Children's risky play from an evolutionary perspective: the anti-phobic effects of thrilling experiences

Healthy childhood development through outdoor risky play: Navigating the balance with injury prevention

Free play is essential for children's development and for their physical, mental, and social health. Opportunities to engage in outdoor free play-and risky play in particular-have declined significantly in recent years, in part because safety measures have sought to prevent all play-related injuries rather than focusing on serious and fatal injuries. Risky play is defined by thrilling and exciting forms of free play that involve uncertainty of outcome and a possibility of physical injury. Proponents of risky play differentiate "risk" from "hazard" and seek to reframe perceived risk as an opportunity for situational evaluation and personal development. This statement weighs the burden of play-related injuries alongside the evidence in favour of risky play, including its benefits, risks, and nuances, which can vary depending on a child's developmental stage, ability, and social and medical context. Approaches are offered to promote open, constructive discussions with families and organizations. Paediatricians are encouraged to think of outdoor risky play as one way to help prevent and manage common health problems such as obesity, anxiety, and behavioural issues.

Exploring the world of active play: A comprehensive review of global surveillance and monitoring of active play based on the global matrix data

A valid assessment tool that measures active play is not yet available due to the sporadic and spontaneous nature of play, as well as the potential differences in how active play is understood and measured across different age groups, cultures, and contexts. The purpose of this review was to identify the scope and gaps in the measurement of active play based on data gathered from 68 countries that participated in the Global Matrix (GM) initiative, led by the Active Healthy Kids Global Alliance (AHKGA). GM is the global-level, biennial evaluation system of physical activity related behaviors among children and youth, including the Active Play indicator, and the sources of influence using letter grades (ranging between "A" and "F"). Based on the identified scope and gaps, this study offers recommendations for future research dedicated to the measurement/surveillance of active play. Out of the 68 countries involved in the previous GM (2014-22), 55% of the grades remained unassigned due to insufficient data on the Active Play indicator. The high number of unassigned grades, combined with the absence of valid measurement tool, highlight a need for a standardized measurement tool for improved global data generation of active play among children and youth. Our findings emphasize the need to address challenges in measuring active play. This review offers future considerations, research recommendations specific to the GM initiative, and two sets of age- and location-specific (indoor and outdoor settings) questionnaire items along with guidelines for its use. Together, these elements provide a roadmap for guiding future research and evaluation efforts on active play.

Validation of an Instrument That Measures Factors Affecting Saudi Parents' Tolerance of Risky Play: A Rasch Analysis

IMPORTANCE

Benefits of children's participation in risky play are broadly recognized. However, most related research originates in Western countries; none focuses on outdoor play in Eastern countries, including Saudi Arabia. Furthermore, although the literature identifies varying perspectives on risky play among parents, there is no objective measure to assess personal, situational, and cultural factors shaping their risk tolerance.

OBJECTIVE

To establish the construct validity and internal reliability of data gathered with the newly developed Factors Affecting Tolerance for Risk in Play Scale (FAC-TRiPS).

DESIGN

Instrument development.

SETTING

Online survey.

PARTICIPANTS

Ninety Saudi parents with children ages 7 to 10 yr.

OUTCOMES AND MEASURES

The FAC-TRiPS, a 17-item, self-report measure. We used Rasch analysis (Winsteps 4.4.4) to establish evidence for construct validity (item fit, match of item difficulty and parent tolerance, principal-components results) and internal reliability (person reliability index).

RESULTS

Item fit analysis revealed that data from 15 of 17 items (88%) conformed to Rasch model expectations. Item difficulty closely matched parents' risk tolerance level. The principal-components analysis of residuals demonstrated that observed variance (49.6%) closely matched expected variance (49.7%). The first contrast's unexplained variance had an eigenvalue slightly greater than 2.5, suggesting possible multidimensionality. The person reliability index was .90.

CONCLUSIONS AND RELEVANCE

Preliminary analysis suggests that the FAC-TRiPS yields valid, reliable data measuring factors that influence parents' risk tolerance. Further research is needed. Plain-Language Summary: This study contributes to the knowledge of how parents in Eastern countries perceive risky play. The Factors Affecting Tolerance for Risk in Play Scale (FAC-TRiPS) is a newly developed tool that occupational therapy practitioners can use to understand parents' beliefs about and tolerance for their children's participation in risky play. The findings facilitate an understanding of the complex nature of parenting when determining whether to allow children to participate in risky play activities.

A novel independence intervention to treat child anxiety: A nonconcurrent multiple baseline evaluation

Rates of child and adolescent anxiety have increased markedly over the past decade (Haidt & Twenge, 2023). Exposure-based cognitive-behavioral therapy is the gold standard in the treatment of anxious children (Hofmann et al. (2012)). However, many clinicians refrain from using exposure due to concerns about its safety, effectiveness, and ethics (Deacon et al., 2013; Whiteside et al., 2016). We propose a novel treatment approach for child anxiety composed of independence activities (IAs), which are child-directed, fun, unstructured, developmentally challenging tasks performed without parents' help. These tasks are purposely topographically unrelated to the stimuli that cause anxiety, in direct contrast to exposure therapy. Despite this dissimilarity, IAs target putative mechanisms involved in the development and maintenance of child anxiety (e.g., parental accommodation and overinvolvement, child avoidance, unhelpful thinking styles). Using a nonconcurrent multiple baseline design, this five-session treatment provided preliminary evidence of high treatment acceptability from children and parents. Medium to large improvements were reported in child anxiety and avoidance, parent and child (behavioral and cognitive) mechanisms involved in the maintenance of child anxiety, and untargeted secondary outcomes such as child happiness. Results may suggest a new treatment paradigm, which is desperately needed, given unabated increases in child and adolescent anxiety despite vast resources being directed toward the problem.

"And I still remember it to this day": A qualitative exploration of retrospective memories of school-based recess

Objectives

Previous research has shown the most common memory of physical education (PE) was embarrassment, and that childhood memories of PE relate to physical activity (PA) attitude, intention, and sedentary behavior in adulthood [13]. Recess memories may have a similar effect on adult attitudes towards PA, given that recess is a physically active part of the school day, yet is more autonomous and less supervised than PE. Recent literature has supported this, as Massey and colleagues (2021b) reported memories of recess enjoyment were associated with PA enjoyment in adulthood, whereas negative recess memories were associated with social isolation. In an effort to better understand recess memories, and how they may be related to adult behaviors, the purpose of this study was to examine qualitative descriptions of adults' worst recess memories as it related to physical and social health.

Study design

Mixed methods design; inductive content analysis and analysis of covariance.

Methods

As part of a larger project, 433 participants between the ages of 19 and 77 (M = 44.91; SD = 15.35) were asked to recall their worst recess memories and the grades in which those memories occurred. Participants identified as predominantly female (52%), White (72%), and college educated (46%). Data analysis was conducted via an inductive content analysis by three research team members.

Results

The most common negative memories included isolating experiences, physical injuries, victimization, and contextual factors (e.g., weather). Through a series of analysis of covariance, self-reported isolation and self-efficacy of exercise were significantly related to participants with social isolation and physical injury memories respectively.

Conclusions

This study adds to a growing line of research documenting the importance of recess as a developmentally impactful environment with implications for physical and emotional health.

Opportunities for risk-taking during play alters cognitive performance and prefrontal inhibitory signalling in rats of both sexes

Social play behaviour is a rewarding activity that can entail risks, thus allowing young individuals to test the limits of their capacities and to train their cognitive and emotional adaptability to challenges. Here, we tested in rats how opportunities for risk-taking during play affect the development of cognitive and emotional capacities and medial prefrontal cortex (mPFC) function, a brain structure important for risk-based decision making. Male and female rats were housed socially or social play-deprived (SPD) between postnatal day (P)21 and P42. During this period, half of both groups were daily exposed to a high-risk play environment. Around P85, all rats were tested for cognitive performance and emotional behaviour after which inhibitory currents were recorded in layer 5 pyramidal neurons in mPFC slices. We show that playing in a high-risk environment altered cognitive flexibility in both sexes and improved behavioural inhibition in males. High-risk play altered anxiety-like behaviour in the elevated plus maze in males and in the open field in females, respectively. SPD affected cognitive flexibility in both sexes and decreased anxiety-like behaviour in the elevated plus maze in females. We found that synaptic inhibitory currents in the mPFC were increased in male, but not female, rats after high-risk play, while SPD lowered prefrontal cortex (PFC) synaptic inhibition in both sexes. Together, our data show that exposure to risks during play affects the development of cognition, emotional behaviour and inhibition in the mPFC. Furthermore, our study suggests that the opportunity to take risks during play cannot substitute for social play behaviour.

Gender Differences in Caregivers' Attitudes to Risky Child Play in Britain: A Cross-Sectional Study

BACKGROUND

This study examines gender differences in parental attitudes toward risky play for 5- to 11-year-old boys and girls in Britain.

METHODS

Analyses use data from the cross-sectional, nationally representative British Child Play Survey. Survey respondents were caregivers of primary-school-aged children living in Britain. Parent self-reported their risk tolerance in play via the Tolerance for Risk in Play Scale (TRiPS) and the Risk Engagement and Protection Survey (REPS). The REPS includes subscales that assess caregiver attitudes around "Protection from Injury" (PFI) and "Engagement with Risk" (EWR) in relation to children's play. Multiple linear regression compared caregiver gender differences in TRiPS, REPS-PFI, and REPS-EWR at the item level, and overall. Associations between child gender and these scales were also examined.

RESULTS

Among 1919 caregivers, no significant gender differences emerged in mean TRiPS (P = .72), REPS-EWR (P = .58), and REPS-PFI (P = .34) scores. Activity-specific differences were evident in caregivers' tolerance for individual risky play activities (15/31 activities). Parents of boys exhibited higher risk tolerance (B = -4.48, P < .01) and willingness for their child to engage in risky play (B = -0.63, P < .01) than parents of girls.

CONCLUSIONS

While there was no difference between male and female caregivers overall attitudes, gender differences were prominent for specific play activities and attitudes, with male caregivers demonstrating higher tolerance for the riskiest activities. Parents of boys expressed more permissive attitudes toward engagement in risky play. Further work is needed to identify why there is gender-related variation in these attitudes and should be considered in interventions that support parents in enabling adventurous play opportunities for children.

Influence of physical fitness components on personality factors and risk perception of children and adolescents: a cross-sectional study

OBJECTIVES

To examine the associations of cardiorespiratory fitness (VO2 max) and muscular strength with indicators related to the risk scale, such as perceived competence, sensation seeking, competitiveness, risk taking and risk perception in sports.

DESIGN

Cross-sectional study.

SETTING

High schools from the Region of Murcia (Spain).

PARTICIPANTS

Three-hundred-and-seventeen adolescents participated (mean age: 13.69±1.2 years old).

PRIMARY AND SECONDARY OUTCOME MEASURES

Body mass, body height, Course-Navette test, upper limb strength and psychoeducational factors that determine the propensity towards sports accidents in school children, the Sports Accident Propensity Scale were evaluated. It was performance t-test for independent samples, stepwise multiple linear regression models and a multiple mediation analysis.

RESULTS

The analysis showed significant differences with respect to sex in height, VO2 max, handgrip strength and in all factors of the questionnaire (p=0.02-<0.01). Adolescents who presented greater VO2 max, strength in the handgrip test and age showed a higher score in factors 1 and 3. Higher scores in factor 2 were associated with better VO2 max and strength in handgrip test. Youngers and better values of strength in the handgrip showed higher score in factors 4 and 5. The mediation analysis with two mediating variables (handgrip strength and VO2 max) showed a significant indirect effect. When handgrip strength and VO2 max were included in the equations, the association between sex and each factor ceased to be significant.

CONCLUSION

This study highlights the potential benefits of muscular strength (handgrip) and VO2 max in the perceived risk scale, and the variable of age on this.

TRIAL REGISTRATION NUMBER

Clinical trial: NCT05544370 (pre-results).

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

It is theorised that adventurous play offers learning opportunities that help to prevent mental health problems in children. In this study, data from two samples is used to examine associations between the time that children aged 5-11 years spent playing adventurously and their mental health. For comparison, time spent playing unadventurously and time spent playing outdoors are also examined. Study 1 includes a sample of 417 parents, Study 2 includes data from a nationally representative sample of 1919 parents. Small, significant associations between adventurous play and internalising problems, as well as positive affect during the first UK-wide Covid-19 lockdown, were found; children who spend more time playing adventurously had fewer internalising problems and more positive affect during the Covid-19 lockdown. Study 2 showed that these associations were stronger for children from lower income families than for children from higher income families. The results align with theoretical hypotheses about adventurous play.

Designing for inclusion in public playgrounds: a scoping review of definitions, and utilization of universal design

PURPOSE

Public playgrounds afford children and families important opportunities for outdoor play, social participation, and inclusion. Unfortunately, many children and families experience barriers to accessing, using, and being included in public playgrounds. Consequently, Universal Design (UD) is promoted for providing conceptual guidance for designing for inclusion in public playgrounds. However, a lack of research evidence means researchers have engaged in the ongoing interpretation of the UD concept and related non-discriminatory planning and design concepts. Therefore, the aim of this study was to examine how UD, and related concepts, are used in peer-reviewed articles concerning public playgrounds.

MATERIALS AND METHODS

A scoping review was conducted in November 2019, which identified 15 peer-reviewed articles that met the inclusion criteria.

RESULTS

Analysis revealed that the terms UD, inclusive design, accessibility, and usability are all being used to describe non-discriminatory planning and design concepts arbitrarily and without regard for higher or lower order concepts. Two broad interpretations were evident: (a) UD is synonymous with accessibility for some, and (b) UD is a higher-order concept that goes beyond accessibility for others. Nevertheless, findings highlight the utility of UD in underpinning the design of public playgrounds in many developed countries; however, the concept requires further clarity and specificity as it pertains to playground design and more pertinently inclusion in outdoor play.

CONCLUSIONS

We argue for further conceptual refinement to consolidate the importance and future application of UD for Play (UDP) in the design of public playgrounds that promote outdoor play, social participation, and inclusion.IMPLICATIONS FOR REHABILITATIONMost peer-reviewed journal articles reviewed fail to define what is meant by the term Universal Design.Of those that do provide a definition, the outcome of inclusion in play, or the application of Universal Design to enable play in public playgrounds was unclear.Research to date has mostly focused on related concepts, including accessibility and usability, with less emphasis on Universal Design.Recommend a tailored perspective of Universal Design for Play (UDP).

Virtual Risk Management-Exploring Effects of Childhood Risk Experiences through Innovative Methods (ViRMa) for Primary School Children in Norway: Study Protocol for the ViRMa Project

BACKGROUND

Research indicates that risky play benefits children's risk assessment and risk management skills and offers several positive health effects such as resilience, social skills, physical activity, well-being, and involvement. There are also indications that the lack of risky play and autonomy increases the likelihood of anxiety. Despite its well-documented importance, and the willingness of children to engage in risky play, this type of play is increasingly restricted. Assessing long-term effects of risky play has been problematic because of ethical issues with conducting studies designed to allow or encourage children to take physical risks with the potential of injury.

OBJECTIVE

The Virtual Risk Management project aims to examine children's development of risk management skills through risky play. To accomplish this, the project aims to use and validate newly developed and ethically appropriate data collection tools such as virtual reality, eye tracking, and motion capturing, and to provide insight into how children assess and handle risk situations and how children's past risky play experiences are associated with their risk management.

METHODS

We will recruit 500 children aged 7-10 years and their parents from primary schools in Norway. Children's risk management will be measured through data concerning their risk assessment, risk willingness, and risk handling when completing a number of tasks in 3 categories of virtual reality scenarios: street crossing, river crossing, and playing on playground equipment. The children will move around physically in a large space while conducting the tasks and wear 17 motion-capturing sensors that will measure their movements to analyze motor skills. We will also collect data on children's perceived motor competence and their sensation-seeking personality. To obtain data on children's risk experiences, parents will complete questionnaires on their parental style and risk tolerance, as well as information about the child's practical risk experience.

RESULTS

Four schools have been recruited to participate in data collection. The recruitment of children and parents for this study started in December 2022, and as of April 2023, a total of 433 parents have consented for their children to participate.

CONCLUSIONS

The Virtual Risk Management project will increase our understanding of how children's characteristics, upbringing, and previous experiences influence their learning and ability to handle challenges. Through development and use of cutting-edge technology and previously developed measures to describe aspects of the children's past experiences, this project addresses crucial topics related to children's health and development. Such knowledge may guide pedagogical questions and the development of educational, injury prevention, and other health-related interventions, and reveal essential areas for focus in future studies. It may also impact how risk is addressed in crucial societal institutions such as the family, early childhood education, and schools.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45857.

Adventurous play for a healthy childhood: Facilitators and barriers identified by parents in Britain

RATIONALE

Adventurous play, where children take age-appropriate risks involving uncertainty, fear, and thrill, is positively associated with children's physical health, mental health, and development. There is growing concern that children's access to and engagement with adventurous play opportunities are declining in Westernised countries, which may have negative implications for children's health.

OBJECTIVE

The current study aimed to ascertain the facilitators of and barriers to children's adventurous play most identified by parents in Britain and to determine whether these differ across socio-demographic and geographic groups.

METHODS

This study analysed the responses of a nationally representative sample of 1919 parents who took part in the British Children's Play Survey. Two open-ended questions asked parents to identify what they perceive to be the facilitators of and barriers to their child's adventurous play. A quantitative coding scheme, developed using the qualitative framework identified by Oliver et al. (2022), was applied to parents' responses.

RESULTS

A diversity in the most identified facilitators and barriers was found, including concerns about the risk of injury from adventurous play and the safety of society, positive attitudes about the benefits of adventurous play, as well as factors related to child attributes. In general, these were consistently identified across different socio-demographic and geographic groups, although some differences were found in barriers.

CONCLUSIONS

The findings of this research support the identification of key targets for those working with parents to improve children's adventurous play opportunities and ultimately their physical and mental health. Future research should seek to design and tailor interventions by asking parents about the support they would value.

A qualitative study of parental strategies to enable pre-school children's outdoor and nature experiences during COVID-19 restrictions

Outdoor and nature experiences including play have been shown to be beneficial for children's physical, cognitive, social and emotional development. Parents/carers play an important role in encouraging or impeding their child's access to the outdoor environment and participation in outdoor play. The COVID-19 pandemic and associated restrictions on free movement and social interactions placed an unprecedented pressure on families to manage the drastic change in their daily routines. This paper reports findings from two combined data sets generated in 2020 during the COVID-19 pandemic and provides a deeper understanding of the interconnected nature of how contextual factors influence parenting processes and outcomes relating to young children's outdoor and nature experiences and subsequent child health. Findings have the potential to inform the messaging of existing outdoor play policies and the content of new interventions aiming to promote the exposure of children to the natural outdoor environment.

Playing in 'The Backyard': Environmental Features and Conditions of a Natural Playspace Which Support Diverse Outdoor Play Activities among Younger Children

Outdoor play in nature-rich spaces has been associated with healthy development among young children. The diverse play opportunities afforded to children by natural playspaces can scaffold health benefits, appreciation of nature, and pro-environmental behaviors into adulthood. Environmental features and conditions of outdoor playspaces significantly influence the diversity and quality of play opportunities. Understanding how the physical environment can support high-quality play experiences can inform the design of stimulating, health-promoting playscapes for children. An observational behavior mapping framework was utilized to examine the environmental features of The Backyard, a large natural playscape, associated with play activities among young children. The Tool for Observing Play Outdoors was used to capture outdoor play types OPT), along with associated behavioral and environmental data, during seven days of field observation. While the playspace supported most OPTs, Physical and Exploratory play were most prevalent. Associations with activity intensity and risk play are also presented. Loose parts, particularly natural loose parts, were highly involved in most OPTs, but especially associated with Exploratory play. Ground topography showed some association with several OPTs and warrants further investigation. The environmental features of The Backyard supported an abundant and diverse range of outdoor play activities for young children and families.

Parental Assessment of Benefits and of Dangers Determines Children's Permission to Play Outdoors

During the early years, children's outdoor play is dependent on parental supervision. Parents' perceptions are likely to influence what the child is permitted to do. To better understand the involved mechanisms in parents' decision making in such contexts, an online photo-based questionnaire was administered. The tool investigates, in different situations, parents and their children's experience, parents' perceptions, and permission to play. A total of 417 parents of children aged from 1.5 and 6.0 completed the questionnaire. Results showed that parents, overall, have a positive attitude towards outdoor play. Main concerns were about risk of injury but in most cases, perceived benefits outweigh perceived dangers. "Sawing wood" was the only situation with a negative benefits/dangers balance. A linear regression analysis revealed that permission to play outdoors is based on parental assessment of benefits and dangers. Perceived benefits appeared to have more influence on parental decision than perceived dangers, while perceived competence had only a small influence. The results also showed that parents' childhood experience of outdoor play was an important determinant for adults' perceptions, perhaps demonstrating intergenerational concerns, as outdoor play is in decline. To overcome a negative intergenerational effect on children's outdoor play, interventions and communication should focus on associated benefits.

"Children are precious cargo; we don't let them take any risks!": Hearing from adults on safety and risk in children's active play in schools: a systematic review

Background

Understanding determinants of children’s outdoor play is important for improving low physical activity levels, and schools are a key setting for both. Safety concerns shape children’s opportunity to play actively outdoors, therefore, this qualitative evidence synthesis aimed to i) examine adult (e.g., parent, teacher, yard supervisor, principal) perspectives on safety and risk in children’s active play during recess in elementary and/or middle schools, and ii) identify how safety and risk influence playground supervision and decision making in this setting.

Methods

Six electronic databases were systematically searched in March 2021, with an updated search in June 2022. Records were screened against eligibility criteria using Covidence software, and data extraction and synthesis were performed using predesigned coding forms in Microsoft Excel and NVivo. Framework synthesis methodology was employed, guided by a conceptual framework structured on the socio-ecological model (SEM) and affordance theory.

Results

From 10,370 records, 25 studies were included that represented 608 adults across 89 schools from nine countries. The synthesis identified 10 constraining and four affording factors that influenced whether school staff were risk-averse or risk tolerant during recess, and, in turn, the degree to which children’s play was managed. Constraining factors stemmed from fears for children’s physical safety, and fear of blame and liability in the event of playground injury, which shaped parent, school staff and institutional responses to risk. Interrelated factors across SEM levels combined to drive risk-averse decision making and constraining supervision. Emerging evidence suggests children’s active play in schools can be promoted by fostering a risk tolerant and play friendly culture in schools through play facilitation training (e.g., risk-reframing, conflict resolution) and engaging stakeholders in the development of school policies and rules that balance benefits of play against potential risks.

Conclusions

Findings show several socio-cultural factors limited the ability of school staff to genuinely promote active play. Future work should seek to foster risk tolerance in schools, challenge the cultural norms that shape parent attitudes and institutional responses to risk in children’s play, and explore novel methods for overcoming policy barriers and fear of liability in schools.

Trial registration

PROSPERO registration: CRD42021238719.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01344-7.

The Current Status of Public Playground Safety and Children’s Risk Taking Behavior in the Park: Nakhon Si Thammarat Province, Thailand

The playground is perhaps the one area where school children feel like they can roam free, and public playgrounds provide many learning opportunities through different types of play. A cross-sectional descriptive study is presented with the objective of studying playground safety and the play behavior of primary school children at a park in Nakhon Si Thammarat Province, Thailand. The total number of playground equipment pieces was 22, the sample group of children was 362 children, and the data were collected using a playground safety survey and an observation form on playground play behavior. Data were collected from 2017 to 2018 and were analyzed using descriptive statistics including frequency, average, and standard deviation. The research showed that: (1) the most common defects of playground equipment included the material selection, the distance of the stair steps, and the height of the playground equipment; (2) the lack of awareness of children in terms of using the playground equipment safely; and (3) the three top risks in the play behavior of children were not checking equipment or toys before play, playing on the equipment over-adventurously, and playing on the equipment carelessly with friends. Related government agencies should provide support and management for playground areas and playground equipment by continuously implementing equipment checks, improvements, and repairs.

Risky Play and Social Behaviors among Japanese Preschoolers: Direct Observation Method

While limited evidence is available, preliminary studies highlight the potential health benefits of risky play. However, most of the studies have used subjective methods (i.e., questionnaires) to evaluate children’s risky play, which limits their validity and reliability. The purpose of the present study was to examine the relationship between the frequency of risky play and social behavior among Japanese preschoolers by using a valid and reliable method such as direct observation. A total of 32 Japanese preschoolers (71.4 ± 3.5 months old) participated in the study, and their social behaviors were measured by the Strength and Difficulties Questionnaire (SDQ). Data regarding the frequency of risky play was collected through direct observation. Results stated that, in a non-adjusted model, there was no significant association between children’s risky play and prosocial behavior. However, the association became significant after adjusting for covariates such as gender, parental employment status, and physical activity. In contrast, there was no significant association between children’s risky play and problem behavior (hyperactivity and aggression) after adjusting for covariates. In conclusion, covariates such as parental employment should be considered when examining the benefits of risky play.

"All the fun stuff, the teachers say, 'that's dangerous!'" Hearing from children on safety and risk in active play in schools: a systematic review

Background

Active play is vital for healthy child development, and schools are a valuable setting to promote this behaviour. Understanding the determinants of children’s physical activity behaviour during recess, particularly the role of risk-taking and the influence safety concerns have on active play, is required. This systematic review aimed to 1) synthesise qualitative research with children that explored their perceptions of safety and risk in active play during recess in elementary and/or middle school, and 2) develop a model from the findings to guide efforts in schools to optimise children’s active play opportunities during recess.

Methods

Six online databases were systematically searched for articles published between January 2000 and March 2021. Following PRISMA guidelines, records were screened against eligibility criteria using Covidence software, and data extraction and synthesis was conducted using customised forms in Excel and NVivo software. Framework synthesis methodology was employed, conceptually guided by Bronfenbrenner’s socio-ecological model and Gibson’s affordance theory.

Results

Of 9664 records, 31 studies met inclusion criteria, representing 1408 children across 140 schools from 11 countries. An emergent conceptual framework was developed encompassing 23 risk and safety themes and 10 risky play types that children desired in schools. Individual characteristics (age, gender, physical literacy) influenced children’s engagement with risk and how they kept themselves safe. Across outer SEM levels, factors interacted to constrain or afford children’s active play. Socio-cultural factors (supervision practices, rules, equipment restrictions) constrained active play, which children perceived were driven by adults’ concern with physical safety. These factors contributed to a cycle of risk-averse decision making and diminished play affordances, which could inadvertently exacerbate safety issues. A model for risk tolerance in children’s active play has been proposed.

Conclusions

The findings show a disparity between the active play children want in schools and what they are able to do. Future work should balance the concerns of adults against the active play children want, involve children in decisions about playground policy, and foster a risk-tolerant culture in schools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01305-0.

The Evolution of Playfulness, Play and Play-Like Phenomena in Relation to Sexual Selection

By conceptualizing Sexual Selection, Darwin showed a way to analyze intra-specific individual differences within an evolutionary perspective. Interestingly, Sexual Selection is often used to investigate the origins of sports, arts, humor, religion and other phenomena that, in several languages, are simply called "play." Despite their manifested differences, these phenomena rely on shared psychological processes, including playfulness. Further, in such behaviors there is usually considerable individual variability, including sex differences, and positive relationship with mating success. However, Sexual Selection is rarely applied in the study of play, with exception to what is concerned as infant training behavior for adult sex roles. We offer an integrated grounding of playful phenomena aligning evolutionary propositions based on sexual selection, which might stimulate further exploration of playfulness within evolutionary perspective.

Nature-Based Early Childhood Education and Children's Physical Activity, Sedentary Behavior, Motor Competence, and Other Physical Health Outcomes: A Mixed-Methods Systematic Review

BACKGROUND

The purpose was to synthesize evidence on the association between nature-based Early Childhood Education (ECE) and children's physical activity (PA) and motor competence (MC).

METHODS

A literature search of 9 databases was concluded in August 2020. Studies were eligible if (1) children were aged 2-7 years old and attending ECE, (2) ECE settings integrated nature, and (3) assessed physical outcomes. Two reviewers independently screened full-text articles and assessed study quality. Synthesis was conducted using effect direction (quantitative), thematic analysis (qualitative), and combined using a results-based convergent synthesis.

RESULTS

1370 full-text articles were screened and 39 (31 quantitative and 8 qualitative) studies were eligible; 20 quantitative studies assessed PA and 6 assessed MC. Findings indicated inconsistent associations between nature-based ECE and increased moderate to vigorous PA, and improved speed/agility and object control skills. There were positive associations between nature-based ECE and reduced sedentary time and improved balance. From the qualitative analysis, nature-based ECE affords higher intensity PA and risky play, which could improve some MC domains. The quality of 28/31 studies was weak.

CONCLUSIONS

More controlled experimental designs that describe the dose and quality of nature are needed to better inform the effectiveness of nature-based ECE on PA and MC.

A GoPro Look on How Children Aged 17–25 Months Assess and Manage Risk during Free Exploration in a Varied Natural Environment

Research indicates that risky play has positive effects on children’s development, learning and health, and ability to assess and manage risk, but there is a lack of knowledge on how toddlers engage in risky play. This study aims to investigate how toddlers assess and manage risk in free exploration in a varied natural environment and was conducted within an explorative qualitative approach. Observations were collected through head-mounted GoPro cameras while seven toddlers freely explored a natural environment. The results show that toddlers are able to assess and manage risks in challenging natural environments. They develop their own risk management skills and assess risks directly and indirectly. The results also show that practitioners sometimes perform risk assessment/management on behalf of the child and thus override the child’s own actions. The findings suggest implications for an early childhood education and care (ECEC) practice where children even as young as 17–25 months should be allowed to explore challenging environments and learn how to assess and manage risks.

Hunter-Gatherer Children's Object Play and Tool Use: An Ethnohistorical Analysis

Learning to use, make, and modify tools is key to our species' success. Researchers have hypothesized that play with objects may have a foundational role in the ontogeny of tool use and, over evolutionary timescales, in cumulative technological innovation. Yet, there are few systematic studies investigating children's interactions with objects outside the post-industrialized West. Here, we survey the ethnohistorical record to uncover cross-cultural trends regarding hunter-gatherer children's use of objects during play and instrumental activities. Our dataset, consisting of 434 observations of children's toys and tools from 54 hunter-gatherer societies, reveals several salient trends: Most objects in our dataset are used in play. Children readily manufacture their own toys, such as dolls and shelters. Most of the objects that children interact with are constructed from multiple materials. Most of the objects in our dataset are full-sized or miniature versions of adult tools, reflecting learning for adult roles. Children also engage with objects related to child culture, primarily during play. Taken together, our findings show that hunter-gatherer children grow up playing, making, and learning with objects.

Parent perceived barriers and facilitators of children's adventurous play in Britain: a framework analysis

BACKGROUND

From a public health perspective there is growing interest in children's play, including play involving risk and adventure, in relation to children's physical and mental health. Regarding mental health, it is theorised that adventurous play, where children experience thrilling, exciting emotions, offers important learning opportunities that prepare children for dealing with uncertainty and help prevent anxiety. Despite these benefits, adventurous play has decreased substantially within a generation. Parents have a key role in facilitating or limiting children's opportunities for adventurous play, but research identifying the barriers and facilitators parents perceive in relation to adventurous play is scarce. The present study therefore examined the barriers to and facilitators of adventurous play as perceived by parents of school-aged children in Britain.

METHODS

This study analysed data from a subsample of parents in Britain (n = 377) who participated in the nationally representative British Children's Play Survey. Parents responded to two open-ended questions pertaining to the barriers to and facilitators of children's adventurous play. Responses were analysed using a qualitative Framework Analysis, an approach suitable for managing large datasets with specific research questions.

RESULTS

Four framework categories were identified: Social Environment; Physical Environment; Risk of Injury; Child Factors. Social Environment included barriers and facilitators related to parents, family and peers, as well as community and society. Dominant themes within the Social Environment related to perceptions about the certainty of child safety, such as supervision and the safety of society. Beliefs about the benefits of adventurous play for development and well-being were also important in the Social Environment. Physical Environment factors focused on safety and practical issues. Risk of Injury captured concerns about children being injured during play. Child Factors included child attributes, such as play preference, developmental ability and trait-like characteristics.

CONCLUSIONS

Improved understanding of what influences parent perceptions of adventurous play can inform public health interventions designed to improve children's opportunities for and engagement in adventurous play, with a view to promote children's physical and mental health.

Primary School Educators' Perspectives and Experiences of Nature-Based Play and Learning and Its Benefits, Barriers, and Enablers: A Qualitative Descriptive Study

Nature-based play and learning is of increasing interest to primary schools and research suggests that it has many potential benefits for children’s health and development. However, little is known about educators’ perspectives and experiences of nature-based play and learning, particularly the barriers, benefits and enablers, despite their direct relevance to the uptake of nature-based play and learning in schools. A qualitative descriptive methodology was employed to uncover these. Individual, semi-structured interviews were conducted with 12 principals and educators from South Australian public primary schools, recruited via a participant contact list from a previous study. The participants were two principals, eight educators and two individuals with dual principal and educator positions. Metropolitan and rural schools were equally represented. Interviews were audio-taped, transcribed verbatim and analysed using thematic analysis. Analysis identified four overarching themes: the practice, perceived benefits, barriers and enablers of nature-based play and learning. Children’s learning, enjoyment, creativity, and a relaxed and flexible environment were clear benefits. Meanwhile educator knowledge and confidence and the crowded curriculum were barriers. Enablers were nature-based play and learning champions and support from school leadership. The findings suggest that schools can help engage students with nature-based play and learning activities by mitigating these barriers and promoting these enablers.

Impact of an outdoor loose parts intervention on Nova Scotia preschoolers' fundamental movement skills: a multi-methods randomized controlled trial

Development of fundamental movement skills in early childhood supports lifelong health. The potential for outdoor play with loose parts to enhance fundamental movement skills has not been investigated. A multi-methods randomized controlled design was used to determine the efficacy of integrating outdoor loose parts play into Nova Scotia childcare centers (19 sites: 11 interventions, 8 control). Movement skills (n = 209, age 3-5 years) were assessed over a 6-month period to investigate changes in fundamental movement skills over time and between groups. Qualitative data was also collected on the educators' perceptions of outdoor loose parts play. Quantitative data (fundamental movement skills) revealed a non-intervention effect, however, educators spoke of outdoor loose parts play providing opportunities to combine/ repeat movements and take risks; supporting physical, cognitive and socio-emotional (holistic) development; and increasing awareness of children's physical development and how to support it. Our findings demonstrate value in outdoor loose parts play for the development of fundamental movement skills in childcare settings.

Is vegetation cover in key behaviour settings important for early childhood socioemotional function? A preregistered, cross-sectional study

The environmental influences on early childhood development are understudied. The association between vegetation cover (i.e., trees, shrubs, grassed areas) in four key behaviour settings and socioemotional functioning was investigated in 1196 young children (2-5 years). Emotional difficulties were inversely associated with vegetation cover in the home yard (OR: 0.81 [0.69-0.96]) and neighbourhood (OR: 0.79 [0.67-0.94]), but not in early childhood education and care (ECEC) centre outdoor areas or the ECEC neighbourhood. The higher odds of emotional difficulties associated with lower levels of maternal education was reduced with higher percentages of home yard vegetation cover. There was no evidence of mediation of the relationship between emotional difficulties and vegetation cover by time spent playing outside the home, day or nighttime sleep duration, or physical activity. We found no associations between vegetation cover and conduct, hyperactivity and inattention, peer difficulties, or prosocial behaviours. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=J3HeEiIjVZc.

Developmental associations between risk-taking and anxiety symptoms across ages 8-12 years

This study explored the transactional association between anxiety symptoms and risk‐avoidance in Dutch elementary schoolchildren (N = 1200; 50% girls) across ages 8–12. Anxiety symptoms were obtained using self‐, peer‐, and teacher‐reports. Risk‐avoidance was measured using the Balloon Analogue Risk Task—Youth Version. Random‐intercept cross‐lagged panel models showed that, across informants, increases in anxiety symptoms predicted decreases in risk‐taking. Apart from minor exceptions, this effect was similar across sexes. For peer‐reports, the reverse path from decreases in risk‐taking to increased anxiety was also found. Overall, this study gives insight into the developmental link between symptoms of anxiety and risk‐avoidance which is important for early signaling and prevention as well as for our understanding of the consequences of childhood anxiety symptoms.

Development and evaluation of a new measure of children's play: the Children's Play Scale (CPS)

Background

There is increasing recognition of the importance of children’s play from a public health perspective, given the links between play and children’s physical and mental health. The present research aimed to develop and evaluate a new parent-report questionnaire that measures the time children spend playing across a range of places and includes a supplement to evaluate how adventurously children play.

Methods

The questionnaire was developed with input from a diverse group of parents and experts in children’s play. It was designed to yield a range of metrics including time spent playing per year, time spent playing outside, time spent playing in nature and level of adventurous play. The reliability of the questionnaire was then evaluated with 245 parents (149 mothers, 96 fathers) of 154 children aged 5–11 years. All participants completed the measure at time 1. At time 2, an average of 20 days later, 184 parents (111 mothers and 73 fathers) of 99 children completed the measure again.

Results

Cross-informant agreement, evaluated using Concordance Correlation Coefficients (CCCs), ranged from 0.36 to 0.51. These fall in the poor to moderate range and are largely comparable to cross-informant agreement on other measures. Test-retest reliability for mothers was good (range 0.67–0.76) for time spent playing metrics. For fathers, test-retest reliability was lower (range 0.39–0.63). For both parents the average level of adventurous play variable had relatively poor test retest reliability (mothers = 0.49, fathers = 0.42). This variable also showed a significant increase from time 1 to time 2. This instability over time may be due to the timing of the research in relation to the Covid-19 lockdown and associated shifts in risk perception.

Conclusions

The measure will be of value in future research focusing on the public health benefits and correlates of children’s play as well as researchers interested in children’s outdoor play and play in nature specifically. The development of the measure in collaboration with parents and experts in children’s play is a significant strength. It will be of value for future research to further validate the measure against play diaries or activity monitors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10812-x.

Children's Play and Independent Mobility in 2020: Results from the British Children's Play Survey

The British Children’s Play Survey was conducted in April 2020 with a nationally representative sample of 1919 parents/caregivers with a child aged 5–11 years. Respondents completed a range of measures focused on children’s play, independent mobility and adult tolerance of and attitudes towards risk in play. The results show that, averaged across the year, children play for around 3 h per day, with around half of children’s play happening outdoors. Away from home, the most common places for children to play are playgrounds and green spaces. The most adventurous places for play were green spaces and indoor play centres. A significant difference was found between the age that children were reported to be allowed out alone (10.74 years; SD = 2.20 years) and the age that their parents/caregivers reported they had been allowed out alone (8.91 years; SD = 2.31 years). A range of socio-demographic factors were associated with children’s play. There was little evidence that geographical location predicted children’s play, but it was more important for independent mobility. Further, when parents/caregivers had more positive attitudes around children’s risk-taking in play, children spent more time playing and were allowed to be out of the house independently at a younger age.

A case study exploring the 'real world' process of 'naturalizing' school playgrounds

Background: The aim of this study was to examine the lived experiences of teachers and administrators at two schools (one elementary Kindergarten-Grade 5 and one middle school, grades 6-8) following the 'naturalizing' of a portion of their schoolyard. Methods: A qualitative case study design was used. Focus groups and interviews allowed participants to express their rationale, identify implementation facilitators and barriers and critical processes/steps for realizing their naturalization goals. Researcher questions explored (1) factors which led to naturalizing the schoolyard, (2) key planning and process steps (3) challenges and successes experienced, and, (4) lessons learned. Findings: Six themes were identified as rationale for naturalizing including: re-integration of outdoor play into children's daily lives, pro-active mental health, opportunity for inclusion, nature as a positive space for learning, it fit with our values and principles, we had a need. Implementation was facilitated by having champions and support from multiple levels, adopting a phased approach, resources and having the buy-in to persevere over time. Significant challenges and 'how to' steps were also identified. Conclusions: Naturalizing schoolyards does not happen without a supportive context, significant time and effort. Implementation steps and issues were those commonly found in other school-based health promotion efforts.

Paving the Way for Outdoor Play: Examining Socio-Environmental Barriers to Community-Based Outdoor Play

Outdoor play and independent, neighborhood activity, both linked with healthy childhood development, have declined dramatically among Western children in recent decades. This study examines how social, cultural and environmental factors may be hindering children’s outdoor and community-based play. A comprehensive survey was completed by 826 children (aged 10–13 years) and their parents from 12 schools (four each urban, suburban and rural) from a large county in Ontario, Canada. Five multilevel regression models, controlling for any school clustering effect, examined associations between outdoor play time per week and variable sets representing five prevalent factors cited in the literature as influencing children’s outdoor play (OP). Models predicted that younger children and boys were more likely to spend time playing outdoors; involvement in organized physical activities, other children nearby to play with, higher perception of benefits of outdoor play, and higher parental perceptions of neighborhood social cohesion also predicted more time in outdoor play. Time outdoors was less likely among children not allowed to play beyond home without supervision, felt they were ‘too busy’ with screen-based activities, and who reported higher fears related to playing outdoors. Study findings have important implications for targeting environmental, cultural and policy changes to foster child-friendly communities which effectively support healthy outdoor play.

Adventurous Play as a Mechanism for Reducing Risk for Childhood Anxiety: A Conceptual Model

In this conceptual article, we draw upon the literature regarding cognitive and behavioural factors that underpin childhood anxiety to outline how a range of these risk markers might be targeted through adventurous play. When children play in an adventurous way, climbing trees, riding their bikes fast downhill and jumping from rocks, they experience feelings of fear and excitement, thrill and adrenaline. We propose that the positive, thrilling and playful emotions associated with this type of child-led play facilitate exposure to fear-provoking situations and, in doing so, provide opportunities for children to learn about physiological arousal, uncertainty and coping. We hypothesise that these learning opportunities will, over time, reduce children's risk for elevated anxiety by increasing children's expectations and ability to cope with anxiety, decreasing intolerance of uncertainty and preventing catastrophic misinterpretations of physiological arousal. If our conceptual model is correct, then ensuring that children have the physical and psychological space required to play in an adventurous way may help to decrease their risk for elevated or clinical anxiety.

Paediatric elbow fractures and public play spaces: adherence to standards for children's playground equipment and surfacing

BACKGROUND

Supracondylar humerus fractures (SCHF) are the most common fractures sustained following a fall onto an outstretched hand among healthy children, and one of the leading causes of hospital admission and surgical intervention. The aim of this study was to examine SCHF occurring at public play spaces-particularly to determine whether or not the playground equipment implicated in injurious falls aligned with Canadian playground safety standards.

METHODS

Cases of children who attended the provincial paediatric orthopaedic clinic following SCHF at a public playground between April 2017 and October 2019 were included in the study. A research assistant visited each playground to measure the play structure type and dimensions, height of the equipment at the point from which the child fell and the type and depth of the surface material, and compare measurements to the 2016 safety standards. Child demographics and injury classification were also noted. Descriptive statistics were calculated and a scatterplot of fall height and surface depth was generated.

RESULTS

Forty-three sites, representing 47 SCHF cases (18 female, 29 male), were included in the final analysis. Fourteen children sustained type 1 fracture, 23 had type 2 fracture and the remaining 10 had type 3 fracture. Five children with type 2 fracture and all 10 children with type 3 fracture required surgery. The majority of sites had engineered wood fibre surfacing, with surfacing at 35 sites being less than 300 mm deep. Twenty-six play structures were upper body equipment (ie, monkey bars or similar), seven were track rides, five were rotating structures and the rest comprised a variety of classified and unclassified structures. Twenty-seven children fell from a height exceeding 2 m.

CONCLUSIONS

The majority of SCHF cases occurred at playgrounds with insufficient surface depth and/or non-compliant equipment. Upper body equipment, track rides and rotating play structures were of particular concern, as the children fell from heights exceeding the recommended standard, likely reflecting the degradation and compaction of the surfacing material over time.

Landscapes of becoming social: A systematic review of evidence for associations and pathways between interactions with nature and socioemotional development in children

BACKGROUND

Existing research indicates that spending time in nature is associated with diverse aspects of children's health and wellbeing. Although fundamental to later life chances and health, no systematic reviews, to our knowledge, have focused specifically on the effects of interaction with nature on socioemotional functioning in childhood.

OBJECTIVES

Amongst children, what is the consistency of associations between the availability of or spending time in nature on socioemotional function and development? Furthermore, which child behaviours and states independently associate with socioemotional function and availability of or spending time in nature, and what is the consistency of associations between these behaviours and states and contact with nature?

DATA SOURCES

Embase, Environment Complete, MEDLINE, and APA PsycINFO. Eligible studies were backward and forward snowball-searched.

STUDY ELIGIBILITY CRITERIA

Studies investigating effects of, or associations between, availability of or interaction with nature on socioemotional or proximal outcomes in children under the age of 12 years were included in this review.

STUDY APPRAISAL AND SYNTHESIS METHODS

The internal validity of studies investigating socioemotional outcomes were based on assessments of elements of study design, conduct, and reporting to identify potential issues related to confounding or other biases. The number of analyses indicating positive, negative, and non-significant associations between availability or interaction with green space and the outcomes were summed.

RESULTS

A total of 223 eligible full-texts, of which 43 pertained to socioemotional outcomes and 180 to proximal outcomes, met eligibility criteria. Positive associations between availability of and spending time in green space were found with children's intra- and interpersonal socioemotional function and development. Proportions of positive findings ranged from 13.9% to 55% across experimental and observational research, exposures, populations, and contexts. Modifying and mediating factors were identified. We found consistent evidence for improved aspects of cognition and, for children over six years, reduced risk of obesity and overweight in association with green space; consistent links between movement behaviours in the experimental, but not observational research; tentative trends suggesting associations with play, motor skills, language, screen time, and communication skills; little evidence for positive associations between green space and mood, physical wellbeing, and stress; some evidence for associations with healthy birth outcomes, and little evidence for direct associations between availability of green space and asthma and allergy prevalence, however, mediation via, for example, air pollution was likely.

LIMITATIONS

We identified few studies without either probable or severe risk of bias in at least one item. Improved study quality may therefore result in different results. Restricting analyses to include only studies considered at low risk of bias indicated similar or slightly lower proportions of positive findings. Risk of bias in proximal outcomes was not assessed.

CONCLUSIONS

The empirical evidence for benefits of availability of and interaction green space for child socioemotional function and development must currently be considered limited. A number of proximal indicators were identified. Systematic review registration number.

PROSPERO ID

CRD42019135016.

Can universal design support outdoor play, social participation, and inclusion in public playgrounds? A scoping review

PURPOSE

To synthesize evidence regarding the physical design features and non-physical aspects of public playgrounds that facilitate/hinder outdoor play, social participation, and inclusion; identify design recommendations; and explore the current discourses and concepts around designing for outdoor play, social participation, and inclusion in public playgrounds in the context of Universal Design (UD).

METHODS

Published studies addressing public playgrounds, inclusion, and design, were identified via a systematic search of eleven databases from health, science, education, and humanities.

RESULTS

Fifteen documents met the inclusion criteria. Three main themes were identified concerning physical design features and non-physical aspects of public playgrounds that facilitate/hinder outdoor play, social participation, and inclusion, with associated design recommendations. Although UD is recognized to have the potential to support the design of public playgrounds, no studies examined UD solutions for playgrounds or tested them for effectiveness.

CONCLUSION

We cannot yet determine whether UD can support outdoor play, social participation, and inclusion in public playgrounds. Research to date has mostly focused on understanding users' perspectives; future research should continue to be informed by diverse users' perspectives to address gaps in knowledge concerning children's voice from migrants, lower socioeconomic communities, and intergenerational users with disabilities alongside researching design solutions for play.Implications for rehabilitationChildren, particularly children with disabilities and their families, continue to experience marginalization and exclusion in public playgrounds, despite a commitment to inclusion in international treaties.Universal design is recognized to have the potential to support the design of public playgrounds, however, the evidence is currently very sparse.While accessibility is an important consideration for playground design, it does not ensure that play occupations can take place.Extending knowledge on universal design as it applies explicitly to playgrounds and play occupation requires multi- and trans-disciplinary collaboration that includes a play-centered perspective.

Children's active outdoor play: 'good' mothering and the organisation of children's free time

This qualitative study draws on the Foucault-inspired notion of biopedagogies to examine and problematise the salient factors of contemporary motherhood impacting children's active outdoor play (AOP). The study positions mothering as a practice, through which children's health and bodies are constructed and disciplined. A discourse analysis of 21 interviews with Canadian mothers identified three discursive constructions of the 'good mother': mothers as time managers, risk managers and screen-time managers. Each was characterised by discursive conflicts that compromised the provision of AOP by mothers. This study provides data necessary for successfully including AOP as a leisure practice within family-centred health promotion.

Acrophobia and visual height intolerance: advances in epidemiology and mechanisms

Historical descriptions of fear at heights date back to Chinese and Roman antiquity. Current definitions distinguish between three different states of responses to height exposure: a physiological height imbalance that results from an impaired visual control of balance, a more or less distressing visual height intolerance, and acrophobia at the severest end of the spectrum. Epidemiological studies revealed a lifetime prevalence of visual height intolerance including acrophobia in 28% of adults (32% in women; 25% in men) and 34% among prepubertal children aged 8–10 years without gender preponderance. Visual height intolerance first occurring in adulthood usually persists throughout life, whereas an early manifestation in childhood usually shows a benign course with spontaneous relief within years. A high comorbidity was found with psychiatric disorders (e.g. anxiety and depressive syndromes) and other vertigo syndromes (e.g. vestibular migraine, Menière’s disease), but not with bilateral vestibulopathy. Neurophysiological analyses of stance, gait, and eye movements revealed an anxious control of postural stability, which entails a co-contraction of anti-gravity muscles that causes a general stiffening of the whole body including the oculomotor apparatus. Visual exploration is preferably reduced to fixation of the horizon. Gait alterations are characterized by a cautious slow walking mode with reduced stride length and increased double support phases. Anxiety is the critical factor in visual height intolerance and acrophobia leading to a motor behavior that resembles an atavistic primitive reflex of feigning death. The magnitude of anxiety and neurophysiological parameters of musculoskeletal stiffening increase with increasing height. They saturate, however, at about 20 m of absolute height above ground for postural symptoms and about 40 m for anxiety (70 m in acrophobic participants). With respect to management, a differentiation should be made between behavioral recommendations for prevention and therapy of the condition. Recommendations for coping strategies target behavioral advices on visual exploration, control of posture and locomotion as well as the role of cognition. Treatment of severely afflicted persons with distressing avoidance behavior mainly relies on behavioral therapy.

Father Involvement and Cognitive Development in Early and Middle Childhood: A Systematic Review

This systematic review aims to examine the existing literature concerning the association between father involvement and the development children's cognitive skills during early and middle childhood. Specifically, it analyzes: (1) how the number of researches developed across years; (2) which are the main socio-demographic characteristics of the samples; (3) which are the main focuses examined; and (4) which operational definitions were used to assess father involvement and children cognitive skills. Following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, the articles were searched through PubMed and EBSCO (PsycInfo, PsycArticles, Education Source, Social Sciences Abstract, Family Studies Abstracts, Gender Studies Database and CINAHL complete). The findings suggest that, although each research used a different operational definition of the father involvement construct, in recent years there was a wide and constant interest increase about this issue. Most of the empirical studies utilized quantitative methods, whereas relatively few used qualitative and only one mixed methods. As regards the analysis of socio-demographic characteristics of the samples there is a great evidence that most of them included biological and residential fathers: it may reflect that this type of sample is easier to recruit than non-residential and non-biological fathers. Regarding the socio-economic status and the ethnicity of families, the data highlighted how in recent years the literature on father involvement is starting to look at differences in ethnic and cultural backgrounds, in contrast to past researches. The findings revealed that the main focus is the impact of father involvement on children's cognitive skills and the most of the studies highlighted that it is positive and statistically significant. Regarding to the assessment of father involvement and children's cognitive skills, the literature is quite heterogeneous.

What Is the Relationship between the Neighbourhood Built Environment and Time Spent in Outdoor Play? A Systematic Review

Outdoor play has been associated with children’s and adolescents’ healthy development and physical activity. Attributes of the neighbourhood built environment can influence play behaviours. This systematic review examined the relationship between attributes of the neighbourhood built environment and the time children and adolescents (0–18 years) spend in self-directed outdoor play. We identified and evaluated 18 relevant papers using the Mixed Methods Appraisal Tool and developed a narrative synthesis of study results. We found moderate evidence that lower traffic volumes (ages 6–11), yard access (ages 3–10), and increased neighbourhood greenness (ages 2–15) were positively associated with time spent in outdoor play, as well as limited evidence that specific traffic-calming street features such as fewer intersections, low traffic speeds, neighbourhood disorder, and low residential density were positively associated with time spent in outdoor play. To our knowledge, this is the first systematic review on this topic. The limited number of “good quality” studies identified highlights the need for additional research on the topic.

A Cross-Sectional Description of Parental Perceptions and Practices Related to Risky Play and Independent Mobility in Children: The New Zealand State of Play Survey

The potential for risky play and independent mobility to increase children’s physical activity, and enhance cognitive development and emotional wellbeing has been recognised for some time. The aim of this study was to describe the attitudes of New Zealand parents towards such risky play practices and independent mobility, the barriers preventing them from allowing their children to participate, and how often their children engaged in risky play activities. An online survey comprised mostly of validated scales and standardised questions was completed by a nationally representative sample of 2003 parents. We found that parents had neutral feelings about the risk of injury to their child through play, rather they were concerned about road safety and “stranger danger”. There was strong agreement that there are multiple benefits to be gained from exposure to risk and challenge, and that health and safety rules are too strict. However, 73% of respondents stated that their 5–12 year old child seldom or never engaged in four or more risky activities, and only 14.3% engaged in four or more often or always. While parents agree that their child is likely to benefit from risky play, they do not have the confidence to allow their children to engage in such activities. Future research should address barriers and fears when implementing strategies to facilitate risky play.

To Analyze Thrill, Define Extreme Sports

Emotions are a signaling system, evolved by providing selective advantage through enhanced survival and reproduction. The selective advantage conferred by thrill or exhilaration, however, remains unknown. Hypotheses, as yet untested, include overcoming phobias or honing physical skills as juveniles, or exhibiting desirability during mate selection. Extreme sports can provide an ethically and experimentally feasible tool to analyze thrill. To use this tool, extreme sports must first be defined in a non-circular way, independent of participant psychology. Existing concepts, from different disciplines, focus, respectively, on drama, activity types, or consequences of error. Here, I draw upon academic and popular literature, and autoethnographic experience, to distinguish extreme from adventurous levels for a range of different outdoor sports. I conclude that extreme outdoor adventure sports can be defined objectively as those activities, conditions, and levels, where participant survival relies on moment-by-moment skill, and any error is likely to prove fatal. This allows us to examine the motivations, experiences, and transformations of individuals who undertake these activities. In particular, it will allow us to examine the emotional experience of thrill, previously studied principally as an aspect of personality, from new neurophysiological and evolutionary perspectives.

Go Play Outside! Effects of a risk-reframing tool on mothers' tolerance for, and parenting practices associated with, children's risky play: study protocol for a randomized controlled trial

Background

Children’s risky play is associated with a variety of positive developmental, physical and mental health outcomes, including greater physical activity, self-confidence and risk-management skills. Children’s opportunities for risky play have eroded over time, limited by parents’ fears and beliefs about risk, particularly among mothers. We developed a digital tool and in-person Risk-reframing (RR) workshop to reframe parents’ perceptions of risk and change parenting behaviours. The purpose of this paper is to describe our RR intervention, rationale and protocol for a randomised controlled trial to examine whether it leads to increases in mothers’ tolerance of risk in play and goal attainment relating to promoting their child’s opportunities for risky play.

Methods

We use a randomised controlled trial design and will recruit a total of 501 mothers of children aged 6–12 years. The RR digital tool is designed for a one-time visit and includes three chapters of self-reflection and experiential learning tasks. The RR in-person tool is a 2-h facilitated workshop in which participants are guided through discussion of the same tasks contained within the digital tool. The control condition consists of reading the Position Statement on Active Outdoor Play.

Primary outcome is increased tolerance of risk in play, as measured by the Tolerance of Risk in Play Scale. Secondary outcome is self-reported attainment of a behaviour-change goal that participants set for themselves.

We will test the hypothesis that there will be differences between the experimental and control conditions with respect to tolerance of risk in play using mixed-effects models. We will test the hypothesis that there will be differences between the experimental and control conditions with respect to goal attainment using logistic regression.

Discussion

The results of this trial will have important implications for facilitating the widespread change in parents’ risk perception that is necessary for promoting broad societal understanding of the importance of children’s risky play. In addition, the findings may provide relevant information for the design of behaviour-change tools to increase parental tolerance of risk.

Trial registration

ClinicalTrials.gov, ID: NCT03374683. Retrospectively registered on 15 December 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2552-4) contains supplementary material, which is available to authorized users.

Nature Elements and Fundamental Motor Skill Development Opportunities at Five Elementary School Districts in British Columbia

The majority of Canadian children are not physically active enough for healthy development. School playgrounds are a primary location to promote physical activity and motor skill practice. The benefits of children’s play in nature have also been highlighted, but few studies have evaluated children’s access and exposure to nature for play on school grounds. This study examined children’s access to nature on school grounds and the opportunities afforded by those natural elements for motor skill practice. Results: Extensive naturescapes (multiple nature elements in one setting) were not common, and natural elements were limited, ranging from 1.97 to 5.71 elements/school. The most common element was a forested area (26.5% of all natural elements identified). In comparison to built structures, the number of natural elements was low. Some elements differed between school districts and appeared to be related to local geography and terrain (hilly, rocky terrain, tidal flats, etc.). Our assessment showed that naturescape elements afforded opportunities for the development of some key fundamental motor skills (FMS), specifically, locomotor and stability skills, but opportunities to develop manipulative skills were limited. To maximize potential FMS development, physical literacy, and psycho-social benefits, additional elements or more comprehensive multi-element naturescapes and facilitation (social or environmental) are recommended.

Quality of life in anxious adolescents

PURPOSE

To examine associations between health-related quality of life (HRQoL) and anxiety symptoms across anxiety domains (obsessions/compulsions, social anxiety, panic disorder, agoraphobia, separation anxiety, physical injury fears, generalised anxiety, and posttraumatic stress) in a general adolescent population. Expanded knowledge about these associations can provide valuable information for improving interventions and prevention strategies for adolescent anxiety.

METHODS

Cross-sectional data about anxiety were collected via a school survey from a community sample of Norwegian adolescents aged 12-17 (N = 1719). Based on scores from the Spence Children's Anxiety Scale (SCAS), each adolescent was categorized as reporting a low, medium, or high level of anxiety. Each adolescent's HRQoL was then measured using the Questionnaire for Measuring Health-Related Quality of Life in Children and Adolescents Revised Version (KINDL-R). Hierarchical regression analyses were performed to determine any relationship between anxiety symptoms and HRQoL.

RESULTS

Across domains of anxiety, anxiety symptoms were inversely associated with overall HRQoL. All HRQoL-dimensions were inversely associated with overall level of anxiety symptoms. In adolescents with medium and high anxiety symptoms, poor HRQoL was documented in all HRQoL dimensions with the exception of the family dimension.

CONCLUSIONS

The strong association between elevated levels of anxiety symptoms and poor HRQoL demonstrate the importance of improved mental health interventions and prevention initiatives targeting anxious adolescents.

Independent Development of Imagination and Perception of Fitts' Law in Late Childhood and Adolescence

Recent neurophysiological and behavioral research suggests perception-action systems are tightly coupled. Accordingly, Fitts' law has been observed when individuals execute, perceive, and imagine actions. Developmental research has found that (a) children demonstrate Fitts' law in imagined actions and (b) imagined movement time (MT) becomes closer to actual MT as age increases. However, action execution, imagination, and perception have yet to be assessed together in children. The authors investigated how imagined and perceived MTs related to actual MTs in children and adolescents. It was found that imagined MTs were longer than execution MTs were. Perception MTs were lower than execution MTs for children and more consistent with execution MTs for adolescents. These results suggest potential mechanistic differences in action imagination and perception.