The Importance of Play

As a pediatric therapist, I've met parents from many walks of life, all with their own experiences. Some parents have had previous negative experiences with speech therapy and say that they want "actual therapy", not just someone playing with their child. With these families, I take the time to explain the importance of play; that playing is therapy, but more than that, I explain HOW playing is therapy. I often find that once the parents understand the "why", they will be on board and no longer view our time together as "just playing". So let's take a look at the "why" together.

Building a relationship

Just like adults, children can be anxious or shy in new situations. For these children, I really will "just play", but I help parents understand that this isn't the end goal. Rather, it is a stepping stone toward productive therapy sessions. Play helps them feel at ease with the therapist. Here is the example of little Tyler. I started working with Tyler when he was just turning 3 years old. Tyler had significant anxiety coming into the therapy room. He often needed his mother to carry him in and took a few minutes to settle. Even once the crying stopped, he had not yet built trust with me. Our first 7/8 sessions were spent making the therapy room and time with this therapist, feel warm, inviting, and comfortable for Tyler. I pulled out his favourite toys, let him explore the room, and allowed him to come to me. Through these sessions, I was still modelling language and acknowledging the messages he was sharing, but there was no expectation that he would repeat after me or really verbalize at all. As he grew more comfortable with me, I slowly started adding small expectations. For example, I might pause a little longer before giving a desired object to see if he would repeat after me. By week 7, he happily trudged into the therapy room, without needing his mother to carry him in. He requested his favourite toys (either verbally or non-verbally) and was comfortably interacting with this clinician. Tyler had childhood apraxia of speech, meaning that once sessions began in earnest, there was a lot of repetition, drills, and tactile prompting (as I am PROMPT® trained), all in the context of play of course. Having him trust me was crucial to having positive and productive sessions. By the end of our second block of therapy, Tyler was leaning forward, seeking out the tactile prompting to support his production of target words.

Imagine how productive our sessions would have been if I had tried to dive right into therapy while he was still reluctant to enter the therapy room. Very little progress would have been made and he likely would have become more and more reluctant as the sessions progressed, as he would view the experience as negative. Those first seven sessions were critical in establishing the relationship and trust that opened the door to productive therapy sessions.

Interest

Many caregivers have the best intention when using cue cards with their children. They are often trying to increase vocabulary and try to prepare the child for school. I like to remind parents that children are little humans, which means they also experience interest and boredom, just like we do. I encourage parents and caregivers to think back to their school days. Who was your favourite teacher? Why? What was your favourite subject? How easy was it to study for or pay attention in your favourite class compared to your least favourite class? What I often hear is that the favourite teacher was someone who made them feel heard, someone who made the material interesting, someone who made it possible for them to feel successful in class. Caregivers usually said that they tended to do better academically in their favourite class, and had to work significantly harder for their least favourite class. They were more likely to remember facts from their favourite subject, and were quick to forget information from their least favourite subject.

At it's core, it boils down to finding the material interesting. And it's the same for children. Working on speech and language in the context of a game makes the material relevant and interesting. Some children may enjoy cue cards, but I find the vast majority of them prefer to play. Modelling target words and sounds in play make them more interesting, meaning the child is more likely to listen to the model and use it again in the future, because it describes something fun and they will want to ask for it again. The words also tend to be more functional, because they are relevant to the activity being played.

Attention

An important strategy I give to parents when playing with their child is to follow the child's lead. It's a lot of hard work to support a child's language while they are engaging in an activity. Caregivers/therapists have to think about setting up the activities, plan for communication opportunities, plan for target vocabulary, etc. It has happened to me on more than one occasion where I have planned an activity only for the child to refuse to play it, or take the activity in an entirely different direction. The natural inclination is to redirect the child to the prepared activity, however; the child is either not interested in the original activity or is more interested in this new way of playing. As we discussed in the previous section, interest is hugely important in getting buy-in and participation from children. The often better approach is to see where this new activity leads.

Imagine that you are doing an activity that interests you. It could be woodworking, colouring, painting, shooting hoops, etc. Now imagine your reaction to the following two scenarios:

1) someone joins you in your activity or does the same activity next to you, then starts discussing that activity

2) someone joins you, but makes it impossible for you to continue your activity. They might bring the car into the garage where you were woodworking, plays hockey in the driveway where you were shooting hoops, takes over the table where you were colouring to do a puzzle. They then start talking about the new activity they have set up.

Which scenario would you prefer? In which scenario are you more likely to listen to and engage with the other person?

Now let's imagine you are a child in similar scenarios:

1) You are playing with cars. Your caregiver sits near you with some of their own cars and talks to you about the cool things the cars are doing.

2) You are playing with cars. Your caregiver sits near you and starts asking you to label farm animals.

Realistically, the child is more likely to pay attention to, and engage with, the caregiver who is joining in on their activity, rather than trying to redirect their focus.

The takeaway

While it might look like a therapist is "just playing", they are using playing to build a relationship with the child. They are then using play to capture the child's interest and attention to make language and speech models meaningful and fun. This translates to better outcomes in therapy.

As always, if you suspect your child has speech or language difficulties, it is recommended you have your child's communication skills assessed by a Speech-Language Pathologist.