Play for Health Across the Lifespan
Sarah Fabrizi, PhD, OTR/L
Annemarie Connor, PhD, OTR/L
FGCU
Play is a fundamental human occupation with profound implications for health and well-being, a perspective championed by occupational therapy practitioners. Play enhances brain structure, executive function, and social skills, mitigating toxic stress (Yogman, 2018). Recent publications in the American Journal of Occupational Therapy (AJOT), including “Play as an Occupation: The State of our Science and a Research Agenda for the Profession” by Kuhaneck et al. (2024) and Anita Bundy’s 2024 Eleanor Clarke Slagle Lecture, underscore the value of play as a lifespan occupation. This evidence synthesis explores the science of play, highlighting health and well-being benefits and practical and actionable examples for early childhood, school-age children, tweens and teens, young adults, middle-age adults, and older adults. Occupational therapy practitioners are well positioned in a profession to harness play’s transformative power.
The State of the Science
Occupational therapists are pioneers in viewing play as a right and occupation. Play enhances developmental health and adaptive functioning, yet children today face deprivation from limited outdoor time and risk aversion (Kuhaneck et al., 2024). Play is linked to brain development and resilience, and play at all ages and stages extends the benefits long beyond childhood. Anita Bundy (2024) challenges occupational therapy providers to embrace risky play in “Bubble Wrap Is for Packages, Not for People: Balancing Duty of Care with Dignity of Risk.” Play deprivation risks physical and social participation, a perspective applicable across the ages. Knowing that toys are the “words” and play is the “language” of childhood (Landreth, 2002), the fundamental relationship between play and child development is irrefutable. While occupational therapy has embraced this notion of play as the preeminent occupation of childhood, other disciplines, including related mental health professions, are embracing the primacy of play not just for children but across the lifespan.
Play Across the Lifespan
From birth to five, a child’s brain undergoes its most rapid growth, forming neural connections at a rate of up to a million per second (Harvard Center for the Developing Child, 2023). Play drives this process, whether peek-a-boo, stacking blocks, or making mud pies. Social play builds empathy, physical play strengthens muscles, and creativity emerges from play. Play has a role in building relationships with caregivers and peers. Play activities of younger children include adults engaging with children. Play activities for school-age children, from 6 to 11, allow the adults to step back, enabling children’s independence to blossom as they transition to playing more often with peers. Cooperative play enhances social skills; risky play builds competence and executive function. Open-ended play fosters creativity and helps one develop self-regulation skills. Including a child’s perspective about play is essential in play research. How children view play often differs from the adult perspective (Rivas-Quarneti et al., 2024). Gathering information about play through interviews with children, play observation, photos and videos, and drawings can inform from the child’s perspective.
Adventurous and recreational play that includes free play and risk has mental health benefits, promoting autonomy and confidence and reducing anxiety in teens. Play is a critical outlet for emotional regulation and stress reduction in tweens and teens. Active play supports physical health. Autonomy in play supports growth. In recent years, the call for inclusivity has influenced occupational therapy research on play. Some occupational therapy researchers have examined play through a neurodiverse lens, describing play as differently social (Kornblau & Robertson, 2021). The international autistic community suggested considering differences rather than deficits and understanding play from the autistic perspective. The rise of digital play is underexplored despite its prevalence among teens.
Play benefits people of all abilities, promoting physical health, cognitive function, socioemotional well-being, and lifelong learning. For example, active play and sports can help young people build strength, endurance, agility, and balance while helping older adults prevent illness and injury. Neuroplasticity does not vanish with age, and play can be a powerful mechanism for maintaining cognitive, physical, and emotional well-being later in life. As a dynamic and physically and socially engaging occupation, play is a key plasticity driver with significant implications for occupational therapy practice. Even with the research gap in adult play, we know that the brain adapts through experience-dependent plasticity. Activities like puzzles, dancing, or social games increase gray matter volume and slow any decline. Play’s novelty and problem-solving activate neural pathways and counter any atrophy—leisure-type play linked to mental resilience and occupational balance. Recent assessments created by occupational therapists for use with adults as they play with children align well with play elements such as intrinsic motivation, internal control, suspension of reality, and framing. As we age, consistent play across time, whether pickle ball or line dancing, is also associated with stable social ties, even among particularly vulnerable older adults, such as those with serious mental illness (Dobbins et al., 2020). Games and puzzles may preserve cognition in seniors; playful challenges maintain agency. Specifically, research has found an association between cognitively stimulating leisure activity (CSLA) among older adults, even those with mild cognitive impairment (MCI), and benefits to memory, executive function, and processing speed (Lee et al., 2024). It is currently recommended that older adults with MCI engage in CSLA at least three to four times per week, ideally in community-based social settings with caregiver support (Lee et al., 2024).
Play may also be more motivating and enjoyable than rote exercise, mainly when it induces a flow state. According to Csikszentmihalyi (Pierini, 2019), flow is a state of deep engagement and immersion in a meaningful task, which can lead to enjoyment and even ecstasy. As occupational therapists, we are uniquely situated to promote play with clients of all ages, stages, and abilities to connect with the health and wellness benefits induced and the sheer joy of engaging in play! While it may be common for children receiving pediatric occupational therapy to squeal with glee when they see the toys and games facilitated by the therapist, it is perhaps not so common for adults in rehabilitation settings to so enthusiastically approach therapy.
Knowing that the science of play's benefits is well established, how will you incorporate play and playfulness into your own life and into your next client session?
Play is a fundamental human occupation with significant effects on health and well-being, a perspective championed by occupational therapy practitioners. It supports brain structure, executive function, and social skills while reducing toxic stress (Yogman, 2018). Recent publications in the American Journal of Occupational Therapy (AJOT), including “Play as an Occupation: The State of Our Science and a Research Agenda for the Profession” by Kuhaneck et al. (2024) and Anita Bundy’s 2024 Eleanor Clarke Slagle Lecture, highlight the importance of play across the lifespan. This synthesis explores the science behind play, emphasizing its health benefits and providing practical examples for early childhood, school-age children, teens, young adults, middle-aged adults, and older adults.
The State of the Science
Occupational therapists lead the charge in recognizing play as both a right and an essential occupation. Play promotes developmental health and adaptive functioning, but children today face deprivation due to limited outdoor time and risk aversion (Kuhaneck et al., 2024). Play is closely linked to brain development, resilience, and well-being at all life stages. Anita Bundy (2024) encourages occupational therapy providers to embrace risky play, as explored in “Bubble Wrap Is for Packages, Not for People: Balancing Duty of Care with Dignity of Risk.” Play deprivation can negatively affect physical and social participation, a challenge spanning all ages. Play, often described as the “language” of childhood while toys act as the “words” (Landreth, 2002), demonstrates an undeniable relationship with child development. Although occupational therapy acknowledges play as the preeminent occupation of childhood, disciplines such as mental health are increasingly recognizing its value across the lifespan.
Play Across the Lifespan
From birth to age five, children’s brains form neural connections at an extraordinary rate—up to one million per second (Harvard Center for the Developing Child, 2023). Play fuels this process, whether through peek-a-boo, stacking blocks, or mud pie-making. Social play nurtures empathy, physical play strengthens muscles, and creative play fosters relationships with caregivers and peers. For school-age children (6–11), adults step back to let independence blossom as children engage more with peers. Cooperative play builds social skills, risky play strengthens competence and executive function, and open-ended play enhances creativity and self-regulation. Including children’s perspectives on play, through interviews or observations (Rivas-Quarneti et al., 2024), enriches research on how they experience this vital occupation.
Among tweens and teens, adventurous and free play promotes autonomy, mental health, and confidence while reducing anxiety. Digital play, increasingly prevalent, remains underexplored in terms of its benefits and challenges. Inclusivity in play research continues to grow, with neurodiverse perspectives redefining its social dimensions (Kornblau & Robertson, 2021).
For adults, play boosts physical health, cognitive function, socioemotional well-being, and lifelong learning. Active play like sports improves strength, endurance, agility, and balance. Neuroplasticity persists into later life, making play a valuable tool for maintaining health and preventing decline. Puzzles, dancing, and social games stimulate neural pathways, while leisure activities promote resilience and occupational balance. Research reveals links between cognitively stimulating leisure activities (CSLA) and improved memory, executive function, and processing speed, even for older adults with mild cognitive impairment (Lee et al., 2024). Recommended CSLA for older adults includes engaging in these activities three to four times per week, ideally in community-based social settings with caregiver support.
Play offers an alternative to rote exercise, especially when inducing a “flow state.” Flow, described by Csikszentmihalyi (Pierini, 2019), is a state of deep engagement and immersion that leads to joy and fulfillment. Occupational therapists are uniquely positioned to incorporate play into therapy, connecting clients of all ages to the health benefits—and sheer delight—of playful engagement.
References
Bundy, A. (2024). Bubble Wrap Is for Packages, Not for People: Balancing Duty of Care and Dignity of Risk. American Journal of Occupational Therapy, 78(6), 7806150010. doi: https://doi.org/10.5014/ajot.2024.078602
Center for the Developing Child at Harvard University (n.d.) Brain architecture. Brain Architecture: An ongoing process that begins before birth
Dobbins, S., Hubbard, E., Flentje, A., Dawson-Rose, C., & Leutwyler, H. (2020). Play provides social connection for older adults with serious mental illness: A grounded theory analysis of a 10-week exergame intervention. Aging & mental health, 24(4), 596–603. doi: 10.1080/13607863.2018.1544218
Kornblau, B.L., & Robertson, S.M. (2021). Special Issue on Occupational Therapy With Neurodivergent People. American Journal of Occupational Therapy, 75(3), 7503170010. doi: https://doi.org/10.5014/ajot.2021.753001
Kuhaneck, H., Bundy, A., Fabrizi, S., Lynch, H., Moore, A., Román-Oyola, R., Stagnitti, K., & Waldman-Levi, A. (2024). Play as Occupation: The State of Our Science and a Research Agenda for the Profession. The American journal of occupational therapy: official publication of the American Occupational Therapy Association, 78(4), 7804185150. https://doi.org/10.5014/ajot.2024.050824
Landreth, G. L. (2012). Play therapy: The art of the relationship. Routledge.
Lee, J., Kim, J., & Valdivia, D. S. (2024). A Longitudinal Analysis of the Relationship Between
Different Levels of Cognitively Stimulating Leisure Activity and Cognitive Function Among Older Adults with MCI. Journal of Cognitive Enhancement, 8(3), 257-270.
Pierini, F. (2019). The popularization of specialized knowledge through TED Talks: The case of positive psychology. International Journal of English Linguistics, 9(4), 15–27.
Rivas-Quarneti, N., Viana-Moldes, I., Veiga-Seijo, S., Canabal-López, M., & Magalhaes, L. (2024). Politicizing children’s play: A community Photovoice process to transform a school playground. American Journal of Occupational Therapy, 78, 7804185100. https://doi.org/10.5014/ajot.2024.050435
Yogman, M., Garner, A., Hutchinson, J., Hirsh-Pasek, K., & Golinkoff, R.B. (2018). The Power of Play: A Pediatric Role in Enhancing Development in Young Children. Pediatrics, 142 (3): e20182058. 10.1542/peds.2018-2058