Children's play

Coping can be child's play

by Susan Griffith

The thought of getting a shot and having a tooth filled at the dentist makes most children anxious. CWRU psychologists have found a relationship between how well children play and how they are able to find a variety of ways to cope with going to the dentist.

Thirty-seven children (21 boys and 16 girls) from age six to nine participated in the study, which Professor Sandra Russ and graduate student Beth Christiano in CWRU's Department of Psychology conducted.

All children were scheduled to undergo a restorative dental procedure, involving an oral examination, a Novocaine injection, and the use of a rubber dam and drill at CWRU's School of Denistry or a private dental practice.

"The strongest finding emerging from this study was the positive relationship between play and cognitive coping. Children who were good players were also good cognitive copers and reported less distress," said Russ, professor and chair of psychology.

"Play affords the child with the opportunity to come gradually to terms with a threatening experience and alleviate anxiety."

The child's ability to express emotions reflects generally on the ability to work on problems, she added. This would help the child cope in a wide variety of situations.

Researchers administered the Affect in Play Scale, which Russ created, to each child to measure the emotions and fantasy of children in play.

The test is a five-minute puppet play task with neutral-looking boy and girl hand puppets and three wooden blocks. Before the dental procedure, the children were asked to play with the puppets and blocks in any ways they desired. The sessions were videotaped.

During the unstructured play period, each child was assessed for the frequency and variety of emotions they expressed, the child's comfort with play, and organization, elaboration, imaginative, and repetitiveness of the play.

Play scores do not relate to intelligence scores, Russ said.

After the test, the children were escorted to the dental chair. Following their treatment, they were administered coping and distress tests. Children described the thoughts they used to cope with the stress of the treatment.

According to Christiano, the principal investigator in the study, children focused some of their thoughts on playing with their pet or thinking the procedure is almost finished, what they would have for dinner, or anticipation of what the dentist might do next.

The better players, Christiano said, were flexible in switching from one coping mechanism to another throughout the process.

"Equipped with a variety of coping options, a child would be able to adjust his or her strategy based on the situational demands," Christiano said.

Nine studies have used the Affect in Play Scale to measure the relationship between the expression of emotions in play to creativity and coping.

"Children work through their problems through play, while adults talk about them," Russ said.

"The creative and divergent thinker generates unique ideas and solutions which is important in creative problem solving," she added.

Russ has found in other studies that expressing emotions in play relates to a child's creativity. "People open to emotions are open to experiences, which may broaden associations."

The Journal of Clinical Child Psychology published the findings of the "Play as a Predictor of Coping and Distress in Children during an Invasive Dental Procedure" study this summer.

This research has led to another study using the Affect in Play Scale, in which children play out a dental situation prior to the treatment to see if it helps with their coping skills while in the dental chair.

The play of these children is compared to those who play with plastic blocks or color in coloring books.