Playfulness and the Environmental Support

of Play in Children With and Without

Developmental Disabilities
Ellen M. Hamm
Key words: Test of Playfulness, Test of Environmental Support, early intervention

ABSTRACT

The primary purposes of this study were to examine the reliability and validity of the Test of
Playfulness (ToP) and the Test of Environmental Supportiveness (TOES), to compare play-
fulness and environmental support of play in children with and without developmental dis-
abilities, and to examine the correlation between the ToP and the TOES. Participants included
20 children with various developmental disabilities and 20 children without developmental
disabilities between 6 and 38 months old. Results revealed the ToP and the TOES to be reli-
able and valid. Furthermore, children with developmental disabilities were less playful than
children without developmental disabilities. The ToP and the TOES were found to be highly
correlated for both groups; however, the magnitude of this correlation was greater for children
with disabilities.

R
eview of current research regarding play and
playfulness in children reveals a discrepancy
between young children with and without
developmental disabilities. Although some research-
ers have found a significant difference in the play of
children with and without developmental disabili-
ties (Bromwich, 1985; Brooks-Gunn & Lewis, 1982;
Gowen, Johnson-Martin, Goldman, & Hussey, 1992;
Hanzlik, 1989; Okimoto, Bundy, & Hanzlik, 2000),
others report nonsignificant differences (Buchanan,
1995; Harkness & Bundy, 2001). Playfulness goes
beyond the performance of play skills because it
lends description to the quality of a child’s play,
regardless of physical ability. The more playful child
may be more flexible, and flexibility is thought to
be an important trait for individuals with disabili-
ties (Harkness & Bundy, 2001). If playfulness is a
child’s disposition to play (Lieberman, 1977), and
play is the primary occupation of young children
(Parham & Primeau, 1997; Reilly, 1974), then assess-
ment of playfulness in addition to the assessment
of play skills may be a consideration in pediatric
occupational therapy. The current study examined
playfulness and environmental support for play in
young children with and without developmental
disabilities.
Context for Play
When children feel safe and comfortable in their
environment, they will be able to play (Rubin, 1977).
Therefore, the goal of enabling playful interactions
requires occupational therapists to look beyond skill
development and examine the role of the environ-
ment as it supports or inhibits playful interactions.
Kielhofner (1985) stated “. . .the environment both af-
fords opportunities for performance and presses for
certain types of behavior” (p. 2). Assessment of the
child’s play environment may be a preliminary step
in addressing play. Occupational therapists are often
experienced in how to construct play environments
that afford opportunities for play performance.
Play
Children with developmental disabilities often
exhibit deficits in play that parallel deficits in other
areas of development (Field, Roseman, De-Stefano,

Ellen M. Hamm, PhD, is Assistant Professor, Canisius College, Buffalo, New York.
Address correspondence to Ellen M. Hamm at hamme@canisius.edu.

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& Knoewler, 1982; Malone, 1999). Past research has
demonstrated that children with disabilities often do
not have the same play skills or opportunities to play
as their typically developing peers (Barrera & Vella,
1987; Brodin, 1999; Field et al., 1982; Hanzlik, 1989;
Hanzlik & Stevenson, 1986; Hestenes & Carroll, 2000;
Hill & McCune-Nicolich, 1981; Mack, Lindquist, &
Parham, 1982). Although deficits in motor, speech,
cognitive, or social–emotional domains are readily
addressed in early intervention programs, play defi-
cits are often neglected because emphasis is directed
toward educational goals (Lane & Mistrett, 1996).
The role of play in occupational therapy has
evolved from that of a diversionary activity (Slagle
& Robeson, 1941) to a lifelong occupation (Kielhof-
ner, 1985). Consideration of play in early interven-
tion is important because research has linked play
to social and emotional development, growth of lan-
guage and motor skills, and creativity and problem-
solving (Bruner & Sherwood, 1976; Garvey, 1990).
Occupational therapists often use play as an activity
for assessing and promoting development; however,
assessment of children’s play skills often focuses
on the manipulation of play objects and not on the
child’s inherent propensity for play known as play-
fulness (Bundy, 1993).
Playfulness
Playfulness, defined as a disposition to play, is
thought to be a trait of the individual (Lieberman,
1977). Based on the work of others (Neumann, 1971;
Rubin, Fein, & Vandenberg, 1983), Bundy (1997a) de-
fined playfulness as contingent on a combination of
four elements: intrinsic motivation, internal control,
the freedom to suspend reality, and framing.
According to Bundy (1997b), intrinsic motivation
refers to some unnamed aspect of the activity, rath-
er than to an external reward. This element may be
measured by observing traits of play, including play
that is all-absorbing, play involving more attention
to process than to product, and play that is surpris-
ing and unpredictable. Internal control suggests that
the child is largely in control of his or her actions
and some aspect of the activity’s outcome. This el-
ement may be observed through traits consisting
of the player’s feeling safe and reaching beyond
himself or herself to meet a challenge. Freedom to
suspend reality means that the individual chooses
how close the transaction will be to objective reality.
This element is manifested in play when the usual
meaning of objects no longer applies. Framing is the
ability to give and to interpret play cues (Bateson,
1972). This element is measured by the child’s ability
to give and read social cues and be engaged in play.
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These concepts are not mutually exclusive, because
certain play behaviors may suggest that one or more
of these elements is present. The degree to which
each element is present determines whether a child’s
transaction is considered playful (Bundy, 1991).
In a study designed to investigate playfulness in
young children, differences in playfulness among 19
children without disabilities and 19 children with
cerebral palsy and developmental disabilities were
examined (Okimoto et al., 2000). The children’s
chronological ages ranged from 3 to 32 months.
Mother–child dyads, matched for gender and mental
age, were videotaped during 15 minutes of free play
in their home with a standard box of toys provided
by the researcher. Playfulness was measured using
the Test of Playfulness (ToP) (Bundy, 1997b). Results
indicated that children with cerebral palsy and de-
velopmental disabilities scored significantly lower
on the playfulness measure than their peers without
disabilities. In addition to comparing playfulness,
this study also established reliability and validity for
the ToP to be used with children with cognitive defi-
cits and children as young as 3 months.
Harkness and Bundy (2001) also examined the
playfulness of children with and without physical
disabilities. Their sample included 25 children with
a variety of physical disabilities but no cognitive
limitation, and 25 children without developmental
disability. Children’s ages ranged from 2 to 12 years
and participants were matched for gender, age, and
ethnicity. Despite references in the literature to de-
creased play ability and playfulness of children with
physical limitations (Mogford, 1977; Russell, 1985;
Sheridan, 1975), results of the study by Harkness and
Bundy found no significant difference in mean scores
of playfulness between the two groups (t = .63; p =
.53). Study limitations included unexpectedly high
scores on the ToP item that measures a child’s exu-
berance, which may have resulted in children with
disabilities receiving a higher score on this item than
was appropriate. Another limitation included the
play environments chosen by participating families.
The authors found that families of children with dis-
abilities often chose to be observed in familiar envi-
ronments with few obstacles, whereas the families of
children without disabilities chose novel situations
in which their child was less familiar.
Further research suggests a positive significant
relationship between playfulness, as measured by
the ToP, and environmental support of play, as mea-
sured by the Test of Environmental Supportiveness
(TOES), with the magnitude of that relationship be-
ing greater for children without disabilities than for
children with disabilities (Bronson & Bundy, 2001).
89
Participants included 160 children, 51 without dis-
abilities and 109 with disabilities, with a mean cog-
nitive age of 70 months. The TOES measured a vari-
ety of environments, including home, daycare, and
outdoor play settings. Environments were not con-
sistent among participants because some children
were in unfamiliar surroundings and others played
in their home. Based on their results, the authors
also concluded that the TOES is a reliable and valid
measure of environmental support.
Based on limited and conflicting research, the cur-
rent study examined playfulness and environmental
support of play for children with and without devel-
opmental disabilities. Other independent variables of
interest included gender, to account for differences
in the playfulness of boys and girls, and presence of
siblings, to account for differences due to the effect
of having a sibling as a model for playful interac-
tions. Additionally, the reliability and validity of the
ToP (version 4.0) and the TOES was examined and
the relationship between environmental support and
playfulness in each group was probed. The following
research questions guided this investigation:
1. Is the ToP a reliable and valid measure of playful-
ness in young children with and without devel-
opmental disabilities?
2. Is the TOES a reliable and valid measure of the
environmental support of play in young children
with and without developmental disabilities?
3. Do children with and without developmental dis-
abilities demonstrate differences in playfulness?
Should an overall significant difference be detect-
ed, can that difference be attributed to one demo-
graphic characteristic such as disability, gender,
or presence of siblings?
4. Do children with and without developmental dis-
abilities receive different levels of environmental
support for play? Should an overall significant
difference be detected, can differences be attrib-
uted to one demographic characteristic such as
disability, gender, or presence of siblings?
5. Do children with and without developmental dis-
abilities demonstrate differences in strength of
correlation between playfulness, as measured by
the ToP, and the environmental support for play,
as measured by the TOES?
Method
Participants
The sample consisted of 20 children with devel-
opmental disabilities and 20 children without dis-
abilities whose chronological ages ranged from 6
to 38 months. Participants with developmental dis-
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abilities were part of a larger study on playfulness
(Lane, 2001) and were identified through the Early
Intervention Program in a large county in New York
State. Participants with developmental disabilities
were matched with participants without develop-
mental disabilities for gender, cognitive age, socio-
economic status, ethnicity, and presence of siblings.
Cognitive age for children with disabilities was
determined from standardized testing completed
for the child’s most recent Individualized Family
Service Plan. The mean cognitive age for this group
was 16.3 months. For children without disabilities,
cognitive age was equivalent to chronological age
and mean cognitive age was 16.2 months. Empiri-
cal research has found that the play of children with
disabilities is commensurate with cognitive age, not
chronological age (Bromwich, 1985, Buchanan, 1995;
Gowen et al., 1992; Okimoto et al., 2000); therefore,
children were matched on cognitive age within 2
months, regardless of chronological age.
Participants included 27 boys (14 with disabili-
ties, 13 without) and 13 girls (6 with disabilities, 7
without). Types of disabilities varied, and ranged
from mild to severe limitations. Twenty-four chil-
dren (12 per group) had older siblings, and 12 (6 per
group) were only children at the time of videotap-
ing. Subjects included two sets of twins; one set of
male twins in the group of children with disabilities,
and one set of male–female twins in the group with-
out disabilities.
According to study classification criteria, all fami-
lies had a socioeconomic status of working or mid-
dle class and all children, with the exception of one
boy with a developmental disability, resided with
both parents. All participating parents had com-
pleted high school and most were college educated
(15 parents of children without disabilities and 14
parents of children with disabilities). All fathers in
both groups were employed outside the home. Nine
mothers of children with disabilities worked outside
the home, whereas 16 mothers of children without
disabilities worked outside the home. Nineteen of
the 20 children in each group were white, and one
child in each group was African American. Nineteen
of the 20 children in each group were videotaped in
a play session with their mother, and one girl in each
group was videotaped in a play session with her fa-
ther.
Instruments
Test of Playfulness (ToP). The ToP (version 4.0)
(Bundy, 1991) is a 32-item observation instrument
designed to evaluate free play in children 6 months
to 14 years of age regardless of developmental level.
OTJR: Occupation, Participation and Health
The ToP provides a measure of playfulness without
penalties for motor skill deficits and defines playful-
ness as the combination of internal control, intrinsic
motivation, freedom to suspend reality, and fram-
ing. The extent, intensity, and skillfulness of out-
lined play behaviors are rated on a 4-point (0 to 3)
scale. Children are scored on items such as the ex-
tent, intensity, and skill with which they are actively
engaged in play; the extent that they decide what to
do during play; the intensity with which they try to
overcome barriers to persist in play; the skill they
use to modify an activity to maintain challenge and
fun; and the extent, intensity, and skill displayed in
social play. Scores are derived from a 15- to 20-min-
ute observation of free play with playmates or a fa-
miliar adult caregiver.
Preliminary evidence suggests that the ToP is a
valid and reliable measure of playfulness in chil-
dren with or without disabilities. Support for re-
liability was established using Rasch modeling
(Wright & Masters, 1982; Wright & Stone, 1979) and
with investigations (Brooks, 1995; Bundy, 1997a)
indicating that 93% to 95% of items, 95% to 98% of
children tested, and 100% of raters fell within the
established measurement model. Reliability and
construct and concurrent validity of the ToP has
been further established when used with children
with and without developmental disabilities be-
tween 15 months and 10 years old (Bundy, Nelson,
Metzger, & Bingaman, 2001) and with children with
cognitive deficits as young as 3 months (Okimoto et
al., 2000).
Test of Environmental Supportiveness (TOES).
Bundy (1999) designed the TOES to be administered
simultaneously with the ToP. The 17-item observa-
tional measure assesses both the human and the
non-human elements in the environment that posi-
tively or negatively influence playfulness. Human
environment consists of caregivers, peers, and play-
mates (either children or adults) and non-human en-
vironment consists of both play items and the play
setting. Caregivers are scored based on behaviors
that ensure safety and provide play opportunities.
Objects are scored on the existing amount, ability to
support play, and degree of modification they allow.
Space is rated on amount, configuration, safety, and
accessibility. The sensory environment consists of
colors, sounds, temperature, and the extent to which
these invite play in the environment. Administration
of the TOES involves a 15- to 20-minute observation
of free play. Participants in this study were video-
taped for 20 minutes of free play in an indoor setting
selected by the parent. As was deemed acceptable by
the test author, partial scoring of the TOES was used
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because three items related to play with younger
playmates were not observed.
Items on the TOES are rated on a 4-point contin-
uum (-2, -1, 1, 2). Negative scores indicate that an
environmental element is interfering with play and
positive scores indicate support from the environ-
ment. Data on inter-rater reliability and model error
values provide support for reliability. Model error
values are calculated on each item, subject, and rater
and provide further evidence of scale reliability. Us-
ing Rasch analysis, Rogers (1999) examined several
aspects related to construct validity, including fit of
items and data to the Rasch model, percentage of un-
expected ratings, logic of item order, and separation
of items into levels. Analysis indicated that 94% of
the items, 95% of environments, and 96% of raters
conformed to the expectations of the Rasch model.
Setting
Based on past research (Buchanan, 1995), the set-
ting for the play session was the child’s natural play
environment. This environment was determined by
the parents and in all cases was a room in the family
home where the child typically engaged in play. For
the purposes of this study, a 20-minute videotape of
an indoor free play session in a setting familiar to the
child was taped for scoring.
After receiving informed consent and consent
for video release, videotaping was conducted in the
family home. Videotaping was conducted with lim-
ited involvement from the researcher in the play ses-
sion, as suggested in the ToP manual (Bundy, 1997b).
Caregivers were instructed to engage in typical play
with their child, using toys or materials with which
they were comfortable. No toys or materials were
supplied by the researcher. Data were collected with
an awareness of the effect of videotaping on sub-
jects; however, due to the age of the children, most
appeared unaware of the camera.
Videotaped play sessions were scored by two in-
dependent raters trained and calibrated in scoring
the ToP and the TOES. The raters were naïve to the
research hypothesis and tapes from each group were
randomly divided to ensure each rater scored an
equal number of children representing each group.
Inter-rater reliability was performed by randomly
selecting 10% of the tapes from the total sample to
be scored by both raters. Raters were in 100% agree-
ment on the scoring of this sample of tapes.
Results
To determine the reliability and validity of the
ToP to assess playfulness and the TOES to assess the
91
 Table 1
A Summary for 2 3 2 3 2 Multivariate Analysis of Variance
Univariate
Multivariate ToP TOES
Source of Variation df F p df F p df F p
Main Effects
Group 2, 31 5.5 .008* 1, 32 10.90 .002* 1, 32 3.3 .08
Gender 2, 31 0.6 .320 1, 32 2.00 .16 1, 32 0.3 .58
Siblings 2, 31 0.6 .550 1, 32 0.20 .65 1, 32 1.0 .30
Interaction Effects
Group 3 Gender 2, 31 0.25 .77 1, 32 0.49 .48 1, 32 .13 .72
Group 3 Siblings 2, 31 1.30 .26 1, 32 1.70 .21 1, 32 .02 .87
Siblings 3 Gender 2, 31 0.19 .82 1, 32 0.11 .73 1, 32 .02 .88
Group 3 Gender 3 Siblings 2, 31 1.08 .34 1, 32 1.70 .19 1, 32 .17 .68
Note. ToP = Test of Playfulness; TOES = Test of Environmental Supportiveness.
*p < .01.

environmental support of play in young children
with and without developmental disabilities, good-
ness-of-fit was analyzed using fit statistics generated
by Rasch analysis. Goodness-of-fit is determined
through mean square (MnSq) and t statistics. MnSq
is the ratio of the observed score and the score ex-
pected by the measurement model. The t statistic is
the standardized difference between the observed
and expected scores. The ideal value is 1.0 for MnSq
and 0 for t statistic; however, MnSq values 1 ± 0.4
and t values 0 ± 2.0 are acceptable. MnSq values less
than 0.6 or greater than 1.4, accompanied by t sta-
tistics less than -2 or greater than +2 for either infit
or outfit, failed to conform adequately to the Rasch
model and indicated data that were too consistent
or too erratic and required further investigation
(Wright & Linacre, 1994).
Item response validity of the TOES was exam-
ined by determining how well data from items fit
the Rasch model. Fit statistics of all 17 items (100%)
fell within acceptable limits. Person-response valid-
ity of the ToP was examined by determining the fit
of both items and participants to the Rasch measure-
ment model. Data from 100% of the participants and
raters conformed to the Rasch model. Additionally,
construct validity was examined for the ToP. All
items (100%) fit the model supporting that the ToP
reflects a unidimensional construct of playfulness.
To determine inter-rater reliability, rater calibrations
were examined for fit to the measurement model.
Both raters fit the measurement model for the ToP
and the TOES, indicating that the scales were used
in a consistent manner. Scale reliability for the ToP
and the TOES was examined through analysis of
the percentage of individual item ratings that fit
the measurement model. For this sample, 100% of
the ratings assigned conformed to the Rasch model
supporting reliability of the scale when scored by
trained raters.
Standard scores for the ToP and the TOES were
used for data analysis. A three-way multivariate
analysis of variance (2 3 2 3 2 MANOVA) was
conducted to determine the effect of the three in-
dependent variables (group, gender, and presence
of siblings) on the two dependent variables (ToP
and TOES scores). To examine the role of the en-
vironment in relation to playfulness, correlation of
the ToP and the TOES was generated for the entire
sample of 40 children and subsequent correlation of
the ToP and the TOES was generated for each of the
two groups of 20 children for comparison among
groups.
MANOVA was computed to examine playful-
ness and environmental support of play in the two
groups. Because differences between the two groups
were significant, follow-up univariate tests were con-
ducted. Independent variables of interest included
group, gender, and presence of siblings. MANOVA
results are reported in Table 1.
Correlation of the ToP and the TOES for all sub-
jects was followed by correlation of the tests for
each group (n = 20). Correlations were subjected
to Fisher’s z to determine differences in magnitude
of correlation of the ToP and the TOES for children
with and without disabilities (Minium, King, & Bear,
1993). Correlation results are reported in Table 2.

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Multivariate and Univariate Effects
Significant multivariate effects were found be- Table 2
tween the two groups. Using Wilk’s Lambda, results Correlation Between ToP and TOES Scores
of the MANOVA indicated a significant effect for Correlation 2-tailed
group. Univariate effects were analyzed to deter- Coefficient Significance
mine which of the three independent variables con- Subjects (Pearson r) (Fisher’s z)
tributed to the multivariate effect. Inspection of the Both groups .723 .000
means revealed that children without developmen- (N = 40)
tal disabilities scored significantly higher on the ToP With disabilities .757 .000
compared with peers with developmental disabili- (n = 20)
ties; however, TOES scores were not significantly Without disabilities .636 .000
different between the two groups. Mean scores are (n = 20)
reported in Table 3. Note. ToP = Test of Playfulness; TOES = Test of Environmental
Supportiveness.
Effect sizes are reported in terms of Partial Eta
Squared. Partial Eta Squared represents the variance
accounted for by the dependent variables. Partial
Eta Squared is a correlation squared and effect sizes ple of 40 children and then separately for the two
reported are correlations that may be interpreted as groups. The coefficient for ToP and TOES scores in
follows: 0 = trivial, .1 = small, .3 = moderate, .5 = the entire sample of children was found to be sig-
large, and .7 = very large. With small numbers of nificant (df = 38; p < .01), with the amount of shared
participants, as in this study, inferential statistics can variance at 49%. The coefficient for the sample of
produce misleading results. Moderate to large effect children without developmental disabilities was
sizes indicative of substantial differences in means .636 (df = 18; p < .01), whereas the coefficient for the
are likely to be insignificant with a small number sample of children with developmental disabilities
of participants because of restricted power. Signifi- was .757 (df = 18; p < .01). The percentage of shared
cant multivariate effects were found among the two variance between ToP and TOES scores for these
groups with effect size, (ES) r = .477. Univariate ef- two groups was 42% and 56%, respectively. For both
fects were significant for group on the ToP only, (ES) groups, a significant and positive relationship was
r = .356. found between playfulness and environmental sup-
port of play. Fisher’s z transformation was used to
Analysis of Correlations compare the coefficients of the two samples. Results
Regarding magnitude of correlation for the ToP of the analysis indicated a significantly higher cor-
and the TOES for the two groups, data were ana- relation between the ToP and the TOES for children
lyzed using the Pearson product moment correla- with developmental disabilities compared with their
tion. Coefficients were calculated for the entire sam- peers without developmental disabilities.

Table 3
Mean Scores for Playfulness and Environmental Support
Group ToP Mean SD TOES Mean SD
With disability -.2995 .8882 2.1995 1.0186
Male with siblings -.4318 .7935 2.0473 .93871
Male no siblings -.4000 .45211 2.1733 .09815
Female with siblings .3763 1.4607 2.6767 1.4950
Female no siblings -.3633 1.0979 2.2800 1.6513
Without disability .6510 .9114 2.8995 1.2153
Male with siblings 1.0556 1.0880 2.9110 1.4745
Male no siblings .0100 .58583 2.4675 .99225
Female with siblings .5220 .62815 3.2000 1.2758
Female no siblings .4350 .6434 2.9600 .0000
Note. ToP = Test of Playfulness; SD = standard deviation; TOES = Test of Environmental Supportiveness.

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 Discussion
In response to the first research question regarding
the reliability and validity of the ToP for measuring
playfulness in young children, results suggest that
the ToP is both reliable and valid and may provide
clinicians and researchers with a practical means of
measuring the construct of playfulness. Knowledge
and understanding of the four elements measuring
the construct of playfulness (intrinsic motivation, in-
ternal control, freedom to suspend reality, and fram-
ing) may be useful in assessment and intervention
for the pediatric therapist.
Reliability and validity of the TOES as a measure-
ment of the environmental support of play was also
supported. Caution should be taken in interpreting
this finding because the environments assessed were
limited to play with a parent in the family home. The
results provide evidence that the TOES is reliable
with respect to raters, suggesting that the TOES may
be a viable option for therapists to use in assessing
the human and non-human environment as it sup-
ports play.
Examination of mean scores between the two
groups of children suggests that children with de-
velopmental disabilities were less playful than their
peers without developmental disabilities, regardless
of the presence of siblings or gender. This finding is
consistent with previous research conducted by Oki-
moto et al. (2000), who measured playfulness in chil-
dren with and without cerebral palsy and concluded
that the ToP mean score for children without a dis-
ability was significantly higher than the mean score
for children with cerebral palsy. However, the re-
sults contradict findings from Harkness and Bundy
(2001), who measured playfulness of children with
and without physical disabilities and found no sig-
nificant differences between the two groups.
Regarding the environmental support of play, no
significant differences were found for environmental
supportiveness as measured by the TOES. This find-
ing suggests that the environments where the par-
ticipating children were videotaped for evaluation
were all equally supportive of play. For this study, all
children were videotaped in their home in a famil-
iar environment. One interpretation of this result is
that the parents had anticipated the specific needs of
their child with or without a disability and adapted
the environment to fit the requirements. Additional
research is suggested to determine the supportive-
ness of play in a greater variety of environments,
such as community playgrounds.
The final research question examined the corre-
lation of the ToP and the TOES. Results identified a
94
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significant difference in the magnitude of correla-
tion for the two groups. Children with disabilities
demonstrated a stronger correlation of the ToP and
the TOES compared with their peers without dis-
abilities. This finding does not support the work of
Bronson and Bundy (2001), who found the magni-
tude of the relationship of the ToP and the TOES
was greater for children without disabilities than
for children with disabilities. The significant dif-
ference in the correlation of the ToP and the TOES
suggests that the environment may play a more
important role in supporting playfulness for chil-
dren with developmental disabilities compared
with those without. The environment under study
involved the physical environment and the human
environment, which in this case was represented by
parent as play partner.
This finding lends support to the findings of Malo-
ne (1994) and Malone and Langone (1999), who sug-
gested that exposure to toys alone is not adequate to
increase play, and recommended adult intervention
to assist children in the selection of appropriate toys
and modeling toy use. Lane and Mistrett (1996) also
suggested that parents of children with disabilities
may need intervention to learn to be playful with
their children. Implications of this finding place
emphasis on the therapist’s role in structuring the
child’s environment to promote play. Constructing
an overall environment that encourages play is pre-
requisite to a child’s exploration of the environment
(Morrison, Metzger, & Pratt, 1996).
Results of this study should be considered in light
of several limitations, including the use of a small
sample of convenience. Additionally, only partial
scoring of the TOES was analyzed because the hu-
man environment focused on play with a parent as
playmate and did not address play with peer play-
mates.
Conclusions
Based on the current data analysis, the ToP ap-
pears to be a valid and reliable assessment of play-
fulness and the TOES a valid and reliable assessment
of the environmental support of play for young chil-
dren with and without developmental disabilities.
As measured by the ToP, children with and without
developmental disabilities demonstrated differenc-
es in playfulness, as those with developmental dis-
abilities scored lower on the ToP compared to their
peers without developmental disabilities. No differ-
ences in the environmental supportiveness of play
were detected between the two groups; however, the
correlation between playfulness and environmental
OTJR: Occupation, Participation and Health
support was greater for children with developmen-
tal disabilities.
Because of the importance of adaptability in the
life of a person with a disability (Bundy, 1993) and
the potential relationship between adaptability and
playfulness (Harkness & Bundy, 2001), occupational
therapists should consider playfulness as an area of
assessment and intervention. In designing effective
interventions to increase playfulness in young chil-
dren, each element of Bundy’s model of playfulness
(intrinsic motivation, internal control, freedom to
suspend reality, and framing) should be examined
for its contribution to the overall construct of play-
fulness.
Based on interpretation of the results, interven-
tion to increase playfulness should include direct
involvement with the child and with the child’s hu-
man and non-human environment. This support
may be provided by training parents or caregivers
and service providers in effective ways to promote
play in children with developmental disabilities, or
by making changes in the physical environment to
accommodate children with disabilities and encour-
age playfulness. Furthermore, in light of findings
that indicate a high correlation between playfulness
and the environmental support of play, continued ex-
amination of the role of the human and non-human
environment in play is warranted. Further studies
are also recommended to compare the effectiveness
of interventions to increase play and playfulness in
children with developmental disabilities.
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OTJR: Occupation, Participation and Health