Exploring Play in Children With Special Needs: A Photovoice Study

RESEARCH PURPOSE: This research explores Photovoice as a methodology to give children with mild cognitive disabilities a process to describe what is meaningful to them and to allow occupational therapists to gain a greater understanding of their play occupations/environment.

BACKGROUND: Completing occupational profiles is a critical component of the occupational therapy evaluation; however, client-centered information can be difficult to obtain with children who have cognitive disabilities. Photovoice gives an opportunity for children to show therapists what is important to them despite potential verbal or expressive communication barriers.

OBJECTIVES: This study used the Photovoice methodology to explore play from the perspective of children with mild cognitive disabilities.

DESIGN: Children were given disposable cameras, asked to take pictures of play (from their perspective), and then interviewed by the researcher regarding their experience. Four researchers independently coded 181 photos for themes related to play.

PARTICIPANTS: Ten children (ages 7–18 yr) with mild cognitive disabilities participated from the Dominican Republic and an urban U.S. city. Teachers at two schools selected students who met the requirements of having a mild to moderate cognitive disability, being physically able to manipulate a disposable camera, and having adequate verbal communication skills to participate in an semistructured interview.

METHOD: Cameras were given to children who had mild cognitive disabilities with instructions to “take pictures of how you play.” Researchers printed the photographs, and the meaningfulness and content of the photos were discussed with the children through a semistructured interview process.

ANALYSIS: Four researchers independently coded 181 photos to identify themes. Themes were addressed on the basis of how gender, age, and country of residence influenced each category. Member checking and interrater reliability testing were completed to establish validity of results.

RESULTS: Results showed interrater reliability was intraclass correlation (ICC) = .939 (p < .05). Consensus meetings were held to discuss differences in ratings, and some scores were changed, which led to an increase in interrater reliability (ICC = .992, p < .05). Themes emerging from the data showed that factors such as gender, presence of family and friends, geography, and object types influence play for children with mild cognitive disabilities.

DISCUSSION: This study showed that children’s behavior is highly influenced by their environmental and social context. To understand their engagement in the world, it is important to recognize this inextricable person–-environment relationship when evaluating the chosen occupations of children, which the Photovoice method provides a glimpse into. The Photovoice method allowed children with special needs the opportunity to potentially share more about what is meaningful to them than an interview alone. This study provides preliminary evidence for the use of Photovoice as a qualitative supplement to better develop a more holistic perspective of a child and his or her affordances, barriers, and context.

IMPACT STATEMENT: This study established the preliminary efficacy and reliability of using Photovoice to understand play from the perspective of children with mild cognitive disabilities. The Photovoice method inherently in its nature provides a truly client-centered approach to a population that often has difficulties with verbal expression. This presents a useful tool to the occupational therapy profession, which may want to further investigate the Photovoice method as an evaluation technique, especially in clients with expressive communication limitations.