Play In Adults

‘We don’t stop playing because we grow old; we grow old because we stop playing’- George Bernard Shaw

When I began my career as a pediatric occupational therapist, play was at the forefront of my mind. How couldn’t it be? For a youngster, play can serve so many meaningful purposes- from exploring their environment, to increasing their tolerance to sensory stimulation, to achieving a flow like concentration state, to connecting with their peers. Every single session I facilitated had play at its core. My therapy room was full of toys, colour and laughter, and I believe I enjoyed getting the chance to play every day just as much my clients did.

And yet, when I moved onto working with adults with intellectual disabilities, I put play neatly away in a box. After all, play is for children- these adults should be working on life skills! My sessions became about teaching the practical techniques required to be independent in activities of daily living. My therapy room was suddenly full of resources- money management worksheets, conversation skills flashcards, bus timetables. And yes, I saw results- clients increased their independence and achieved personal goals. Still, I couldn’t help but wonder some days, where was the fun?

I stumbled across the benefits of play with my adult clients purely by accident. One morning, I decided to introduce an additional component to a stress management session, in the form of containers of warm, scented water for clients to soak their feet in during guided meditation. What was intended to be an extremely zen environment quickly transformed into a high energy situation as one client picked up his water container and tipped the whole thing over my head! I stood there, mouth opening and closing as I tried to think of a professional way to respond to this situation, and watched non-verbal clients who rarely responded to environmental cues dissolve into peals of laughter. This was without question the most engagement I had ever seen from this group of individuals. Was my goal for the session achieved? Well, I guarantee you not one person left that room feeling stressed. I chalked it down as a roaring success.

One young man who is tactile hypersensitive began the session by dipping a tentative baby finger into the foam, and ended it with just as impressive a beard as the rest of us.

And so it became a game. The next week I brought shaving foam to the stress management session and by the time we had finished giving ourselves Santa Claus style beards and making pretend desserts, the room and all of our clothes were covered in it. So what? Shaving foam wipes right off. We all left the session with our stomachs in pain from laughter. Furthermore, confidence grew- I watched as one shy lady who tends to blend into the background of the group received a rapturous applause from her peers as she pushed a plate of shaving foam into my unsuspecting face. Relationships deepened- I saw two clients who were prone to arguing advising each other on how to make their shaving foam hairstyles stand up higher. Tolerance increased- one young man who is tactile hypersensitive began the session by dipping a tentative baby finger into the foam, and ended it with just as impressive a beard as the rest of us. And in addition to all this, my original stress management goal was more than met- staff reported that the group was in excellent form for the rest of the day.

As the weeks progressed, I began to find Parten’s stages of play (Parten, 1932) just as relevant in this client group as I did in my younger clients. It started to dawn on me that many adults with learning disabilities have not had the opportunity to progress through the stages of play. Some of these adults were left behind socially by their typically developing peers during their school days, or not included in group games for a variety of reasons, meaning they had remained at a solitary or onlooker play level since childhood. Through creating safe environments where adult clients can play with appropriate peers, I have seen people in their forties and fifties move onto cooperative play. Vygotsky’s zone of proximal development theory (Vygotsky, 1978) really comes to life here, when we watch clients learn play skills from each other. A perfect example of this is how one client watched a group of his peers sorting a sensory bin of beads into different colour categories (onlooker play). When I brought back the same sensory bins the following session, the client began modelling their actions by sorting a bin of painted matchsticks into colour categories (parallel play), and was then eventually invited by one member of the bead group to help them with their sorting (cooperative play). Staff reported that this client was suddenly coping much better during social outings- when the group would go out to eat previously, he would become upset if somebody else’s food arrived first, and would throw tantrums about sharing table condiments. On reflection, of course he did, if he had never learnt the turn taking and sharing skills that play teaches us in our pre-school years- how can we expect anyone to just ‘know’ these things? The take home lesson for me was not to assume that age necessarily has an impact on play skills, and not to belittle the impact that under-developed play skills can have on all aspects of engagement.

Nowadays, having fun is once again a necessary goal of all my sessions. There is no limit to the ways play can be incorporated into activities- whether it means making an adapted Monopoly style board game to teach money management, incorporating charades into communication skills lessons, or learning a bus route via a pirate’s treasure map. Because of the inclusion of play, I have seen improvement in therapeutic rapport with my clients, I have seen higher motivation to engage, and I have seen dramatic increases in attendance at OT sessions. We are ticking off goals without even realising it. My therapy room is still full of resources, but it is now also full of colour and laughter. When I look back, I’m not sure why I ever thought the two were mutually exclusive.

Parten, M. B. (1932). "Social Participation among Preschool Children". Journal of Abnormal and Social Psychology. 27 (3): 243–269

Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.

Nicola Spendlove is a successful occupational therapist by day, and a struggling playwright and actress by night. She lives in the sometimes sunny (and always beautiful) Tramore, Ireland, with a nice man and hopefully soon a lovely dog.