“Play is often talked about as if it were a relief from serious learning. But for children, play is serious learning. Play is really the work of childhood.”
Fred Rogers

From Maria Montessori to Mr. Rogers, as well as in scads of academic papers, many in the occupational therapy literature, the unique role that play has for a child’s development and overall wellbeing is well known. From pediatricians to the United Nations High Commission on Human Rights, play is regarded as crucial, and even a human right. The AOTA (American Occupational Therapy Association) wrote, Play is one of children’s major occupations—how they occupy their free time and learn.” 

Many therapists working with children put a lot of effort into providing a playful atmosphere. But playful therapy and authentic play are not the same.

Consider this non-feeding related story (adapted from Rowell’s book Love Me, Feed Me)

Pam adopted Sara when she was 11 months old. At age five, Sara was seeing an Occupational Therapist (OT) for sensory challenges. Pam recalls an afternoon at the park watching Sara and a friend play. When the friend pulled off her shoes and ran to the slide, Pam watched as Sara pulled off her shoes and socks, gingerly at first, but then ran through the wet sand and played happily—barefoot.

Pam was shocked. While Sara had made progress with transitions and anxiety, the work on desensitization around touch, especially on her feet wasn’t going well. Sara refused for months during therapy sessions to walk barefoot through a shallow, long pan of dry rice. As Pam understood it, they were trying to desensitize her feet so that she could tolerate different socks and shoes and do things like play at the beach at their cabin. And here she was playing in the sand, with a smile on her face! 

Similar happened with showering: after months of trying to get Sara comfortable in a shower (with rewards and counting ‘1-2-3 in’ and ‘1-2-3 out’), she simply followed a friend into the communal shower after open swim at the local Y, where they chatted away about their swim teacher. Sara continued to shower after swim class, and soon was showering at home (the hand-held shower head that gave Sara more control was a game-changer).

Pam provided Sara with enjoyable opportunities to grow in her capabilities in ways that felt meaningful to her. Breakthroughs came when Sara was playing, in her case, within mutually satisfying peer relationships. 

Authentic play is a unique experience where children are in felt safety, in their window of tolerance, and where they are in control.

Felt safety + social connection + I do it = powerful motivation

Play vs Playful in Responsive Feeding Therapy

Sara’s therapists were playful, with bubbles, music, clapping games, praise, big smiles, and colorful and bright therapy spaces. 

Still, she resisted, tolerated, and tried to comply with most tasks, but she wasn’t usually smiling or truly engaged. The therapy sessions focused on the rice were not authentic play. (Not all therapy has to be in play, but this post is about drawing attention to playful therapy that may compromise autonomy and intrinsic motivation.)

Playful therapy is adult and agenda-driven; as with the adults were trying to get Sara to walk across the rice.

Play is self-initiated.

Playful therapy tasks may not align with internal motivation: there is no real-world WHY to the activity from the child’s POV. (Why would Sara want to walk across rice in therapy, other than to please or comply?)

Play is spontaneous and intrinsically motivated; it offers many benefits, from pleasure to self-regulation, connection, and more.

(Play varies and has been hard to define and measure. Some assessments may view neurodiverse play as lacking and needing to more closely resemble neurotypical play.)

Responsive feeding therapy strives to support autonomy; authentic play can’t happen without it. It can be tricky to know the difference between playful and play. It can be even trickier to consider that while playful therapy may share some of the outward features of what we think of as play, it can undermine autonomy and intrinsic motivation.

From the White Paper on Responsive Feeding Therapy

  • You can’t replace internal motivation with praise or stickers.
  • For many children, external rewards and pressure undermine and hinder the true, deep motivation to grow up and be capable. (Jo, paper on autonomy thwarting?)

From our website

  • RFT is not simply ‘having fun’ with food. Just because an approach is playful, that doesn’t necessarily make it responsive.
  • Accepting a child’s ‘no’ or giving a child a choice does not necessarily imply that an intervention is responsive. Children may comply for many reasons, including a desire to please or to escape from a situation.

Questions to ponder:
How can you tell, when observing a child, if they are in authentic play or not?
How might play look different with a neurodiversity-affirming lens?

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Katja, Natalia, and Jo