Child’s Play: Examining the Association Between Time Spent Playing and Child Mental Health

Recent research estimates that, outside of school, children in Britain spend just over three hours a day playing [1]. Play is intrinsically rewarding for children, provides a way for them to interact with the world, express themselves, and make sense of the world around them. Despite this, there has been growing concern that children’s play, particularly their outdoor, independent, adventurous play has been declining over recent decades. For example, Clements [2] found that whilst 70% of mothers surveyed in the United States reported that they played outdoors daily as children, only 31% of their children were reported to do so. Moreover, findings from the UK suggest that whilst parents reported spending approximately 40% of their time playing as children in natural spaces, only 10% of their children’s play was reported to happen in these spaces [3]. Furthermore, there is robust evidence of increasing restrictions over the past 50 years on children’s independent mobility, defined as the age at which children are allowed out alone and how far they allowed to travel [1, 4]. Alongside these declines in outdoor play and independence, rates of emotional disorders in UK children aged 5–16 years increased by 49% between 1994 and 2017 [5] and recent data show further increases, with an estimated one in six UK children having a probable mental health problem in July 2020 [6]. It has been proposed that reductions in children’s outdoor, risky play, may have negative consequences for children’s mental health, and may be contributing in part to the increase in children’s mental health problems [7‐9]. To date though, no empirical research has directly examined this association [10].

Adventurous play, or risky play, is defined as child-led play where children experience subjective feelings of excitement, thrill and fear; often in the context of age-appropriate risk-taking. Several theoretical articles have hypothesised links between adventurous play and children’s mental health, particularly internalising problems such as anxiety and phobias. For example, Sandseter and Kennair [9] propose that children have a natural drive to engage in risky play, which evolved because it has anti-phobic effects, naturally exposing children to stimuli that may otherwise be feared such as heights and water. In keeping with this, Gray [7] theorises that the decline in play over the last generation is associated with increasing rates of mental health problems in children. A recent conceptual model drew on the extensive literature related to the development of anxiety in children to argue that sufficient adventurous play experiences during childhood may help to prevent anxiety in children [8]. Specifically, Dodd and Lester describe the role of intolerance of uncertainty [11], coping [12, 13], anxiety sensitivity [14] and avoidance [15, 16] in child anxiety and propose that adventurous play provides a motivating, positive context for exposures to, and subsequent healthy learning about, uncertainty, coping and physiological arousal. They argue that through these learning experiences children’s ability to cope adaptively in the face of uncertainty and arousal increases and their risk for problematic anxiety decreases.

Despite this theoretical work, research examining the association between adventurous play and children’s anxiety, or mental health more broadly defined, is scarce. Qualitative evaluations of school-based interventions to increase levels of adventurous play report positive outcomes of adventurous play, including increases in resilience [17] and improvements in children’s happiness at school [18]. There is also evidence that play, in general, is good for children’s wellbeing and mental health; children admitted to hospital show lower levels of anxiety and fewer negative emotions when they take part in a play intervention [19] and, when given time for free play, hospitalised children show reductions in stress [20]. Outdoor play and being in nature, which facilitate adventurous play, also have a positive effect on children’s wellbeing [21‐23], but the direct link between adventurous play and children’s anxiety has yet to be examined.

Although the theoretical links between play and internalising symptoms have been described in previous work, to our knowledge adventurous play has not been explicitly linked to externalising problems such as Attention Deficit Hyperactivity Disorder (ADHD) and Conduct Disorder within psychological theory. There are some findings that would be consistent with adventurous play offering benefits for externalising problems. For example, schools taking part in an intervention to prioritise risk and challenge in the playground reported less bullying and conflicts on the playground post-intervention [18]. Further, children with ADHD who played regularly in green play settings were reported to have milder symptoms than children who played in built outdoor or indoor play settings [24]. It is not clear though that adventurous play has a specific role in these positive effects and, again, there is a lack of research directly evaluating the link.

In this paper we present two studies which examine the association between parent-report of children’s time spent playing and child mental health. Study 1 and Study 2 use the same measures of play and mental health; Study 1 uses an opportunity sample of parents living in Northern Ireland and Study 2 examines the extent to which the findings hold using a large nationally representative sample of parents living in Great Britain. To capture mental health broadly, in both studies we evaluate long term symptoms of internalizing and externalizing problems as well as shorter term positive and negative affect, which were assessed during the first weeks of the Covid-19 lockdown. Internalising problems include symptoms of anxiety and depression whereas externalising problems refer to difficulties with behaviour and attention. Positive and negative affect refer to more transient mood states. Time spent playing adventurously, time spent playing unadventurously and time spent playing outdoors are estimated using the Children’s Play Scale (CPS; 25) in both studies.

Our primary hypothesis follows relevant conceptual models: that children who spend more time playing adventurously will have fewer internalizing symptoms. In addition, we hypothesise that children who typically spend more time playing adventurously will have less negative affect and more positive affect during the Covid-19 lockdown, which we conceptualise as indicating better coping under uncertainty. To evaluate the specificity of these associations, we also examine associations between adventurous play and externalizing symptoms, as well as associations between mental health and both time spent playing unadventurously and time spent playing outdoors.

The aim of Study 2 was to further evaluate the hypotheses outlined within Study 1 via analysis of data from the British Children’s Play Survey.

It has been proposed that to prevent anxiety and broader mental health problems, children need opportunities to play adventurously and take risks in their play. We therefore evaluated, across two studies, the hypothesis that more adventurous play is associated with fewer internalising problems. In both studies, there was support for this hypothesis. In Study 2, the correlation was stronger for children growing up in households with lower income. Although the effect sizes were notably small, the association between adventurous play and internalising problems was robust, holding after a wide range of demographic factors were accounted for, and when an alternative cutoff was used to define adventurous play. The small effect size is arguably to be expected given the broad range of factors that affect children’s mental health; any individual factor such as play experience would be expected to account for only a small proportion of variance. The variation in effect size due to household income may be due to corresponding differences in exposure to adventure via more structured activities. For example, activities such as scouts, martial arts or adventure camps all provide children with exposure to the feelings of uncertainty, arousal and coping that are proposed to underpin associations between adventurous play and anxiety. These opportunities may be less abundant for children from families with lower household income and therefore, adventurous play may have be more important for these children. The CPS measures unstructured play so it does not capture these additional activities, but this explanation would be in keeping with previous research focused on the benefits of adventure experiences (e.g. [34]).

We also hypothesised that children who typically spend more time playing adventurously may have coped better with the uncertainty of the Covid-19 pandemic and lockdown and may therefore have experienced more positive affect and less negative affect during this period. The results partially supported this hypothesis; across both studies a clear positive association between adventurous play and positive affect was found. Children who typically played more adventurously were happier during the first Covid-19 lockdown than those who did not. Again, although effect sizes were small they were robust across studies and held after controlling for a range of other demographic factors. In contrast, no direct associations between adventurous play and negative affect were found. Although there was some indication that children from higher income families may have experienced more negative affect during lockdown if they usually played more adventurously, this did not hold after controlling for other demographic factors. The effects for positive affect are of relevance to mental health given that low positive affect is a core feature of depression. Children with higher positive affect have lower symptoms of depression over time [35]. This finding therefore provides some initial support for the idea that adventurous play may help children to cope, or at least maintain positive affect, during difficult periods, even if it does not prevent negative affect.

An additional aim was to explore the specificity of any associations found between adventurous play and internalising problems. Theoretical models propose that whilst play offers broad benefits for children’s development, happiness and wellbeing, it is adventurous play specifically that provides learning opportunities which buffer against anxiety. Our findings broadly support this; no associations with externalising problems were found and unadventurous play was either not associated with internalising symptoms or was positively associated such that more unadventurous play was associated with more internalising symptoms. Notably, there is significant overlap between our adventurous play and outdoor play measures, as indicated by the high correlation, but results were less consistent across the two studies for outdoor play than for adventurous play.

From a theoretical perspective, the results provide some initial support for the predictions of a number of models [8, 9] but the data are cross-sectional and we cannot rule out the the direction of effect is that children with higher internalising problems play less adventurously. We also cannot conclude that adventurous play experience definitely helped children to cope during lockdown, without having a baseline, or pre-pandemic, measure of positive affect or a control group not exposed to the pandemic. Nevertheless, this research provides an important first step in evaluating theoretical claims and provides a foundation for future longitudinal and experimental work. For example, where it may be possible to manipulate adventurous play (i.e. through school-based interventions) and directly assess the impact on children’s mental health.

The research has a number of strengths including the use of two independent samples, one of which was large and nationally representative. There are some significant limitations. The primary limitation is the reliance on parent report of play and mental health. We are confident that the results are not due to shared method variance due to the specificity of the associations, but parent report offers only one perspective on both the child’s play and the child’s mental health. It is also important to acknowledge that parents were asked to report retrospectively about their child’s play and mental health due to the national lockdown as a result of Covid-19. It is not possible to evaluate the accuracy of this retrospective report but the measures were completed very soon after the start of the lockdown (a maximum of one month later) which means we can be reasonably confident that parents would have been able to report with reasonable accuracy [36]. Furthermore, due to the large sample, we relied on questionnaire measures but it may be beneficial for future work with more focused samples to use diary-based measures of play perhaps combined with technology to allow tracking of activity levels or geographical location. Finally, adventurous play is likely to offer a range of benefits to children, including an increased sense of autonomy, improved risk perception and greater physical activity, but these outcomes were not assessed given our focus on children’s mental health. Future research would benefit from taking a holistic view of children’s development and well-being to better capture the effects of this type of play.

To conclude, the results indicate that providing children with opportunities to play adventurously may have a small but positive effect on their mental health, particularly for children from low income families. Importantly, small effects can have substantial real world consequences due to their ability to accumulate over time and at scale [37]. This has been argued to be particularly important when the outcomes are consequential (e.g., mental health). For example, whilst universal free school breakfasts are related to a small increase of 0.09 standard deviations in math achievement, over a year duration the benefits of free school breakfast may equate to around 1.6 months of schooling per child [38]. Given that children enjoy playing in an adventurous way, interventions to support children’s access to and engagement in adventurous play are likely to be an appealing way to support children’s mental health.

A number of theories indicate a role for adventurous or risky play in anxiety prevention. In this paper for the first time, the association between children’s time spent playing adventurously and their mental health is examined. More adventurous play was associated with lower internalising symptoms and more positive affect. The results suggest that giving children more opportunity to play in an adventurous way when they are in and out of school may offer benefits in terms of children’s mood and longer term mental health. To support children’s mental health, they need opportunity to play outdoors and adventurously, planning policy must consider children’s needs to ensure that every child, particularly those growing up in lower income families, has free access to safe space for adventurous outdoor play close to home. Longitudinal and experimental work is required to tease apart direction of effect in future research.