Parents of a child with disabilities and their views about their child’s play

Adapted toys that allow to play independently; Creative toys; Toys to activate pressing a button: soap bubble machine; Soap bubbles; Affordable toys to guarantee variation, diversity; Interesting toys; Toys from favourite series; Adapted to the ability and age-appropriate looking; Games, puzzles, jigsaws; Letters in all colours and shapes; Favourite toys; Toys for playing in the sand; New toys; Engaging toys taking account of physical and cognitive peculiarities.


Family relationships
The majority of the responses were given by mothers (n=112) while fathers gave 10 of the answers. A few answers were provided by other family members and others (1 sibling, 1 grandmother, 5 therapists/guardians).

Characteristics of the children 4.3.1 Age of the children
The parents reported the age of the child whose experience they were thinking about. The majority of the children were reported being in the age range 6-9 years (33%), while the other age groups were rather evenly represented, with the younger children being represented in 21% of the answers, the adolescents aged 10-13 years being the 24% and the older adolescents 14-18 the 22%. Thus, the received questionnaires include opinions about experiences from a broad range of ages, with a slight major representation of primary-school-aged children, as described in Figure 9.

Gender distribution
The majority of the children were boys (63%), the girls were 37%.
Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM Parents were also asked to explain the meaning of the words chosen in the following question. If you have time to say why these words are important, then please do.... Almost all (121 respondents in 129) have reported on this additional section, to explain the choice of the 3 words they have mentioned in their answer to the previous question.
The answers to these questions are analysed in this section using content analysis. The parents used overall 146 expressions about their children's play in their responses.
They could be categorised into six categories: Positive expressions, Negative expressions, Expressions about type of play or activities, Expressions about objects and items; Expressions about other people; Expressions about development.
Some expressions were quite clear, in relation to these categories (e.g., "happy" is interpreted as a positive expression), whereas a few might have more than a unique interpretation, such as "play alone"). Some expressions might possibly fit in more than one category (like the sentence "She loves company, talking, physical contact, and variety" which refers to positive expressions, expressions of actions and expressions about others). These expressions have not been considered in this report.
The emotions involved in play are strongly positive for the majority of the answers regarding emotional states (84 cases): in fact, the words that were chosen most often by the respondents in terms of feelings and emotions related to play, regarded fun, enjoyment, creativity, pleasure, enthusiasm, well-being. These concepts suggest that the play activity is conceived as very important and meaningful to the child.
However, parents wrote also 55 words or sentences which were categorized as negative expressions. Restrictions were seen in attention, in children's play and in peer relations, the frustration experienced on failure, the frustration when the play situation or the toys are not suitable for the child, and trouble as an outcome when the relationship with peers are not working well. Box 1 contains a list of the concepts that were used in the responses. Relax, calmness, curiosity, stimulating, enthusiasm, enthusiastic, bustling, cheerful, creative, fun, funny, free, surprise, pleasure, concentration, joy, happy, laughing, laughter, enjoyment, smile, smiling, well-being, imaginative, imagination, interest, distraction, love, parents love child, happiness and pleasure, shared moments of joy, like, vivid, tolerance, respect.

Negative emotions
Stubborn, father's anxiety, not exciting, boredom, mischief, frustration on failure, loneliness, monotonous poor, rejecting, lack of concentration, alone with assistant or parent, solitude, isolation.

Box 1. Concepts used in the responses
Expressions referring to type of play or activities were mentioned 41 times. We categorized these activities with reference to the Classification of the types of play Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM adopted by the Action "LUDI. Play for children with disabilities" (Bulgarelli & Bianquin, 2017). Within this framework, according to the parents' answers regarding their children's play, the most representative type of play reported is practice play. The children are capable of experiencing simple activities such as repeating gestures and phrases, listening to the music, often accompanying with body movement, or touching and handling stimulating sensorial materials and colourful toys with different textures. For instance, children with intellectual disabilities are more interested in the physical characteristics of play materials, than in their representational possibilities (Lender, Goodman & Linn, 1998).
There are also many activities that involve the whole body, such as motor activities in playgrounds, exercises as walking, running, climbing.
The second type of play more represented is play with rules which includes videogames or technological tools, such as tablet, i-Pad, PlayStation. These devices have a wide range of applications in the case of children with motor impairments or with autism spectrum disorders and in general they strongly attract all children (Weiss, Bialik & Kizony, 2003;Reid, 2004).
Symbolic play is the third type of play cited by parents. This includes simple symbolic play such as play with shapes and drawing, but also more sophisticated activities as for example playing with alphabet, with cards or role play and pretend play with toys and friends.
As to its cognitive dimension, construction play appears rarely in the parents' answers. The parents mentioned widespread materials of building play, such as Lego bricks. One father said that his child was not capable in doing construction play, but was able to disassembling materials, indicating the difficulties that may be experienced at the symbolic level of play: children with intellectual disabilities are delayed in the emergence of symbolic play (Bulgarelli & Stancheva-Popkostadinova, 2017).
In the social dimension of play it is difficult to distinguish among the different types (solitary, parallel, associative or cooperative) from the parents' answers. Solitary play and onlooker play are mentioned. The parents said in some cases that their children play also with animals. Some mentioned play activities fall unambiguously under the cooperative play type, such as play with the ball freely or with rules (as in the case of football), or play with cards, or simply dealing with rules. The parents cited also generic activities from a social point of view such as talking, smiling, laughing, and having company.
Objects or items, like a ball, a tablet or toys, were mentioned 18 times. Play is thus also playing with something or handling objects. What is needed for playing are toys and other objects like tablets, scissors, and mobile phone. Some parents (16) connect play with different kind of activities, like dancing, running, singing, doing things on the PC. The fact that so many objects other than toys and so many activities other than playing with toys or role play are mentioned by the parents, shows that the concept Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM of 'playing' is understood quite broadly, and in some answers has been interpreted as close to the concept of leisure time.
Other people, adults and children, or the lack of them, were associated with play 32 times. Issues such as assistance, inclusion and solitude were categorized here. Play needs the presence of peers, sisters, brothers, adults. Sometimes parents reported that children with disabilities do not have the opportunity to play with their peers, but instead there are adults who play with them. Parents express clearly that playing is doing something with others. Thus, the lack of play can be related to the lack of other people to interact with.
Many parents acknowledged the need that the adults lead or supervise the play of a child with disabilities. In addition, the adults should also socially act to increase the awareness of the need for play companions for children with disabilities. Some other aspects may be added. For instance, several parents mentioned that their children need often to change play activity and that they ask for a wide variety of play activities. This occurrence may be related to the lack of concentration that characterizes some types of disability or to the lack of awareness or capacity in peers to interact with the child with disabilities, or to the adults' lacking skills to support or lead the child's play.
Sometimes these situations are evaluated as a low level of culture of inclusion, as the following words show: The non-disabled children are not prepared by adults to accept diversity. This leads inevitably to isolation of children with disabilities.
In some cases the play is compromised by the intrinsic difficulties due to a specific type of disability: The deaf child needs to understand the play proposed and sharing his playing experience with peers rewards and makes him feel included. In another case the child doesn't speak: He is dependent on communication partners.
The last category of this content analysis, that connects play with development, includes 12 expressions, which were relating play for example to learning and educational goals. Some parents in fact connect play to development by talking about cognitive skills, strategy play, where play is seen as allowing the integration of discovering skills and learning. One father underlined the rhythm of play, and called it "action-reaction". He understood in this interactive dialogue an important developmental aspect that must be introduced, supported and sustained in some kinds of impairments -such as severe intellectual disabilities. In many cases play does not occur spontaneously, because of the child's lack of initiative and concentration. In Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM these cases, it is fundamental that the child's play is supported by a competent adult. When involved in structured situation, defined by adults, children with intellectual disabilities show higher levels of pretend play (Nader, Grosbois & Vieillevoye, 2012). The previous limitations in playing alone have been then overcome, but this result needed a purposeful pedagogic intervention: He was taught how to play with focus on sharing, playing with others. His spontaneous play was schematic and alone.
The child needed one-to-one relationship, a condition cited by several parents: Playing with too many children does not work: it is too chaotic and she'd get overstrung.
The play was defined by parents in various ways. Some parents pinpointed that play was an important occasion of communication between the caregiver and the child, and a main medium for the child to express his/her own feelings. One mother said: Playing is the main way to communicate with him, and for him to express his feelings.
Others referred that through play the child acquires a self-marking behaviour, an element known in the studies of play and disability, which may have positive or negative aspects, depending on the specific situation. So a mother said: She has an incredible need to make a mark. Being very smart she suffers more the lack of dexterity than the fact of not walking.

Another mother said:
He wants to gain more exclusive attention.
Summarizing, parents seem to think at play as a positive and valuable experience for the child, and to consider that their child's play wakes up positive feelings, like enjoyment, happiness and fun. But this attitude is not shared by all the parents involved in the survey. Many comments have been collected underlying the negative side of the child's play: why the play doesn't succeed, the lack of peers to play with, the fact that the only play activity that might be practiced is destroying objects, and that sometimes it reveals limited and difficult.
Finally, since play is generally seen as an activity that may fulfill important needs of the child, parents feel frustrated and unhappy when their children experience shortcomings and limitations to their play.

Places and companions for play
With the second question the respondents were asked to explain where and with whom their child plays. A large number of parents (70) answered that the child plays at home, sometimes in specific rooms, and they added often the type of activities preferred, which could be pretend play, role play, play with various toys (cuddly toys, dolls, educational toys, computer games, tablet, board games, Lego bricks), play with sounds, music and dancing, colours, puzzles, motor play. Some examples: She plays fantasy play at home, so she plays most by herself. Or with one friend at a time. My daughter feels that she easily ends up outside the play situation, when several friends play together. She plays gladly fantasy play with an adult too. She plays a lot of games, both with friends and with adults /parents. Usually she plays alone at home. She interacts with her little sister and enjoys a lot.
One's own home is often one of several places in which the child plays, but sometimes the home environment is the only place where the child plays, due to health issues or other circumstances: The girl is playing exclusively at home with adults, care must be taken to infection because she is immunosuppressed.
Many parents (51) answered that their child plays at an educational environment like school, preschool, kindergarten, nursery, and day-care centre. In these places the children play with peers and classmates.
At school he plays with some selected class mates. My daughter plays alone at home and she does not rely on adults' attention. She does not always take part in the games with her peers at the kindergarten (mainstream). Unfortunately, she does not speak yet and that is why she has difficulties to play with other children, but she is never isolated. My daughter is part of the group and she feels good playing with her peers. At school with a few peers. Some parents (14) mentioned also other particular indoor environments for learning, play and leisure time attended by the child after school: play therapy, after-school therapy, leisure centre, rehabilitation centre, playroom, speech-language therapy group, institute, extracurricular activities, ludoteque, non-profit youth organisation: She has friends in the speech and language therapy group. In rehabilitation centre -with therapists and peers. She goes to a non-profit youth organisation […] weekly.
Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM Other environments for play are sport centres (6): (…) on the street, sport centres, shopping centres; she is very sociable. In the sport centre with adults, but she loves going to the gym and be with the older girls.
Others answered (13) that the child usually played indoor without further specification.
My daughter plays most indoor. She has never liked physical activities very much. Indoors he likes to play computer plays or play with Lego with his friends. Some parents (7) told that child liked to play with and in the water, swim in the swimming pool or in the sea.
Water is the element that attracts him […] He likes playing with water. She likes to swim in the swimming pool.
Many parents answered that the children played outdoor in various environments. Sometimes the answers reported outdoor without any additional specifications (16). Most of the time outdoor places are clearly close to home -such as in the following cases: yard, backyard, courtyard, and garden (18) -where the children can play for instance ball games, with the assistance of siblings or other family members.
With assistance they play games in the yard like tag and things like that. Outdoor in garden with adults, very rarely with other children. Outside in the garden with brother, parents, sometimes with the uncle and frequently with other kids (not from school). Other environments where the child is going to play are playgrounds. They are mentioned by 29 parents, also to underline that they are not always suitable to the child.
He likes playgrounds, especially swings and slides. He enjoys any physical activity in which he can jump and move. At playground with friends or neighbours. He loves to ride his bicycle and to swing outdoor or on playground (there are not many playgrounds and the existing ones are in bad condition or inappropriate for children with disabilities). She went on the swings when she was a little child. She has some difficulties with the gross motor activities, so she has difficulties with the balance, and she does not dare to run around so much. My son prefers to play outdoors: on a play set with a slide, going down and up on the stairs, riding wild with his wheelchair on the terrace. Outdoors the game experience is almost non-existent. Playgrounds and sports centres are not equipped and not properly accommodate children with disabilities especially in cases of multiple disabilities.
Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM The children also use to play outdoors in parks (18), or in equipped parks alone or with siblings, peers and parents.
Outdoors she plays sometimes hide and seek, but not often. My son loves to play outdoor but it is quite difficult to allow that without supervision. Traffic can be really dangerous.
[…] to the park with mates […] at the park with parents and rarely with peers. Some parents (10) describe outdoor activities, games and objects that the child plays with, in the open air and in natural environments. The objects are for example sticks, branches, trampoline, bikes. The activities may be: climbing trees, swinging, jumping and playing sports, like football, soccer, basketball, go-kart etc.
Also plays on her own, in her own way. Spinning or bouncing, climbing, jumping around. He likes to be outside. Climbing trees, contact with animals. Outside he plays with different kinds of branches or sticks and balls, a swing was quite classy. He likes to play football or floorball outdoors with his friends […]. He also enjoys playing (football) with his father and brother.
Another more general type of outdoor environment is mentioned by few (3) parents with the term country, or countryside.
The same question asked also the parents information about the child's play companions.
Several children (60) were reported to play alone. For most of the time the solitary play is reported by parents together to play with partners, but for about one third of the children playing alone is the only type of play reported (18) by parents. The literature as well reports a higher proportion of solitary play in children with intellectual disabilities (Guralnik et al., 1996) with respect to the typically developing ones; deaf children spend more of their time as onlookers and in solitary play (Slade, 1994); blind children spend the majority of their play time playing alone (Shneekloth, 1989).
Playing alone may be something that the child wants to do, an activity that is part of a broad repertoire of various play activities in different contexts involving partners and companions in other situations. In some cases, the parent adds that playing alone is not a problem, but it is instead a preference, or a condition caused by disability.
Most of the time he plays alone at home or I play with him. He does not want to play with other children. Friends are not that important, being alone is not the problem, it gives him a permission to go and immerse himself in the privacy of his own autistic world. She does not always take part in the games with her peers at the kindergarten (mainstream).
[…] but a lot of time he plays alone -autistic features.
Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM In some cases, they use to play alone because they like it, in other cases because they are rejected by peers, or also because there is a lack of time and opportunities to play with others during the leisure time. The lack of children to play with is also mentioned (5).
[…] since he cannot/ he doesn't talk, other children reject or avoid him. Usually he plays alone, by lack of others.
One parents referred derisive attitudes by other children, which is a sign of inadequacy in dealing with a child with disabilities and more generally of lack of inclusive culture: He plays with children, who sometimes laugh at him, which induces frustration.
Sometimes (3) the parents tell that the child likes observing the other children's play: He usually plays alone, he just watches other children, he does not really join them in their games. She likes very much observing her older brother play with his peers.
In many cases different play situations are associated with specific persons: playing with peers at school, playing with brother /sister at home and at the playground for example are often associated. Both siblings and friends are often reported as playing with the child.
At home she plays with her siblings and at school with her friends.
At school, kindergarten and preschool the child is reported to play with peers (28): school friends, selected classmates, peers in "ordinary conditions", children with similar limitations, a few peers, a limited group of peers, older children, and small children.
At school he plays with some selected classmates.
My daughter is part of the group and she feels good playing with her peers. Our daughter likes to play at school (school for 4-20 years with physical and cognitive disabilities) where children with similar limitations can play with her. She plays at nursery with peers in ordinary conditions proposed by the educators.
[She] prefers to play with parents or older children, feels safer that way.
Other types of mentioned play partners are: friends (18), other children (5), children living in the neighbourhood (2).
[He plays] during free time with friends. Sometimes he plays with friends, two friends, always the same ones. At school, he shares games with friends.
Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM Siblings are often (41) mentioned as play partners and also as play supporters.
[He plays] possibly with the older brother and his friends (it is a big happiness when he can be with these friends).
[She plays at] home, with her brother and sister. With her sister she plays less structured games and runs around being silly.
Besides brothers and sisters there are other young relatives that are mentioned (5) as play companions: cousins, niece, and nephew.
[He] plays also with the 12 year old cousin, alternate play, quarrels and pampering. Outside […] with nephew or sister: go-karting, biking, let herself be guided in fantasy play, she enjoys being led.
The parents (44) and other adult family members (4), i.e. uncle (1) are mentioned often as playmates. Both mothers and fathers are reported to be involved in playing.
[He plays] at home with us. She usually plays home in her room, sometimes alone, sometimes with other family members.
[…] primarily with family members. Home -with her mother; in the playgrounds -with her mother.
[…] on playing places with brother and father.
[Mother] I like to play a game with her, but this is difficult with (her) limited concentration. So mostly I sit next to her colouring as well. Often at home with me and his brother, outdoors often with his dad and peers, he also practices basketball.
The play situation may involve the extended family, where the grandparents may have an important role. Grandparents, grandmother, grandfather (10) are mentioned. Adult family members: mother, father, grandma alone both at home and in the garden.
[She plays] at playgrounds with her parents and grandparents. [We play] everywhere we can. School, parks, playgrounds, home, in the yard, with peers at school, with us at home or her grandparents, and also with her caregiver.
Playing with parents or other family members could be one of many developmentally appropriate play activities, but in several (26) cases the child was reported as playing with family members only.
Other adult companions that were reported (9) to play with the child were defined as: teachers, instructors, therapist, trained professionals, volunteers, supervisors, reference adult. These adults are involved in working at the preschool, school, kindergarten, playground, speech-and language therapy centre, play therapy and they were not child's relatives.
Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM [Play] in rehabilitation centre -with therapists and peers.
[Play] with children and therapists in kindergarten. Learning and play happen with the instructor and the teacher are together or (when) the instructor assists in the group.
[Play] indoor alone or with assistant -outdoor alone or with assistant. In the playroom with trained professionals, volunteers and friends. There is always a reference adult who helps him with peers both in indoor and outdoor environments.
Besides specified professionals, also generic adult persons were reported (16) to be involved and supportive in play activities with the child.
And he wants to say hello to all the adults too. For cycling he needs adults help, he can't go cycling alone. Cycling with a tandem is something he enjoys a lot. He's happy to work with adults […].
The children were also reported to play with their pets, and enjoying having contact with animals: in particular dog, horse, cat, chicken were specifically mentioned (5).
[He] plays with dog and cat.
[…] chatting with the chicken, plays a game of fetch with the dog with ball or stick […] […] outside playing with the ball, the dog […] [He] likes to be outside. Climbing trees, contact with animals.

The child's needs about play according to the parents
The questionnaire asked the parent (third question) to describe with their own words what the child would need in order to play for more time, or more easily, or more playfully. The free answers of the parents about what their child's needs were coded below within the same categories that were defined to discuss the Associations' survey. Besides these categories, some concepts emerging from the parents' formulations were added.
The need that was reported most frequently (43) was the company of friends, peers, play mates, partners for play. In Box 2 a collection of expressions taken from various obtained answers is presented.

Peers
More peers mostly; Peers without disability integrated in residential areas; Peers are really important for her but most of the time she cannot find friends; Friends who like to play with him; peers to model (imitate); Playmate; Interactions; Playmates who give pleasure to play, encouraging imitation, interaction; Friends who could adapt their play to him and play structured games; More peers; Needs playmates, even in the family; Playmates of the same age; Share play with peers; Patient playmates respecting time and difficulties; Companions sensitive to inclusion; Some company; Welcome by peers; Friend, brother that support him; Most of all share play with peers.

Box 2. Quotes related to the need of relationship with Peers
Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM According to the parents' views, peers are needed for various reasons: for instance, because they could be models for the child to imitate in play. The interaction with peers is seen as very cherished, since their fellowship can give pleasure to the child, and encourage interaction. The peers should be accepting and able to understand and adapt their play to the child's needs and behaviours, they should like to play with the child, and be sensitive to inclusive issues. They should also be patient and respect the child's difficulties and his/her need for more time to play. The experience of sharing play with other children is considered very important, as if playing only with adults was not good and satisfying enough for the child.
Some answers suggest that playing with other kids is not easy to realise for some children with disabilities. As a consequence, social play with peers is a key experience which some children with disabilities are deprived of. According to the literature in the field, children with intellectual disabilities have difficulty starting to play (Luttropp & Granlund, 2010); children with hearing impairments engage in less associative or cooperative play than the other children (Antia & Dittillio, 1998); in children with motor impairments the different levels of cognitive and verbal competences affect the quality of playing with peers (Stoneman et al., 1989;McCluskey, 2002).
He needs no special toys. He needs peers.
[…] above all he would need to share the play with peers. It is playing that develops skills, especially playing with others. I think for a deaf child to age my son is important to share the plays with peers, understand the play proposed. Probably a playmate would be good for him, with whom he could play […] Many parents (40) think that their child would need toys, in order to play more easily, or for more time. Box 3 contains various expressions taken from the parents' answers.

Toys
Adapted toys; Specialized toys; Toys that turn or pop-up with a cause and effect; Toys producing sounds; Easier games, if it is too difficult he stops playing; Toys with noise and music, but soft, ball with handles; Cards with bigger letters; Materials adapted to needs; Special swing; Adapted toys that allow to play independently; Creative toys; Toys to activate pressing a button: soap bubble machine; Soap bubbles; Affordable toys to guarantee variation, diversity; Interesting toys; Toys from favourite series; Adapted to the ability and age-appropriate looking; Games, puzzles, jigsaws; Letters in all colours and shapes; Favourite toys; Toys for playing in the sand; New toys; Engaging toys taking account of physical and cognitive peculiarities.

Box 3. Quotes related to the need of Toys
The toys that the child would need should be adapted and specialized. They should take account of child's physical and cognitive peculiarity. They should be adapted to their ability on a difficulty level, but should be also age-appropriate-looking, that is, not looking as toys for young children, if the child is a teenager.
Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM More toys with sounds and music would be needed, and they should be soft so that the children would not hurt themselves. The adaptation should be done so that the child can perform an activity more easily and independently. The toys should be designed with devices (i.e. buttons) so that the child is able to play autonomously and to interact with the environments; in addition, they should be made of various materials.
The toys should be interesting, engaging, motivating and relating to the child's interests in narratives, stories and themes. They should allow the child to perform actions, make sounds, to make an effect happening with his /her actions.
There is a need of not too expensive toys, so that it is possible to have many toys, which would guarantee more variation and novelty for the child.
The adaptation of the toys would allow the child to play autonomously: She would need toys to play independently, because the existing ones are either too large or too hard. For example, if she wants to play with the kitchen, the oven door is too rigid and she fails to open. She is eager to play with all toys and games she comes across while shopping but they are not adapted to her needs.
For some child however, there is no need of toys adaptations, according to the parents.
He doesn't need special toys -ordinary toys are enough. Adapted toys are often boring. She needs toys which she can activate with pressing a button. The soap bubble machine is wonderful. There should also be a machine to feed the ducks when going to the park, just by pressing with one hand.
For many parents (20) there is also a need of technological toys, of which the literature has amply demonstrated its effective use in supporting development and playfulness especially in children with motor disabilities and with autism spectrum disorders (Besio, Bulgarelli, Stancheva-Popkostadinova, 2017). Box 4 below presents some examples.

High-tech toys
Smartphone, iPad, touch screen are easy to use; Specialized toys and technology; Sounds of computer games, colourful graphics; Adapted games; Adapted technologies; Toys that makes music; Mini robots; A tablet not so sensitive; Computer games; Better designed video games; Visual remote control; Tablet with Internet; Remote-control toys; She needs to be able to access her tablet games.

Box 4. Quotes related to the need of High-tech Toys
Devices such as computer, tablets, and smartphones are needed, and in all cases the respondent suggests that they should be adapted and accessible, designed in ways Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM that allow the participation of everyone. These toys should also be motivating and interesting with the use of music, colours etc. Technologies as Internet and remote control are also needed by some children.
Definitely she would need technological tools appropriate to her condition that is aggravated to frequent dystonia which is affected that do not allow to have a constant control using writing, play and communicating tools. He needs toys that help develop his creativity. New technologies [he] also likes, touch screens because they are easy to use. Adapted toys to awaken her sensorial capacities, musical toys and technological devices as mini robots which provide sound and movement at the same time which imitate a real person because each parent has not always the time, the energy and the patience to initiate the play time. My child would also need a tablet not too sensitive and able to receive knocks with applications which do not require precise gestures on the screen.
One parent expresses the opinion that high tech toys are related to learning at school, not to play situations, and that playing alone is an important activity. I do not approve the technological tools that instead I think are important at school in teaching. It is important to have playmates, but also engage in playing activities alone: my son, for example, builds with Lego and I see those moments of concentration relax him.
According to the respondents, many children (24) need to improve skills that are involved in play. The skills may be related to motor ability, language, cognitive ability (attention, concentration), social skills, emotional self-regulation and also motivation to play. In Box 5 some examples are reported.

Improved skills needed for play
Motor skills; fine motor skills; He definitely lacks the skills needed to play; Word knowledge vocabulary to understand games and participate; Socialisation of play; Social skills, help developing social skills; High emotional sensitiveness, avoiding high self-criticism, increasing emotional self-regulation; Play skills, skills for play, patience, calm, attention, less distraction; Motivation; concentration one game at a time; Avoid over-excitations; Avoid boredom, keeping a good mood

Box 5. Quotes related to the need of Improved Skills
The improvement of social skills is viewed by these parents as a very important goal.
My child needs improvements of play skills and socialisation of his play. His social skills are not as good as others in this age and he does not 'make a number' of himself but more likes to get out of the situations where are a lot of people together. He has challenges to get new friendships. My child is very sensitive and can cry if he feels that someone insults him. He is very critical of how he himself behaves.
Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM Some children have reported to have a lack of concentration or other intrinsic limitations, so these conditions limit the play and a good feeling in playing, such as in these reports: She needs more concentration.
Other children are reported to experience a condition of boredom, indicating that the environment is not capable to offer suitable stimuli. Some mothers wrote: The disabled child is bored. Fantasy is very important for her.
A large number of various outdoor environments were needed by the respondents (24) and a few other indoor and specialized environments. Box 6 contains some excerpts from the answers.

Outdoor environments
Structured space; Adapted playground with tools that give sounds; More fun at physical activities would have improved her motor skills; Specialized playgrounds; More playgrounds; Special and not crowded spaces; Accessible locations spaces; Affordable adapted bicycles; Playgrounds without so many dangers; Inclusive accessible environments without barriers: specifically designed for disabled children to promote the encounters suitable and equipped spaces; Inclusive playgrounds; Accessible playgrounds equipment; Off-road walker-rollators Indoor environments Extracurricular activities in specialized centres focused on integration; Large spaces, leisure sites.

Box 6. Quotes related to the need of Outdoor and Indoor Environments
Playgrounds should be inclusive and adapted to children with disabilities. If adaptations and specific designed scenarios were available, the child could be more active in her play and could do more social and motor experiences.
When she was younger it should have been valuable to have a disability adapted playground in the vicinity, so I believe it would have been more fun to her to be physically active, for example to follow a path, when she was learning to go/walk. Or if there have been (in the play spaces) outdoor more tools that give sounds to play with, adapted to her age.
Surely they lack the indoors and outdoors environments designed specifically for disabled children where promote the play and the encounter with the other.
The outdoor environment should be accessible, inclusive and safe.
My son would need […] proper outdoor space without too many dangers. (…) more accessible spaces […] Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM He would need to be in inclusive environments for every type of disability, where the child can achieve certain goals and [feel] unhindered.
[…] we need suitable and equipped spaces.

Someone (3) stresses the need to play within safe environments in the case of children with disabilities.
Security is the first thing that must be offered to children with intellectual deficits, which often are not aware of dangerous situations for their safety. The communication must be guided from a reference adult in cases of lack of verbal language.
Another important need that emerges among the needs reported (20) by the parents is the need of more time. Box 7 includes some examples.

Time
Needs more time to understand the play plot; Time to respond; Time for discovery, mess around, lot of time; More playtime during the day; She needs free time, the leisure time is a little and she is tired.

Box 7. Quotes related to the need of Time for play
The child may be involved in many activities and therapies that may limit the time left for leisure time and play. She needs free time, after school and therapies the leisure time is a little and she is tired.
The child may need more time in the play situation in order to understand and take part to what happens around him/her. The other children would also need to be patient and wait a bit longer for the disabled child to respond to their questions and invitations. There should be more time also for unstructured play.
He needs to mess around to discover materials. For learning about the materials, toys he needs time, a lot of time. Activities, time for free discovery and explorations. Some parents (15) reported that their children needed a knowledgeable adult in order to play more easily and for more time. The role of a competent adult in play is mainly declined in three functions, sometimes with some overlaps in meaning: the adult as a facilitator, the adult as a mediator, and the adult as a supervisor (Zappaterra, 2018).
The adult could support the play process and promote participation, help to solve conflicts, help to understand rules. See the box below for examples from the parents' answers. The support of the adult is something that may be always needed.
She always needs support from an adult.

Competent adults
Songs and movements of the hands are interesting and are imitated; Adult to supervise the play; Parents' involvement; People that entertain him, move, swing, hold; Adult supporter, trainers; Support in play so that she stays; Adult that explains new things and introduces people; Someone that directs his attention to play, makes play easier, gives lot of encouragement; Adults with professional training in ACC; A coach who could train him to play in another way than repetitively; A person who could provide him with ideas of adapted games and play; A person who could mediate the interaction between him and others: parents should and must learn how to play better with our children, learn mediation of play; Help from other parents and blog; Adults or companions with whom to interact, get involved and accepted with the time and manner of what their need; Competent adult people with an open mind that would help the peers of the autistic child to play with him; Specialized staff to facilitate the approach to the play and relationships; Competent adult who involve him and help others understand him; Need specialized personnel able to make appropriate proposals; Parents that have fun playing, and share the fun with the child; Assistance while playing concerning the rules, dealing with others.

Box 8. Quotes related to the need of Competent Adults
The adult's role as a play facilitator is widely recognized in the research. The role of the adult in this case is to offer the child educational interactions and pedagogical framing linking play with positive learning outcomes and taking a proactive role in creating play scenarios and supporting their realization (Sylva et al., 2007;Wood, 2009;Besio, 2017).
The adult could have the role of a mediator between the child and his/her peers, by involving the child, supporting the interaction with the play environment and the relations with the others and also by helping the other children to understand the child. According to Haight (1998), pretend play in interaction with the adult has an important role in the acquisition of social skills. Garvey (1982) emphasizes the importance of the adult in the home environment to prompt and elicit social skills through pretend play.
He needs a competent adult who involves him and help others to understand him. If my son meets cosy atmosphere can participate in almost everything, it is very sensitive and sympathetic. What matters is the contact.
The adult should have competences and skills in specific areas, such as alternative communication, activity adaptations, educational planning (e.g., to suggest activities that offers the optimal level of difficulty, and that would expand the child's play experience). The parents may need to learn how to play better with their children.
It also lacks specialized staff to facilitate the approach to the play and relationships.
A parent has given a very comprehensive response saying that the child needs a playmate able to adapt to him/her and to his/her characteristics, he/she needs someone who can support the child's progress towards more and more complex levels of play and who can bridge the relationships with the other children.
Friends who could adapt their play to him and play structured games, a coach who could train him to play in another way than repetitively, a person who could provide him with ideas of adapted games and play, a person who could mediate the interaction between him and others.
The parents must also discover how to have fun playing, instead of prioritizing training, and they should learn to share fun with their child.
The kids really enjoy when they learn something new and gross with the excitement of fun. What 'pass' to the child is the joy of parents who are in touch with the "inner child" of themselves, but the parent of a blind child does not select a fun play, but a therapeutic play. The aim would be to see the child have fun playing and have fun yourself playing with your son.
Other parents (8) underlined instead the need for changes in societal attitudes and behaviours in order to make play easier to a child with disabilities. Some examples of this occurrence are reported in Box 9 below.

Societal attitudes and behaviours
The children tend to end up a bit outside; More togetherness with seeing peers at school; Integration into society; Social inclusion in school; Acceptance from peers; Kind look of others in public places

Box 9. Quotes related to the need of inclusive attitudes and behaviors
The attitudes in schools may make the child with disabilities end up outside the group of peers, if the school staff do not work for intentionally promoting and introducing inclusive practices. These practices would not happen without intentional pedagogical interventions. Attending a mainstream educational environment is not sufficient to guarantee full participation and inclusion into the school community. The presence Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM of the child with disabilities within the educational setting may be accepted, but there might be a lack of attention for his/her specific needs.
When it comes to other children, our children tend often to end up a bit off, outside of the group, regrettably. I think that it is this way for most of the children. My daughter has a couple of seeing friends, that she meets once or two in a week, after school. She is not bullied at school, but she is neither entirely together, if you know what I mean. In school she is often with her adult resource person.
In another response, the parent indicates that there may be a -more or lessopenly negative attitude in the social context, which may be transmitted through disapproving, curious, or even hostile looks, for instance when the child is playing outdoor the simple play activity he/she likes. This situation could be regrettable for the parents, and could contribute to make them feeling restraints in joining these public social situations with their child.
Another suggestion related to attitudes among educators and parents is to make efforts in suggesting and thinking out activities that are more fun, which would also increase the child's motivation to play.
Making activities more fun, thus experiencing positive feelings in activities.
[…] so I believe it would have been more fun to her to be physically active.
The last theme reported (8) concerns policy measures and resources at the community level. Examples are referred to in box 10 below.

Policy and resources
Organized sport for disabled children; integration into society; accessibility; better links to the community; inclusive playgrounds; clear visualisations and step-by step sheets; museums; barnyard.
Box 10. Quotes related to the need of Policy and resources for playing Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM There should be more opportunities to play organized sport activities for children with disabilities. The regular play environments should be made accessible to all children. It should be possible for children with motor impairments for example to access various environments, with other walking resources. Methods that make it easier for children to participate should be adopted, i.e. through visualisations.
I think there should be more sport activities organized by the cities / municipalities. I think this would be important. Assistance while playing concerning the rules, dealing with others, dealing with winning and losing. Clear visualisations and step-by-step sheets. Handicapped accessible playground equipment (stairs to slide, not only a jungle gym with ropes or similar); off-road walker-rollators. More accessible spaces, better links with the local community.
However, some parents express a desire for self-determination of their own children about the play and the desire that logistical difficulties are overcome.
Our daughter is a very active child and it is evident that she needs a lot of active play. Moving around gives her pleasure and it makes her happy. Free style play, with no rules, except for not getting hurt stimulates her and then relaxes her.
Besides playgrounds, there could be other public places that the child could visit for playing and having fun, according to the child's interests, as history museums and barnyards: He would love to go on a barnyard and be together with the animals. But this is not possible, we don`t know someone.

Children's experiences of play
The final part of the questionnaire was designed to collect the perceptions of play of children themselves, giving them the opportunity to make their voices heard.
Examples and ideas about the needs of children with disabilities about play have been gathered through the mediation of the parents. In fact, the last question of the questionnaire asked the parent to interview -If possible -their children, asking them to tell about their play, and collecting their experiences and preferences. In this section the contents of the answers are reported according to some prevailing themes that were identified through the answers provided.
Before presenting the results of the analysis it is necessary to point out that in some cases the views of the child could not be collected, due to extensive communication difficulties; 27 parents answered that they could not report the child's answer because Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM the child for example could not speak, or because the child would not understand it. Furthermore, 12 parents did not answer to this question.
My child does not speak. She cannot say useful answers due to her conditions. Some parents (16) reported that their child could meet difficulties in communicating his or her experiences and will. However sometimes the parents knew what the child liked and they reported these activities, preferences and needs, on his/her behalf.
My child is not able to answer but I would say that she likes dolls, musical toys and to follow our dog and play hide and seek with it. She prefers to play with her younger brother. My daughter is not verbal, but I know the answers -she loves the computers, music and animals. She likes to watch films, videos, listen to sounds and melodies, drawing. My daughter loves walking in the park and playing with the dogs, riding her favourite horse Universe.
Sometimes the parent reported that the child found it difficult to express an evaluation of play.
It is hard for him to define what he likes and why.
The respondents' answers display a range of circumstances, from those in which it was not possible to provide the child's views concerning play, to situations in which the parent interpreted the child's preferences and provided the child's views by proxy, again to situations in which a particular type of verbal explanation or evaluation was difficult to perform for the child, and to situation in which the child's own utterances are reported. In the following analysis of the answers both the parents' proxy and the children's reports (83) are reported. To distinguish these last, they have been put into Italic.
The themes identified are Activities and Events; Partners in play; Emotional states; Agency in play; Evaluations; Places.
Activities and Events. The children -or the respondents that report on the child behalf -describe which play activities they like to do and engage with.
There are varied play activities that give her pleasure: games, physical exercise (sliders, swings, ball, etc.), dolls, little houses, puzzles, etc. My daughter is not verbal, but I know the answers. She loves the computers, music and animals. She likes to watch films, videos, listen to sounds and melodies, drawing. My daughter loves walking in the park and playing with the dogs, riding her favourite horse Universe.

I prefer playing in my room with dragons and other animals, creating stories […]
Play activities vary a lot: many types of toys are mentioned, both traditional -as dolls and Lego bricks, while the practice play is reported 18 times -and digital toys and games provided by new technologies (16 times). Some children (8) like to listen to sounds and melodies and someone has a clear preference for these games.
Another theme is Emotional States. Playing is often associated in the reports with strong often positive emotions and excitement: play is reported many times (34) to be associated with great happiness, pleasure, joy.
I feel most happy/jolly when I play but I can play sometimes scary plays for example on werewolves and spooks. Play brings him pleasure and joy I am happy when I am with friends. Play is a source of pleasure for her and consists of a fundamental activity for her development and well-being. She is really happy when she can play. He likes to play. He enjoys it. He feels glad fulfilled, happy.
The answers indicate that play is immensely appreciated and longed for by the child as a source of joy and happiness, a fact that the parents seem often well aware of. These positive emotions and the pleasure that the child feels when playing may show play as an intrinsically motivated activity and its importance as an engine for development.
Sometimes the answers mention even negative emotional states, as sadness. This is related to what happens when the child cannot participate in play or cannot keep up with others in play situations, or when the play situation is not adapted to the child's needs: When she plays with others she doesn't like it that often as it's going too fast, she can't keep up with them. This makes her sad. It's also often too busy/too much.
But the overall attitude of feeling in playing for the majority of children is very positive. The play is associated to fun, peace, cheerfulness, happiness, freedom, relaxing. Many children (13) said that play is very important for them and they would like to have more time to dedicate to this activity. One child used a suggestive metaphor, saying that play empties his head. It is extraordinary to see these testimonies of different children using the same words: Sometimes the adults insist using the same tools or materials, disregarding the age of child. Other times the play need a presence of an adult to vehiculate good feeling and a sense of security. A mother said: Playing alone is relaxing for her. Sometimes she prefers to play with other children. Playing with many children should not last too long because that would be too oppressive and she would need an adult to protect her.
In other cases, the type of impairment does not allow to understand the feeling of the child towards the play. A mother said sadly: I would like to know as a mother what he likes about the play, and what he feels when he is playing.
In other cases, these feelings can be perceived from a specific behaviour of the child, such as in this testimony: We know that he likes the sound games, toy trains, the wheelchair swings. You can understand why he laughs happy.
Another theme identified is Agency in play: the answers here grouped (10) contain statements on the child's will and choices, from which the child emerges as a subject, as an autonomous protagonist. The child -or the parent on his/her behalf -decides, explains needs, preferences, interactions, negotiations and expresses a feeling of power and the competence of problem solving.

I choose my toys according to my interests and capacity to use them by myself, independently. I like to be leader of my toys. It is I who command.
When I get new Play Mobil toys, I always like the figures most of all. I give them names, so that they will become the characters. Usually she chooses her own toys, but sometimes I also make suggestions that she accepts or proposes an alternative. She prefers choices and she always wants to choose the play. He wants to play with the same objects over and over. He seeks sameness in his play. In one answer the child's agency displays itself in the child's request to be supported by an adult, who gives the right prompts during particular activities. This circumstance may appear paradoxical under the point of view of the child's agency, but on the contrary it shows the child's competence in expressing his awareness on what he is Brought to you by | University of Oulu Authenticated Download Date | 10/31/19 7:02 AM of time to play and a lack of occasions to play properly and effectively with friends that are not living close. Some children want more playmates and buddies to play with. The conflicts that may arise with other children can also hinder play. Lack of adaptations in the play environment may also create unnecessary limitations to the child's play experience. But some children seem aware of these circumstances and try to adopt strategies and self-advocacy in order to deal with these issues.
The last theme that has been singled out is Places: play takes place in various locations: at home (9), in the child's room and in other environments. Children play in educational sites like preschools, kindergartens, schools (3) and outdoors in natural environments (8) or in playgrounds (2).
He wants to play in playing spaces. He wants to play outside, to ride the bicycle. In park with peers. At home with sister. I play most at home in my room […] In the summer I play more outdoor.