, there has been a revival of
interest in children’s play as purposeful, occupational behaviour in its own
right (Parham and Primeau, 1997). Increasingly, occupational therapists are
also looking at the child’s playfulness or flexibility of approach as being a key
determinant of whether an activity becomes play or work (Bundy, 1997). If
play is understood as a need-fulfilling, meaningful occupation involving the
individual child interacting with the environment, then it is important to
understand how physical, social and cultural environments affect play (Cana-
dian Association of Occupational Therapists, 1996).
Since normal play is inadequately defined, it is not surprising that there
has been little attempt to define abnormal play. Ideally, play deficits need to
be defined in terms of a child’s occupational behaviour, such as play prefer-
ences, performance and how his or her environment supports or hinders play
opportunities (Morrison et al., 1996). Play assessment may reveal delayed play
skills or a mismatch between the child wanting to, but being unable to suc-
cessfully play in a preferred manner, because of undeveloped play skills or
overwhelming emotional disturbance (Clifford and Bundy, 1989).
For the purpose of this paper, this author will expand on Bundy’s (1991)
definition: ‘Play is a transaction between an individual and the environment
that is intrinsically motivated, internally controlled and free of many of the
constraints of objective reality’ (1991: 59). Play is a special kind of activity or
transaction that occurs between the individual child and the environment,
influenced by cultural expectations, and engaged in because the child wants to,
not because he or she has to (Neumann, 1971; Bundy, 1993). The individual
child brings his or her developmental abilities and play skills, along with his or
her personal play preferences and playfulness, to the play transaction, while the
child’s immediate environment (physical setting, available play materials and
social elements) either encourages or limits his or her play activities. The sur-
rounding adult cultural values and beliefs, and the child’s experience of care or
parenting, further influence how the play transaction develops. This play trans-
action between the child’s skills and the environment, illustrated in Figure 1, is
a dynamic process that has an impact on the child’s immediate physical and
social environment and, in turn, influences the broader sociocultural expecta-
tions of childhood that adults have (Sutton-Smith, 1980).

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263
FIGURE 1: The play transaction
A model of children’s play
Although the schema in Figure 1 encapsulates a holistic view of what play is,
a model systematically separates out the integral components that constitute
the play transaction in a way that serves as a guiding framework for exploring
children’s play in its different observable forms and contexts. The model pre-
sented in Figure 2 aims to provide occupational therapists with a workable
way of conceptualizing the underlying skills and behavioural elements charac-
teristic of play, and the influences that both individual and environmental
factors have on play. Although separated out in Figure 2, together these com-
ponents embody the developmental play capacities (cognitive, physical and
social play skills) and individual play style (internal control, freedom to sus-
pend reality and intrinsic motivation) that make up the child’s contribution
to the play transaction. The child’s play capacities highlighted in Figure 2 are
separately described in the following section, followed by a description of the
influences of play environment and cultural milieu on a child’s play.
The child’s contribution to play
Successful play engagement relies largely on developmental maturation, with
play reflecting the child’s cognitive, motor, language and social skills. For
instance, cognitive play skills reflect the child’s acquisition of problem solving
(divergent and convergent thinking) and logical reasoning skills which
enable him or her to use play materials or situations in a more adaptive and

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FIGURE 2: A model of children’s play
elaborate manner (Piaget, 1962; Vygotsky, 1976; Sutton-Smith, 1980). Fur-
ther evidence of cognitive capacity is evident in the child’s ability to trans-
form inanimate objects into ‘toys’ and use symbolic actions to represent
properties or absent objects in symbolic play, which is closely related to the
development of representational thought (Fein, 1981; Stagnitti, 1998). Reilly
(1974) conceptualized play as a complex learning process where the child
explores his or her environment out of curiosity and develops competency
through persistent practice until mastery is achieved. This generates self-

The impact of child abuse on children’s play
265
confidence and expectations about future performance leading to more
sophisticated environmental adaptation.
Likewise, it is through physical play activity that children develop and
refine locomotion, eye–hand coordination and manipulation skills. Sensori-
motor play is engaged in solely for the pleasure of exploring new sensations or
mastering gross and fine motor skills, especially in the first two years of infan-
cy (Piaget, 1962).
Social play skills are best described as an expression of the child’s develop-
ing language competence and social knowledge (Larson, 1995). Proficient
social skills underpin the child’s ability to communicate ‘this is play’ when ini-
tiating and maintaining interactive play roles (Rubin et al., 1983). Play as a
form of communication not only reflects a child’s self-concept and language
skills but also his or her social knowledge and interpretation of social roles
(Sutton-Smith, 1980). Gender roles may determine a child’s social play choices.
For example, boys tend to engage in more aggressive rough-and-tumble play,
competitive chasing and play-fighting than girls (Smith et al., 1985). Social
participation is a gradual process of increasing sophistication as the child is
better able to express him- or herself and respond to the different cues and
rules of social situations (Larson, 1995).
Although developmental skills underpin children’s play actions, it is the
individuality of style or preferences that is the most recognizable as play.
According to Bundy (1991), playful behaviour occurs when a child’s individ-
ual approach to the inherent rewards and possibilities of an activity is inter-
nally controlled, intrinsically motivated and when the player is free to
suspend reality.
Internal control is apparent when a child has the ability to determine what
happens, and how or with whom he or she is going to play (Neumann, 1971;
Rubin et al., 1983; Bundy, 1997). Garvey (1991) described play as self-initiat-
ed, voluntary behaviour, which is non-obligatory, has no extrinsic goals and is
free from externally imposed rules. When children are asked to distinguish
between ‘work’ and ‘play’ activities they generally describe the activities that
they have chosen and directed themselves and which are free of adult control
as ‘play’ (Pollock et al., 1997).
Freedom to suspend reality refers to the child’s ability to introduce non-
literal, pretend elements into play (Singer, 1973). Pretend play can either be
closely related to, or far removed from, the child’s immediate life experience,
with play themes reflecting his or her understanding of the world (Stagnitti,
1998). Pretend play enhances creativity and problem-solving skills by
enabling the child to experiment with different responses, roles and emotions,
without the risk of the consequences that would occur in real-life circum-
stances (Vandenberg and Kielhofner, 1982). Children also express their ideas,
feelings and sense of humour through dramatic role-playing, playful mischief
and clowning around.
Play that is intrinsically motivated is not ruled by compliance with social

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expectations or external inducements. It is done solely for its own sake (Rubin
et al., 1983). Therefore, a sense of fun or playfulness clearly separates play
from work or goal-driven tasks. Children want to play and, when playing, get
enjoyment and pleasure out of an activity that is inherently unproductive
(Garvey, 1991). The source of self-motivation that a play activity provides,
whether mastery or gratification, is a determinant of the child’s curiosity,
attention and total absorption.
The play environment
Referring to Figure 2, the physical and social elements present in the child’s
immediate play context will either stimulate or restrict play opportunities.
The child’s physical play environment includes available play space, variety of
play materials and whether the play setting is inside or outside, familiar or
unfamiliar. The presence of other children, parents or adults will also affect
how a child plays or interacts with the human objects in his or her environ-
ment (Coster, 1998). All of these factors influence how a child responds in
play to the physical and social challenges presented by the environmental
context (Schaaf and Mulrooney, 1989; Pollock et al., 1997). For example,
children are more likely to play in a safe, familiar, nurturing environment,
whereas an unfamiliar setting or novel play objects may elicit more explorato-
ry or non-play behaviour (Morrison et al., 1996).
The cultural and familial milieu
The child’s cultural and familial milieu highlighted in Figure 2 is much more
difficult to observe. Ecological factors, such as family, socioeconomic status,
community support, ethnic identity and gender roles, either directly or indi-
rectly shape the child’s experience (Sutton-Smith, 1980). In families, different
ethnic or cultural beliefs, expectations and child-rearing practices will influ-
ence how the child plays (Kagan, 1990). Likewise, the cultural sanctions or
cues that parents, extended family, friends and the broader community give to
children convey a message about the importance of play and permission to
play (Parham and Primeau, 1997). Parents or caregivers probably have the
most impact on how their children play through the way they interact, con-
trol or fail to respond to their children’s play. The quality of parent–child
interactions in the first year of life promotes the development of a secure
attachment between a parent and an infant (Morton and Browne, 1998).
Accurate parental feedback and ability to adjust interactions to meet their
child’s developmental and play needs is an important determinant of the
child’s development of social competency and social identity (Larson, 1995).
Attachment-theory inspired research consistently shows a strong association
between responsive parent–child interactions and a child’s later developmen-
tal and social competence (Pearce and Pezzot-Pearce, 1994).

The impact of child abuse on children’s play
267
The impact of child abuse on children’s play
Given the importance of the child’s familial or care environment in influenc-
ing how the play transaction develops, it is necessary to examine how detri-
mental environmental experiences, such as child abuse and parental neglect,
may affect or impede normal play development. Although there are many
examples of traumatic environmental disruption for children (for example,
children living in war zones or refugee camps), child abuse is a largely hidden
problem that results from the failure of the child’s primary care environment
to protect or nurture them. Numerous causes of child abuse have been identi-
fied, with the level of risk depending on the characteristics of the child, the
parents and the socio-cultural environment (Brown et al., 1998). Parental
immaturity, child-rearing rigidity, history of childhood abuse, alcohol or drug
addiction, low socioeconomic status and social isolation are all risk factors
that may contribute to an adult caregiver’s potential to harm or fail to ade-
quately provide for a child’s needs (Herrenkohl et al., 1995).
Because experience of abuse varies between individuals, children experi-
encing different forms of maltreatment may exhibit different forms of emo-
tional or behavioural disturbance in their play (Cicchetti and Toth, 1995).
For example, sexually abused children’s play may not show obvious develop-
mental delay. Psychological, behavioural and emotional problems are the
most frequently reported effects of sexual abuse (Mullen and Fleming, 1998).
The long-term impact of child abuse will depend on individual factors such as
the type and duration of abuse, the child’s age, gender, personality, relation-
ship to the perpetrator and parental socioeconomic status (Herrenkohl et al.,
1995). Using the previously outlined model of children’s play (see Figure 2), it
is possible to predict some of the detrimental effects that are likely to be man-
ifested in abused or neglected children’s play. These effects are presented in
Figure 3 and are examined in more detail in the following review of the litera-
ture.
The abusive or neglectful care environment
Growing up in a violent or neglectful care environment is likely to limit a
child’s development of competent social skills, self-confidence and experience
of positive interactions (Drake and Pandey, 1996). Abused children may have
a ‘world view’ in which a sense of potential threat is constantly present. Feel-
ing safe is the most basic prerequisite for a child to play. If a child does not
feel safe, he or she will not play. This anxiety invariably extends to any new
social situation and can be a major block to the child developing trust or feel-
ing safe in preschool or therapy settings.
Because child abuse or neglect results from the breakdown of the socializa-
tion system in the family, abuse by a caregiver can be viewed as an extreme
form of insensitive parenting (Morton and Browne, 1998). For example,

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FIGURE 3: The predicted effects of child abuse and neglect on children’s play
physically abusive mothers have been observed to be more critical, controlling
and less likely to give praise or positive reinforcement to their children when
they play (Kavanagh et al., 1988; Fagot and Kavanagh, 1991). Abusive par-
ents show less reciprocal interest in their children’s play, give fewer positive
responses such as handing a toy to a child and have low rates of verbal inter-
action (Bousha and Twentyman, 1984). Neglectful parents tend to ignore or
be unresponsive to their children (Gaudin et al., 1996).

The impact of child abuse on children’s play
269
Researchers have also reported more insecure attachments among abused
and neglected children (Mash et al., 1993). Insensitive parenting produces an
insecure attachment in a child, which can lead to the child developing a neg-
ative set of expectations about future social interactions and an internalized
view of themselves as unable to elicit a caregiver’s attention (Morton and
Browne, 1998). Insecure early attachments, resulting from the experience of
inconsistent or abusive parental responses, are likely to impact on how the
child explores and responds to the human and non-human factors in any play
environment (Pearce and Pezzot-Pearce, 1994). Many parents who abuse were
themselves abused as children and as a consequence have inadequate play
skills and a poor internal locus of control (Morton and Browne, 1998).
Given the strong association between socioeconomic disadvantage and
child abuse, it is also likely that the abused or neglected child’s physical play
environment, access to play objects and mainstream play or learning opportu-
nities may be severely restricted by poverty (Garbarino et al., 1992).
The impact of child abuse on cognitive and physical play skills
The developmental effects of child abuse are well documented (Gaudin et al.,
1996). As a result of delayed language, cognitive and motor skills, the physi-
cally abused or neglected child is likely to show delayed play development
(Cicchetti and Toth, 1995). Howard (1986) found that physically abused
preschool children showed significantly delayed play development.
Observations of physically abused preschool children characterize them as
less able to make full use of play materials or to initiate and organize a
planned play activity (Caughey, 1991). Mann and McDermott (1983)
hypothesized that because some neglected and abused children may never
have learned how to play, they are more likely to engage in repetitive,
exploratory or stereotyped play, frozen at a younger level of development. A
study conducted by Alessandri (1991) found that, when compared with their
non-abused peers, abused preschool children played less, and engaged in more
sensorimotor activity (physical movements with or without objects) than
symbolic play. Their use of play materials was functional, with much repeti-
tive touching and pounding of toys. The lack of an adequate repertoire of play
skills prevents the abused child from fully exploring new toys or potential play
experiences, resulting in reduced expectations about his or her play compe-
tence and ability to influence the environment (Alessandri, 1991).
The impact of child abuse on social play skills
In a preschool-based study, physically abused and neglected children’s play
was found to be more disruptive, aggressive and antisocial than that of sexually
abused children, whose behaviour was more passive and withdrawn (Fagot et
al., 1989). When compared with a non-abused control group, both groups in

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this study exhibited fewer positive play interactions. It is likely that increased
aggressive or disruptive play behaviour and a lack of empathy for peers will
further isolate and prevent the abused child from learning appropriate social
skills (Davis and Fantuzzo, 1989). Playground studies have found that neglect-
ed children are more likely to play alone and be ignored or rejected when they
approach peers, whereas physically abused children, although they actively
seek out social contact, are less positive in their play interactions than their
non-abused counterparts (Segal et al., 1991).
The impact of child abuse on internal control of play
Physically abused children’s play behaviour has been described as poorly con-
trolled, impulsive and disorganized, with little development of a play theme
and a tendency to flit between activities (Gil, 1991). Because abused children
may not be able to initiate play or control their impulses, they may engage in
more repetitive, regressive non-play behaviour (Mann and McDermott,
1983). Young children tend to internalize the experience of abuse and may
blame themselves for causing the abuse. This disturbed sense of self may mani-
fest in destructive behaviour such as deliberately destroying toys or disrupting
other children’s games (Caughey, 1991).
Disruptive play behaviour is a symptom of the child’s emotional distur-
bance and may reflect the only way that a child knows how to control the
play situation. Harper (1988) noted that
...the normal child is in control of the situation and is able to alter or terminate play
without difficulty, whereas the disturbed child may become so involved that reality and
fantasy merge and play seems almost out of control, on the verge of disintegration
(1988: 37).
Post-traumatic stress reactions are also frequently seen in children who
have experienced a traumatic incident or abusive act (Ackerman et al., 1998).
Traumatized children may repeatedly re-enact a traumatic event in their play
with such intensity that the play behaviour becomes more anxiety provoking
for them (Garbarino et al., 1992).
The impact of child abuse on freedom to suspend reality
Decreased pretence and symbolic content in abused or neglected children’s
play has been widely described by both clinicians and researchers. For exam-
ple, Howard (1986) found that physically abused preschoolers, when playing
in the ‘home corner’ with other children, introduced fewer dramatic or imagi-
native play elements. Similarly, Alessandri (1991) described the pretend play
of abused children as being restricted in the extent and variety of fantasy char-
acter roles or imaginative themes used. Abused children, when compared with
their non-abused peers, tended to stick to domestic play themes (for example,

The impact of child abuse on children’s play
271
bathing or feeding a baby doll) or re-enacting parental roles and real-life
events, often in a repetitive manner. Using a sand tray, Harper (1991) com-
pared the symbolic play themes of physically, sexually and physically/sexually
abused children aged 3–9 years with non-abused control children. Her find-
ings indicate that physically abused children are more likely to show aggres-
sive themes of conflict and chaos in their sand-tray play, and obsessive themes
of sexuality and protection dominated sexually abused children’s play.
Sexually abused children’s play often does not show obvious developmen-
tal delay. Fagot and her colleagues (1989) noted that sexually abused
preschoolers preferred to play quietly by themselves and were unlikely to be
seen as deviant by adult observers. The way in which sexually abused chil-
dren’s play differs from that of children experiencing other forms of maltreat-
ment is the frequently observed existence of sexualized play behaviour (Mian
et al., 1996). Clinicians, observing sexually abused children playing, often
report the sudden intrusion of explicit sexual themes, bizarre behaviours and
masturbatory play (Harper, 1988). It is this voyeuristic quality and the trans-
ference of anxiety through play which can make the adult observer uncom-
fortable (Harper, 1991). Considerable research attention has also been
devoted to sexually abused children’s doll play with anatomically correct dolls
(Boat and Everson, 1994). Although the use of anatomically correct dolls is
based on the premise that children’s play is the equivalent of their verbaliza-
tions, the function of these dolls remains highly specific to the sexual abuse
interview (Kendall-Tackett, 1992).
The impact of child abuse on intrinsic motivation
In marked contrast to non-abused infants, who actively explore and adaptively
play with objects, physically abused and neglected infants’ play has been
described as lacking in energy with a marked inhibition of activity, and aimless
in quality with little sustained interest in toys (Gaensbauer et al., 1980).
Neglected children’s observed lack of interest or expressed enjoyment in play
may be due to their experience of an unpredictable, unrewarding world which
requires their total expenditure of energy in just surviving (Ney et al., 1994).
Hypervigilance, or heightened awareness, which is frequently observed in emo-
tionally abused children, not only absorbs their play attention but also dampens
their curiosity, as they are constantly monitoring the verbal and non-verbal cues
of others in their immediate environment (Carrey et al., 1995). Furthermore,
many clinicians have described aspects of pseudomaturity, or adult-like behaviour,
that pervades the play of some abused children (Gil, 1991; Harper, 1991).
Conclusion
In this article, a conceptualized model of children’s play, which was then used
to organize the literature on the effects of abuse and neglect on children’s

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play, has been presented. Although abnormal play behaviour has been report-
ed consistently since the earliest studies of child abuse, this has largely been
anecdotal. Most reports of delayed or disrupted play in abused children have
come from play therapy case studies which, given the therapeutic context and
specialized involvement of the adult therapist, may not reflect the child’s play
in other settings. Reported effects include delayed play development, poor
adaptive play skills and a lack of playfulness, as manifested in poorly con-
trolled, disorganized play behaviour, decreased pretence and a lack of enjoy-
ment or interest in play. From this overview, it is concluded that children
living in a chronically abusive or neglectful care environment seem to be less
able to successfully engage in competent play behaviour or cope with new
social play situations because of emotional disturbance, delayed developmen-
tal skills and restricted experience of positive play opportunities.
Occupational therapists have traditionally been concerned with occupa-
tion and the use of functional activities like play, as therapeutic tools. A rec-
ognized developmental expertise places occupational therapists in a strategic
position to respond to the challenge of treating the young abused child
(Davidson, 1998). Child abuse is a relatively new area of clinical practice and
research for occupational therapists. The aetiology and long-term treatment
implications of child abuse are still not well understood, and the widespread
idealization of children’s play has blurred the issue of critical evaluation of
play-based treatment techniques (Reade et al., 1999). Occupational therapists
working in the field of child abuse need to question more the basis for the
assessment and treatment techniques they employ.
Traditional play-based psychotherapies may not be appropriate for some
young abused or neglected children. Such children may be better managed by
focusing on developing competence in play, or using more structured develop-
mental play activities to address underlying developmental deficits. Early
intervention and prevention programmes must be a priority of intervention.
These programmes could help not only the abused child, but also promote
parental change, through early childhood intervention, therapeutic play
groups or play-focused approaches that enhance parent–child interactions and
play education (Esdaile, 1996). The goal of any play-based intervention
should be to provide a safe, non-threatening, playful environment for the
child (and caregiver) in which to facilitate playfulness, intrinsic motivation
and problem solving which will lead to increased play competence (Canadian
Association of Occupational Therapists, 1996).
The model presented in this paper is one possible model of play. However,
because the model largely reflects Western cultural ideals and theories about
play, it may be of limited value when examining the play of children from
non-Western cultures. It is hoped, however, that by presenting a model of
play, occupational therapists will be better able to understand and critically
examine the complex occupation of children’s play. The model could feasibly

The impact of child abuse on children’s play
273
be applied to different clinical groups of children as a holistic framework for
predicting how disability or environmental dysfunction may affect play. For
example, this framework could be used to select appropriate play assessments
to measure different aspects of a child’s play skills, playfulness and play envi-
ronment or to structure play observations for research or treatment planning.
Clearly, for occupational therapists there is a practical need to better integrate
and utilize the theoretical play literature into clinical practice. In order to
facilitate and strengthen play-based treatment and assessment methods, a
greater clinical research understanding of the specific nature of the effects of
child abuse on children’s play is urgently needed.
Acknowledgements
I wish to thank Dr Jenny Ziviani, University of Queensland, Australia, and
Ted Brown, Children’s Hospital of Eastern Ontario, Canada, for their invalu-
able editorial assistance. This article is based on a paper presented at the
Abused Child Trust Conference, Brisbane, Australia, August 1996, as well as
part of a broader study of abused children’s play, supported by grants from the
Australian Rotary Health Research Fund.
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Address correspondence to Rodney Cooper, BOccThy (Hons), Doctoral candidate,
Department of Occupational Therapy, University of Queensland, Brisbane, Queensland, 4072,
Australia. Email: s031019@student.uq.edu.au