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Pediatrics
January2007,VOLUME119/ISSUE1

TheImportanceofPlayinPromotingHealthyChildDevelopment
andMaintainingStrongParentChildBonds
KennethR.Ginsburg

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Abstract
Playisessentialtodevelopmentbecauseitcontributestothecognitive,physical,social,andemotionalwellbeingofchildrenandyouth.
Playalsooffersanidealopportunityforparentstoengagefullywiththeirchildren.Despitethebenefitsderivedfromplayforbothchildren
andparents,timeforfreeplayhasbeenmarkedlyreducedforsomechildren.Thisreportaddressesavarietyoffactorsthathavereduced
play,includingahurriedlifestyle,changesinfamilystructure,andincreasedattentiontoacademicsandenrichmentactivitiesattheexpense
ofrecessorfreechildcenteredplay.Thisreportoffersguidelinesonhowpediatricianscanadvocateforchildrenbyhelpingfamilies,school
systems,andcommunitiesconsiderhowbesttoensurethatplayisprotectedastheyseekthebalanceinchildrenslivestocreatetheoptimal
developmentalmilieu.

children adolescents play parents resilience mentalhealth college schedules

INTRODUCTION
PlayissoimportanttooptimalchilddevelopmentthatithasbeenrecognizedbytheUnitedNationsHighCommissionforHumanRightsas
arightofeverychild. 1Thisbirthrightischallengedbyforcesincludingchildlaborandexploitationpractices,warandneighborhood
violence,andthelimitedresourcesavailabletochildrenlivinginpoverty.However,eventhosechildrenwhoarefortunateenoughtohave
abundantavailableresourcesandwholiveinrelativepeacemaynotbereceivingthefullbenefitsofplay.Manyofthesechildrenarebeing
raisedinanincreasinglyhurriedandpressuredstylethatmaylimittheprotectivebenefitstheywouldgainfromchilddrivenplay.Because
everychilddeservestheopportunitytodeveloptotheiruniquepotential,childadvocatesmustconsiderallfactorsthatinterferewithoptimal
developmentandpressforcircumstancesthatalloweachchildtofullyreaptheadvantagesassociatedwithplay.

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Nosinglesetofguidelinescoulddojusticetothemanyfactorsthatimpactonchildrensplay,evenifitwastofocusonlyonchildrenliving
intheUnitedStates.TheseguidelineswillfocusonhowAmericanchildrenwithadequateresourcesmaybelimitedfromenjoyingthefull
developmentalassetsassociatedwithplaybecauseofafamilyshurriedlifestyleaswellasanincreasedfocusonthefundamentalsof
academicpreparationinlieuofabroaderviewofeducation.Thoseforcesthatpreventchildreninpovertyandtheworkingclassfrom
benefitingfullyfromplaydeservefull,evenurgent,attention,andwillbeaddressedinafuturedocument.Thoseissuesthatimpactonplay
forchildrenwithlimitedresourceswillbementionedbrieflyheretoreinforcethatplaycontributestooptimalchilddevelopmentforall
childrenandthatwemustadvocateforthechangesspecifictotheneedofeachchildssocialandenvironmentalcontextthatwouldenhance
theopportunitiesforplay.

Theseguidelineswerewritteninresponsetothemultipleforcesthatchallengeplay.Theoverridingpremiseisthatplay(orsomeavailable
freetimeinthecaseofolderchildrenandadolescents)isessentialtothecognitive,physical,social,andemotionalwellbeingofchildrenand
youth.Althoughtheguidelineswerewrittenindefenseofplay,theyshouldnotbeinterpretedasbeingagainstotherforcesthatcompetefor
childrenstime.Academicenrichmentopportunitiesarevitalforsomechildrensabilitytoprogressacademically,andparticipationin
organizedactivitiesisknowntopromotehealthyyouthdevelopment. 2,3Itisessentialthatawidevarietyofprogrammingremainavailableto
meettheneedsofbothchildrenandfamilies.Rather,theseguidelinescallforaninclusionofplayasweseekthebalanceinchildrenslives
thatwillcreatetheoptimaldevelopmentalmilieutoprepareourchildrentobeacademically,socially,andemotionallyequippedtoleadus
intothefuture.

THEBENEFITSOFPLAY
Playallowschildrentousetheircreativitywhiledevelopingtheirimagination,dexterity,andphysical,cognitive,andemotionalstrength.
Playisimportanttohealthybraindevelopment. 46Itisthroughplaythatchildrenataveryearlyageengageandinteractintheworldaround
them.Playallowschildrentocreateandexploreaworldtheycanmaster,conqueringtheirfearswhilepracticingadultroles,sometimesin
conjunctionwithotherchildrenoradultcaregivers. 714Astheymastertheirworld,playhelpschildrendevelopnewcompetenciesthatlead
toenhancedconfidenceandtheresiliencytheywillneedtofacefuturechallenges. 7,10,15Undirectedplayallowschildrentolearnhowto
workingroups,toshare,tonegotiate,toresolveconflicts,andtolearnselfadvocacyskills. 7,10,11,16Whenplayisallowedtobechilddriven,
childrenpracticedecisionmakingskills,moveattheirownpace,discovertheirownareasofinterest,andultimatelyengagefullyinthe
passionstheywishtopursue. 7,10,11Ideally,muchofplayinvolvesadults,butwhenplayiscontrolledbyadults,childrenacquiescetoadult
rulesandconcernsandlosesomeofthebenefitsplayoffersthem,particularlyindevelopingcreativity,leadership,andgroupskills. 17In
contrasttopassiveentertainment,playbuildsactive,healthybodies.Infact,ithasbeensuggestedthatencouragingunstructuredplaymaybe
anexceptionalwaytoincreasephysicalactivitylevelsinchildren,whichisoneimportantstrategyintheresolutionoftheobesity
epidemic. 18,19Perhapsaboveall,playisasimplejoythatisacherishedpartofchildhood.

Childrensdevelopmentaltrajectoryiscriticallymediatedbyappropriate,affectiverelationshipswithlovingandconsistentcaregiversasthey
relatetochildrenthroughplay. 4Whenparentsobservetheirchildreninplayorjoinwiththeminchilddrivenplay,theyaregivenaunique
opportunitytoseetheworldfromtheirchildsvantagepointasthechildnavigatesaworldperfectlycreatedjusttofithisorherneeds.(The
wordparentisusedinthisreporttorepresentthewiderangeofadultcaregiverswhoraisechildren.)Theinteractionsthatoccurthrough
playtellchildrenthatparentsarefullypayingattentiontothemandhelptobuildenduringrelationships. 6,13,14,20,21Parentswhohavethe
opportunitytoglimpseintotheirchildrensworldlearntocommunicatemoreeffectivelywiththeirchildrenandaregivenanothersettingto
offergentle,nurturingguidance.Lessverbalchildrenmaybeabletoexpresstheirviews,experiences,andevenfrustrationsthroughplay,

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allowingtheirparentsanopportunitytogainafullerunderstandingoftheirperspective.Quitesimply,playoffersparentsawonderful
opportunitytoengagefullywiththeirchildren.

Playisintegraltotheacademicenvironment.Itensuresthattheschoolsettingattendstothesocialandemotionaldevelopmentofchildrenas
wellastheircognitivedevelopment.Ithasbeenshowntohelpchildrenadjusttotheschoolsettingandeventoenhancechildrenslearning
readiness,learningbehaviors,andproblemsolvingskills. 2232Socialemotionallearningisbestintegratedwithacademiclearningitis
concerningifsomeoftheforcesthatenhancechildrensabilitytolearnareelevatedattheexpenseofothers.Playandunscheduledtimethat
allowforpeerinteractionsareimportantcomponentsofsocialemotionallearning. 33,34

REDUCEDCHILDDRIVENPLAYANDTHEPOTENTIAL
REPERCUSSIONS
Despitethenumerousbenefitsderivedfromplayforbothchildrenandparents,timeforfreeplayhasbeenmarkedlyreducedforsome
children.Thistrendhasevenaffectedkindergartenchildren,whohavehadfreeplayreducedintheirschedulestomakeroomformore
academics.A1989surveytakenbytheNationalAssociationofElementarySchoolPrincipalsfoundthat96%ofsurveyedschoolsystemshad
atleast1recessperiod.Anothersurveyadecadelaterfoundthatonly70%ofevenkindergartenclassroomshadarecessperiod. 35,36

Currently,manyschoolchildrenaregivenlessfreetimeandfewerphysicaloutletsatschoolmanyschooldistrictsrespondedtotheNoChild
LeftBehindActof200137byreducingtimecommittedtorecess,thecreativearts,andevenphysicaleducationinanefforttofocuson
readingandmathematics. 38,39Thischangemayhaveimplicationsonchildrensabilitytostorenewinformation,becausechildrenscognitive
capacityisenhancedbyaclearcutandsignificantchangeinactivity. 35,40Achangeinacademicinstructionorclasstopicdoesnotofferthis
clearcutchangeincognitiveeffortandcertainlydoesnotofferaphysicalrelease.Evenaformalstructuredphysicaleducationclassmaynot
offerthesamebenefitasfreeplayrecess. 35,41Reducedtimeforphysicalactivitymaybecontributingtothediscordantacademicabilities
betweenboysandgirls,becauseschoolsthatpromotesedentarystylesoflearningbecomeamoredifficultenvironmentforboystonavigate
successfully. 42,43

Somechildrenaregivenlesstimeforfreeexploratoryplayastheyarehurriedtoadaptintoadultrolesandpreparefortheirfutureatearlier
ages. 4446Parentsarereceivingcarefullymarketedmessagesthatgoodparentsexposetheirchildrentoeveryopportunitytoexcel,buya
plethoraofenrichmenttools,andensuretheirchildrenparticipateinawidevarietyofactivities. 45,47Childrenareexposedtoenrichment
videosandcomputerprogramsfromearlyinfancyaswellasspecializedbooksandtoysdesignedtoensurethattheyarewellroundedand
adequatelystimulatedforexcelleddevelopment.Specializedgymsandenrichmentprogramsdesignedforchildrenexistinmany
communities,andthereisanabundanceofafterschoolenrichmentactivities.Thesetoolsandprogramsareheavilymarketed,andmany
parentshavegrowntobelievethattheyarearequirementofgoodparentingandanecessityforappropriatedevelopment.Asaresult,much
ofparentchildtimeisspentarrangingspecialactivitiesortransportingchildrenbetweenthoseactivities.Inadditiontotime,considerable
familyfinancialresourcesarebeinginvestedtoensurethatthechildrenhavewhataremarketedastheverybestopportunities. 33,34,4749

Itisclearthatorganizedactivitieshaveadevelopmentalbenefitforchildren,especiallyincontrasttocompletelyunsupervisedtime. 2Some
researchsubstantiatesthatformostchildren,benefitsincreasewithhigherlevelsofparticipation. 2Inaddition,ithasbeensuggestedthat
becausethislifestyleisassociatedwithmiddleclassfamilies,itmayhaveabenefitinmaintainingsocialclassorincreatingupward
mobility. 50Itislessclear,however,atwhatpointayoungpersonmaybeoverscheduledtotheirdevelopmentaldetrimentoremotional
distress.Freechilddrivenplayknowntobenefitchildrenisdecreased,andthedowntimethatallowsparentsandchildrensomeofthemost

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productivetimeforinteractionisatapremiumwhenschedulesbecomehighlypackedwithadultsupervisedoradultdriven
activities. 4547,51,52

Itislefttoparentstojudgeappropriatelevelsofinvolvement,butmanyparentsseemtofeelasthoughtheyarerunningonatreadmillto
keepupyetdarenotslowtheirpaceforfeartheirchildrenwillfallbehind.Inaddition,someworrytheywillnotbeactingasproperparents
iftheydonotparticipateinthishurriedlifestyle. 4547,51,52

Althoughmosthighlyscheduledchildrenarethriving, 2somearereactingtotheassociatedpressureswithanxietyandothersignsofincreased
stress. 45,46,53Inthisregard,highlyscheduledchildrenhavelesstimeforfree,childdriven,creativeplay, 45,46,47,54whichoffersbenefitsthat
maybeprotectiveagainsttheeffectsofpressureandstress. 45,54Thereisevidencethatchildhoodandadolescentdepressionisontherise
throughthecollegeyears. 5560Althoughtherearecertainlymanyfactorsinvolved,andadirectlinkbetweentheearlypressurefilledintense
preparationforahighachievingadulthoodandthesementalhealthconcernscannotbemadeonthebasisofcurrentresearch,itisimportant
thatweconsiderthepossibilityofthislinkage.Wecanbecertainthatinsomefamilies,theprotectiveinfluencesofbothplayandhigh
qualityfamilytimearenegativelyaffectedbythecurrenttrendstowardhighlyschedulingchildren.

Astrustedchildadvocates,pediatrichealthprofessionalsareideallysuitedtohelpparentsconsidertheappropriatebalancebetweenpreparing
forthefutureandlivingfullyinthepresentthroughplay,childcenteredorganizedactivities,andrichparentchildinteraction.Itislikely
thatthebalancethatneedstobeachievedwillbedifferentforeverychildonthebasisofthechildsacademicneeds,temperament,
environment,andthefamilysneeds.Becausetherearesomanyforcesthatinfluencethetrendtowardfocusingonfuturepreparation,itis
importantthatparentshaveamedicalhomethatcanreinforcetheimportanceofsomeofthebasic,triedandtrueaspectsofchildrearing.

FACTORSTHATHAVECHANGEDTHEROUTINEOFCHILDHOOD
Theremaybeasmanyexplanationsforthecurrenttrendsastherearefamilies,butseveralkeyfactorsthathaveledtodecreasedfreeplay
shouldbeconsidered.

1.Therearemorefamilieswithasingleheadofhouseholdor2workingparentsandfewermultigenerationalhouseholdsinwhich
grandparentsandextendedfamilymemberscanwatchthechildren.Therefore,fewerfamilieshaveavailableadultsupervisioninthe
homeduringtheworkday,whichmakesitnecessaryforchildrentobeinchildcareorothersettingsinwhichtheycanbemonitored
byadultsthroughouttheday. 61Organizedafterschoolactivitiesandacademicenrichmentopportunitiesoffervaluablealternativesto
childrenwhomightotherwisebeleftwithminimalornoadultsupervision.

2.Manyparentshavelearnedhowtobecomeincreasinglyefficientinbalancingworkandhomeschedules.Theywishtomakethemost
effectiveuseoflimitedtimewiththeirchildrenandbelievethatfacilitatingtheirchildrentohaveeveryopportunityisthebestuseof
thattime.Somemayusesomeofthestandardsofefficiencyandproductivitytheyhavemasteredatworktojudgetheirown
effectivenessasparentsthisissometimesreferredtoastheprofessionalizationofparenthood. 51Thisphenomenonmaycreateguiltin
parentswhofinditdifficulttobalancecompetingdemandsafterataxingworkday.Parentswhounderstandthathighinteraction,at
homeactivities(eg,readingorplayingwithchildren)presentopportunitiesforhighlyeffectiveparentingmayfeellessstressthan
thosewhofeelcompelledtoarrangeoutofhomeopportunities.

3.Parentsreceivemessagesfromavarietyofsourcesstatingthatgoodparentsactivelybuildeveryskillandaptitudetheirchildmight
needfromtheearliestages.Theyaredelugedinparentingmagazinesandinthemediawithawiderangeofenrichmenttoolsand
activitiesthattouttheirabilitytoproducesuperachievingchildren.Theyreadaboutparentswhogotoextremeefforts,atgreat
personalsacrifice,tomakesuretheirchildrenparticipateinavarietyofathleticandartisticopportunities.Theyhearotherparentsin
theneighborhoodtalkabouttheiroverburdenedschedulesandrecognizeitisthecultureandevenexpectationofparents. 51,52

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4.Thecollegeadmissionsprocesshasbecomemuchmorerigorousinrecentyears,largelybecauseofababyboomhittingthecollege
years.Parentsreceivethemessagethatiftheirchildrenarenotwellprepared,wellbalanced,andhighachieving,theywillnotgeta
desiredspotinhighereducation.Evenparentswhowishtotakealowerkeyapproachtochildrearingfearslowingdownwhenthey
perceiveeveryoneelseisonthefasttrack. 62,63Childrenareencouragedtobuildacollegeresumethroughbothacademicexcellence
andawidevarietyofactivitiesandvolunteereffortsstartingatyoungerages.Insomecases,parentsfeelpressuredtohelptheirchild
buildastrongresume.

5.Inresponsetotheincreasinglyrigorouscollegeadmissionsprocess,manysecondaryschoolsarejudgedbytheratesinwhichtheir
studentsareacceptedbythemostprestigiouscentersofhigherlearning.Partlyinresponsetothis,manystudentshavebeen
encouragedtocarryincreasinglyrigorousacademicschedules,includingmultipleadvancedplacementcourses.Inaddition,many
studentsaretakingpreparationcoursesforstandardizedentranceexaminations.Thesestudentsareleftwithlessfreetimebecauseof
thehomepreparatorytimeneededfortheirclasses.

6.Thepressureforadmissiontoselectschoolsbeginsforsomefamilieslongbeforecollege.Selectionforprivatepreschoolprograms
canevenbecompetitive,andparentsmayneedtoconsiderhowbesttopackagetheirpreschoolers.

7.Thereisanationaltrendtofocusontheacademicfundamentalsofreadingandarithmetic.Thistrend,spearheadedbytheNoChild
LeftBehindActof2001,isareactiontotheunacceptableeducationalperformanceofAmericaschildreninsomeeducational
settings.Oneofthepracticaleffectsofthetrendisdecreasedtimeleftduringtheschooldayforotheracademicsubjects,aswellas
recess,creativearts,andphysicaleducation. 38,39Thistrendmayhaveimplicationsforthesocialandemotionaldevelopmentof
childrenandadolescents. 33Inaddition,manyafterschoolchildcareprogramsprioritizeanextensionofacademicsandhomework
completionoverorganizedplay,freeplay,andphysicalactivity. 64

8.Thedecreaseinfreeplaycanalsobeexplainedbychildrenbeingpassivelyentertainedthroughtelevisionorcomputer/videogames.
Insharpcontrasttothehealthbenefitsofactive,creativeplayandtheknowndevelopmentalbenefitsofanappropriatelevelof
organizedactivities,thereisampleevidencethatthispassiveentertainmentisnotprotectiveand,infact,hassomeharmful
effects. 6568

9.Inmanycommunities,childrencannotplaysafelyoutsideofthehomeunlesstheyareundercloseadultsupervisionandprotection.
Thisisparticularlytrueinareasthatareunsafebecauseofincreasedviolenceorotherenvironmentaldangers.

WHYISITAPROBLEM?
Itwouldbewrongtoassumethatthecurrenttrendsareaproblemforallchildrensomeexcelwithahighlydrivenschedule.Becausewe
needskilledyoungpeopletobewellpreparedtobetomorrowsleaders,wemustrecognizetheadvantagestotheincreasedexposuresand
enrichedacademicssomeofourchildrenarereceiving.Infact,manyofourchildren,particularlythoseinpoverty,shouldreceivemore
enrichmentactivities.Butevenchildrenwhoarebenefitingfromthisenrichmentstillneedsomefreeunscheduledtimeforcreativegrowth,
selfreflection,anddecompressionandwouldprofitfromtheuniquedevelopmentalbenefitsofchilddrivenplay.

However,forsomechildren,thishurriedlifestyleisasourceofstressandanxietyandmayevencontributetodepression. 45,46Increased
pressuretoachieveislikelytomanifestinschoolavoidanceandsomaticsymptoms. 6972Thechallengeforsociety,schools,andparentsisto
strikethebalancethatallowsallchildrentoreachtheirpotentialwithoutpushingthembeyondtheirpersonalcomfortlimitsandwhile
allowingthempersonalfreeplaytime.

Itappearsthattheincreasedpressuresofadolescencehaveleftsomeyoungpeoplelessequippedtomanagethetransitiontowardthecollege
years.Manystudenthealthservicesandcounselingcentersoncollegecampuseshavenotbeenabletokeeppacewiththeincreasedneedfor
mentalhealthservices,andsurveyshavesubstantiatedthisneedbyreportinganincreaseindepressionandanxietyamongcollege
students. 5759AsurveybytheAmericanCollegeHealthAssociationreportedthat61%ofcollegestudentshadfeelingsofhopelessnessduring

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thepreviousacademicyear,45%feltsodepressedtheyhadtroublefunctioning,and9%sufferedsuicidalideation. 57Severalstudieshave
linkedfeelingsofanxietyanddepressionwiththatofperfectionismandanoverlycriticalselfevaluation. 7277Otherstudieshavelinkedthis
perfectionismwithhighlycriticalparentswhoinstillpressurestoexcel. 7882Perfectionismischallengingtotheindividualandhasabroader
effectonsocietybecauseitmaystiflecreativityandunencumberedthinking. 83Therearenolongitudinalstudiesthatdirectlylinkintense
preparationforadulthoodduringchildhoodtothisriseinmentalhealthneeds,andtherecertainlyareothercauses,butsomeexpertsbelieve
todayspressuredlifestyleisanimportantcontributor. 46,84

Childrenmayalsohavereceivedanunintendedmessagefromthishurried,intensepreparationforadulthood.Theymayhavelearnedthatthe
endpointgoalthebestschoolorthebestjobmustbereachedatallcosts.Highschools,colleges,anduniversitiesthroughoutthecountry
arereportingthatmorestudentsmaybecheatingtoachievethedesiredendresultofasuperiorgrade. 85,86Despitegradeinflationoverthe
lastdecades,manyteachersreportincreasedstressinstudentswhentheyachievelessthanperfectscores. 8789Thiscompetitiveeramaybe
producingaminorityofyoungpeoplesointenselyworriedabouttheappearanceofhighachievementthattheywillforsakecorevaluessuch
asfairnessandhonestyforthesakeofacquiringgoodgrades.

FAMILYCONSIDERATIONS
Somefamilieswhosechildrenarehighlyscheduledmayalsosuffer.Adultswhomayalreadybeburdenedbyworkresponsibilitiesand
maintainingahouseholdfindthemselvessacrificingtheirdowntimebecausetheyneedtoarrangeactivitiesandtransportchildrenbetween
appointments. 4547Inaddition,becauseofthepressurestheyfeeltomeeteveryoneoftheneedstheyperceive(oraretold)theirchild
requirestoexcel,theymayfeelinadequateandultimatelyhavelesspersonalsatisfactioninparenting. 51,52Mostimportantly,parentslosethe
opportunityforperhapsthehighestqualitytimewiththeirchildren.Someofthebestinteractionsoccurduringdowntimejusttalking,
preparingmealstogether,andworkingonahobbyorartproject,playingsportstogether,orbeingfullyimmersedinchildcenteredplay.

Asparentspreparetheirchildrenforthefuture,theycannotknowpreciselywhichskillseachwillneedfortheworkforce.Withadded
anxietyovertheirinabilitytoadequatelypredictthefuture,theybecomesusceptibletothepromisesofsuccessandfullpreparationoffered
byallofthespecialenrichmentprogramsandvulnerabletothebeliefthatiftheirchildrenareatleastexposedtoeverything,theywillhave
thebestchancetobeprepared.Althoughnoonecanbesurewhatskillswillbeneeded,certaincharactertraitswillproducechildrencapable
ofnavigatinganincreasinglycomplexworldastheygrowolder.Thesetraitsincludeconfidence,competenceortheabilitytomasterthe
environment,andadeepseatedconnectednesstoandcaringaboutothersthatcreatethelove,safety,andsecuritythatchildrenneedtothrive.
Inaddition,toberesilienttoremainoptimisticandbeabletoreboundfromadversityyoungpeopleneedtheessentialcharactertraitsof
honesty,generosity,decency,tenacity,andcompassion.Childrenaremostlikelytogainalloftheseessentialtraitsofresiliencywithina
homeinwhichparentsandchildrenhavetimetobetogetherandtolooktoeachotherforpositivesupportandunconditionallove. 9095Many
familiesaresuccessfullynavigatingawidevarietyofcommitmentswithoutsacrificinghighqualityparentchildtime, 2butsomefamilies
abilitytomaintainessentialparentchildtimemaybecompromisedbythishurriedlifestyle.Inthesefamilies,overschedulingmayleadto
lessemotionallycompetent,wellbufferedchildren.

WHATARETHESOLUTIONS?
Becausethereareatleastseveralcausesforthedecreasedamountofchilddirectedplay,thereisnosinglepositionthatchildadvocates
shouldtake.Forexample,inthecaseofachildwhoiseconomicallydisadvantagedanddoesnotresideinasafeneighborhood,itmaybe
unwisetosimplyproposemorechildcenteredplay.Althoughparentscanbeencouragedtooptimizeconditionsforthiskindofplayinthe

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home,theremustbebroadsocietalresponsesthataddresspoverty,socialinequities,andviolencebeforewecanadviseparentstoallow
unsupervisedplay.Inaddition,forchildreninpoverty,enhancedchildcareservices,earlycommunitybasededucation(eg,HeadStart),
increasedacademicprogramming,moreenrichmentactivities,andgreateropportunitiesforcommunitybasedadultsupervisedactivitiesare
warranted.Someoftheneededsolutionsforthisgroupofdisadvantagedchildrenremainbeyondthescopeofthisarticleandareraisedhere
toemphasizethatthesuggestionsofferedhereneedtobeindividualizedonesizedoesnotfitall.

Forallchildren,however,advocatesneedtopromotetheimplementationofthosestrategiesknowntopromotehealthyyouthdevelopment
andresiliency.Someofthosestrategiesarecommunitybased,andothersareschoolbased,butmanyresidewithinthefamily.Theyare
rootedinthedeepconnectionthatdevelopswhenparentsengagewiththeirchildren. 92,93,95Playremainsanidealvenueforparentstoengage
fully,andchildprofessionalsmustreinforcethevalueofthisplay.Someplaymustremainentirelychilddriven,withparentseithernot
presentoraspassiveobservers,becauseplaybuildssomeoftheindividualassetschildrenneedtodevelopandremainresilient.

Parentsneedtofeelsupportedtonotpassivelyacceptthemediaandadvertisingmessagesthatsuggesttherearemorevaluablemeansof
promotingsuccessandhappinessinchildrenthanthetried,trusted,andtraditionalmethodsofplayandfamilytogetherness.Purveyorsof
thesespecialprogramsshouldbeencouragedtoproducelongtermevidencethatdefinehowtheirproducts/strategiesproducemore
successfulchildren.Inparallel,wewouldencourageindependentresearcherstoevaluateboththebenefitsandproblemsassociatedwiththese
enrichmenttools.Researchersshouldalsocontinuetoexplorethetypeandquantityofactivitiesthatarelikelytobeenrichingforchildren
withdifferentneeds.

Collegesareseeingagenerationofstudentswhoappeartobemanifestingincreasedsignsofdepression,anxiety,perfectionism,andstress.
Theyshouldclarifytheirmessagesaboutthetypeofstudentstheyseekinthefaceofwidespreadfolklorethattheyseekonlysuperachieving
students.Collegescertainlyseekaphysicallyandemotionallyhealthystudentbodywiththecharactertraitsthatsupportlearning.Colleges
couldreducethestresslevelsofyoungpeopleandtheirparentsiftheyofferedclear,morerealisticexpectationsaboutthetypeofstudents
theyseekandhelpedfamiliestounderstandthatthereisamatchforeachreasonablypreparedstudent.Inaddition,collegesshouldaddress
themyththatdesirablestudentsarethosewhoexcelineveryarea.Intheadultworld,peoplerarelyexcelinmorethan1or2areas,while
wellbalancedindividualsenjoyseveralothers.Collegesshouldrecognizethepossibilitythatwhenchildrenbelievethattheymustexcelinall
areastogainadmission,theymightrespondtothoseperceivedandunrealisticexpectationswithstressandanxiety. 62,63

ADVICEFORPEDIATRICIANS*
Inthemidstofsomanyconflictingmessagesaboutwhatparentsshoulddotopreparetheirchildforwhatisperceivedtobeanincreasingly
complicated,competitiveworld,pediatricianshaveanaturalroletoserveascaring,objectivechildprofessionalswithwhomparentscan
discusstheirapproachtochildrearingandreflectontheirowndesiresfortheirchildren.Becausepediatricianshaveauniqueandimportant
roleinpromotingthephysical,emotional,andsocialwellbeingofchildrenandadolescents,itisimportantthattheypromotestrategiesthat
willsupportchildrentoberesilientandtoreduceexcessivestressorsintheirlives.

Pediatricianscanpromotefreeplayasahealthy,essentialpartof
childhood.Theyshouldrecommendthatallchildrenareafforded
ample,unscheduled,independent,nonscreentimetobecreative,to
reflect,andtodecompress.Theyshouldemphasizethatalthough
parentscancertainlymonitorplayforsafety,alargeproportionof
playshouldbechilddrivenratherthanadultdirected.

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Pediatriciansshouldemphasizetheadvantagesofactiveplayand
discourageparentsfromtheoveruseofpassiveentertainment(eg,
televisionandcomputergames).

Pediatriciansshouldemphasizethatactivechildcenteredplayisa
timetestedwayofproducinghealthy,fityoungbodies.

Pediatriciansshouldemphasizethebenefitsoftruetoyssuchas
blocksanddolls,withwhichchildrenusetheirimaginationfully,over
passivetoysthatrequirelimitedimagination.

Pediatricianscaneducatefamiliesregardingtheprotectiveassetsand
increasedresiliencydevelopedthroughfreeplayandsome
unscheduledtime.

Pediatricianscanreinforcethatparentswhoshareunscheduled
spontaneoustimewiththeirchildrenandwhoplaywiththeirchildren
arebeingwonderfullysupportive,nurturing,andproductive.

Pediatricianscandiscussthat,althoughverywellintentioned,
arrangingthefinestopportunitiesfortheirchildrenmaynotbe
parentsbestopportunityforinfluenceandthatshuttlingtheirchildren
betweennumerousactivitiesmaynotbethebestqualitytime.
Childrenwillbepoisedforsuccess,baskingintheknowledgethat
theirparentsabsolutelyandunconditionallylovethem.Thisloveand
attentionisbestdemonstratedwhenparentsserveasrolemodelsand
familymembersmaketimetocherishoneanother:timetobe
together,tolisten,andtotalk,nothingmoreandnothingless.
Pediatricianscanremindparentsthatthemostvaluableanduseful
charactertraitsthatwillpreparetheirchildrenforsuccessarisenot
fromextracurricularoracademiccommitmentsbutfromafirm
groundinginparentallove,rolemodeling,andguidance.

Pediatriciansshouldbeastableforce,remindingparentsthatthe
cornerstonesofparentinglistening,caring,andguidingthrough
effectiveanddevelopmentallyappropriatedisciplineandsharing
pleasurabletimetogetherarethetruepredictorsofchildhood,and
theyserveasaspringboardtowardahappy,successfuladulthood.

Pediatriciansshouldhelpparentsevaluatetheclaimsmadeby
marketersandadvertisersabouttheproductsorinterventionsdesigned
toproducesuperchildren.

Pediatriciansshouldemphasizetheprovenbenefitsofreadingtotheir
children,evenatveryearlyages.

Pediatricianscanbeavailabletoparentsassoundingboardstohelp
parentsevaluatethespecificneedsoftheirchildintermsofpromoting
resiliency,developingconfidenceandcompetence,andultimately
enhancingthatchildstrajectorytowardasuccessfulfuture.

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Pediatricianscansupportparentstoorganizeplaygroupsbeginningat
anearlypreschoolageofapproximately2.5to3years,whenmany
childrenmovefromparallelplaytocooperativeplayintheprocessof
socialization.

Pediatricianscanadvocatefordevelopingsafespacesin
underresourcedneighborhoods,perhapsbyopeningschool,library,or
communityfacilitiestobeusedbychildrenandtheirparentsafter
schoolhoursandonweekends.

Pediatricianscaneducatethemselvesaboutappropriateresourcesin
theirowncommunitythatfosterplayandhealthychilddevelopment
andhavethisinformationavailabletosharewithparents.

Pediatriciansshouldsupportchildrenhavinganacademicschedule
thatisappropriatelychallengingandextracurricularexposuresthat
offerappropriatebalance.Whatisappropriatehastobedetermined
individuallyforeachchildonthebasisoftheiruniqueneeds,skills,
andtemperament,notonthebasisofwhatmaybeoverlypressurized
orcompetitivecommunitystandardsoraperceivedneedtogain
collegeadmissions.

Pediatriciansshouldencourageparentstoallowchildrentoexplorea
varietyofinterestsinabalancedwaywithoutfeelingpressuredto
excelineacharea.Pediatriciansshouldencourageparentstoavoid
conveyingtheunrealisticexpectationthateachyoungpersonneedsto
excelinmultipleareastobeconsideredsuccessfulorpreparedto
competeintheworld.Inparallel,theyshouldpromotebalancein
thoseyouthwhoarestronglyencouragedtobecomeexpertinonly1
area(eg,aparticularsportormusicalinstrument)tothedetrimentof
havingtheopportunitytoexploreotherareasofinterest.

Asparentschoosechildcareandearlyeducationprogramsfortheir
children,pediatricianscanreinforcetheimportanceofchoosing
settingsthatoffermorethanacademicpreparedness.Theyshouldbe
guidedtoalsopayattentiontowhetherthesettingsattendtothesocial
andemotionaldevelopmentalneedsofthechildren.

Pediatricianscanjoinwithotherchildprofessionalsandparentsto
advocateforeducationalsettingsthatpromoteoptimalacademic,
cognitive,physical,social,andemotionaldevelopmentforchildren
andyouth.

Pediatriciansshouldassesstheirpatientsforthemanifestationsof
stress,anxiety,anddepressioninfamilycenteredinterviewsfor
childrenandprivatelyconductedinterviewswithadolescents.

Becausestressoftenmanifestswithphysicalsensations,pediatricians
shouldbehighlysensitizedtostressasanunderlyingcauseofsomatic
illness.

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Pediatriciansshouldrefertoappropriatementalhealthprofessionals
whenchildrenortheirparentsshowsignsofexcessivestress,anxiety,
ordepression.

CONCLUSIONS
Playisacherishedpartofchildhoodthatofferschildrenimportantdevelopmentalbenefitsandparentstheopportunitytofullyengagewith
theirchildren.However,multipleforcesareinteractingtoeffectivelyreducemanychildrensabilitytoreapthebenefitsofplay.Aswestrive
tocreatetheoptimaldevelopmentalmilieuforchildren,itremainsimperativethatplaybeincludedalongwithacademicandsocial
enrichmentopportunitiesandthatsafeenvironmentsbemadeavailabletoallchildren.Additionalresearchisneededtoexplorethe
appropriatebalanceofplay,academicenrichment,andorganizedactivitiesforchildrenwithdifferenttemperamentsandsocial,emotional,
intellectual,andenvironmentalneeds.

CommitteeonCommunications,20062007
DonaldL.Shifrin,MD,Chairperson

DanielD.Broughton,MD

BenardP.Dreyer,MD

KennethR.Ginsburg,MD

ReginaM.Milteer,MD

DeborahA.Mulligan,MD

KathleenG.Nelson,MD

Liaisons
TanyaR.Altmann,MD

MediaResourceTeam

MichaelBrody,MD

AmericanAcademyofChildandAdolescentPsychiatry

MichelleL.Shuffett,MD

MediaResourceTeam

BrianWilcox,PhD

AmericanPsychologicalAssociation

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Staff
CarolynKolbaba

VeronicaL.Noland

MarjorieTharp

CommitteeonPsychosocialAspectsofChildandFamilyHealth,2006
2007
WilliamL.Coleman,MD,Chairperson

MarianF.Earls,MD

EdwardGoldson,MD

CherylL.Hausman,MD

BenjaminS.Siegel,MD

ThomasJ.Sullivan,MD

J.LaneTanner,MD

Liaisons
RonaldT.Brown,PhD

SocietyofPediatricPsychology

MaryJoKupst,Phd,MD

SocietyofPediatricPsychology

SallyE.A.Longstaffe,MD

CanadianPaediatricSociety

JanetMims,MS,CPNP

NationalAssociationofPediatricNursePractitioners

FrancesJ.Wren

AmericanAcademyofChildandAdolescentPsychiatry

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Consultants
GeorgeJ.Cohen,MD

Staff
KarenSmith

Footnotes
AllclinicalreportsfromtheAmericanAcademyofPediatricsautomaticallyexpire5yearsafterpublicationunlessreaffirmed,
revised,orretiredatorbeforethattime.

Theguidanceinthisreportdoesnotindicateanexclusivecourseoftreatmentorserveasastandardofmedicalcare.Variations,
takingintoaccountindividualcircumstances,maybeappropriate.

*ThisguidanceisofferedbytheAmericanAcademyofPediatricsand,therefore,istargetedtopediatricians.Otherhealth
professionalswhoservechildrenandadolescents,includingotherphysicians,pediatricandfamilynursepractitioners,andphysician
assistants,arewelcometoconsiderincorporatingtheseguidelinesintopractice.

REFERENCES
1. OfficeoftheUnitedNationsHighCommissionerforHumanRights.ConventionontheRightsoftheChild.GeneralAssemblyResolution44/25of20
November1989.Availableat:www.unhchr.ch/html/menu3/b/k2crc.htm.AccessedJune22,2006

2. MahoneyJL,HarrisAL,EcclesJS.Organizedactivityparticipation,positiveyouthdevelopment,andtheoverschedulinghypothesis.SocPolicy
Rep.200620:131

3. EcclesJS,TempletonJ.Extracurricularandotherafterschoolactivitiesforyouth.RevEducRes.200226:113180

4. ShonkoffJP,PhillipsDA,eds.FromNeuronstoNeighborhoods:TheScienceofEarlyChildhoodDevelopment .Washington,DC:NationalAcademyPress
2000

5.FrostJL.Neuroscience,playandbraindevelopment.Paperpresentedat:IPA/USATriennialNationalConferenceLongmont,COJune1821,1998.
Availableat:www.eric.ed.gov/ERICDocs/data/ericdocs2/content_storage_01/0000000b/80/11/56/d6.pdf.AccessedJune22,2006

6. TamisLeMondaCS,ShannonJD,CabreraNJ,LambME.Fathersandmothersatplaywiththeir2and3yearolds:contributionstolanguageand
cognitivedevelopment.ChildDev.200475:18061820

7. HurwitzSC.Tobesuccessful:letthemplay!ChildEduc.2002/200379:101102

8.IsenbergJ,QuisenberryNL.Play:anecessityforallchildren.ChildEduc.198864:138145

9.BarnettLA.Developmentalbenefitsofplayforchildren.JLeisRes.199022:138153

10. EricksonRJ.Playcontributestothefullemotionaldevelopmentofthechild.Education.1985105:261263

http://pediatrics.aappublications.org/content/119/1/182 12/24
 3/2/2017 TheImportanceofPlayinPromotingHealthyChildDevelopmentandMaintainingStrongParentChildBonds|FROMTHEAMERICANACADEMYOFP

11. PellegriniAD,SmithPK.Thedevelopmentofplayduringchildhood:formsandpossiblefunctions.ChildPsycholPsychiatryRev.19983:5157

12.FlaxmanSG.Play:anendangeredspecies?ScholasticInc.1999110:3941

13. SmithD.Howplayinfluenceschildrensdevelopmentathomeandschool.JPhysEducRecreationDance.199566:1923

14. TsaoL.Howmuchdoweknowabouttheimportanceofplayinchilddevelopment?ChildEduc.200278:230233

15. BandEB,WeiszJR.Howtofeelbetterwhenitfeelsbad:childrensperspectivesoncopingwitheverydaystress.DevPsychol.198824:247253

16. McElwainEL,VollingBL.Preschoolchildrensinteractionswithfriendsandoldersiblings:relationshipspecificityandjointcontributionstoproblem
behaviors.JFamPsychol.200519:486496

17. MacDonaldKB.ParentChildPlay:DescriptionsandImplications.Albany,NY:StateUniversityofNewYorkPress1993

18. BurdetteHL,WhitakerRC.Resurrectingfreeplayinyoungchildren:lookingbeyondfitnessandfatnesstoattention,affiliation,andaffect.ArchPediatr
AdolescMed.2005159:4650

19. AmericanAcademyofPediatrics,CouncilonSportsMedicineandFitnessandCouncilonSchoolHealth.Activehealthyliving:preventionofchildhood
obesitythroughincreasedphysicalactivity.Pediatrics.2006:117:18341842

20. CohnDA.Childmotherattachmentofsixyearoldsandsocialcompetenceatschool.ChildDev.199061:152162

21. HenryM.Morethanjustplay:thesignificanceofmutuallydirectedadult,childactivity.EarlyChildDevCare.199060:3551

22. CoolahanK,FantuzzoJ,MendezJ,McDermottP.Preschoolpeerinteractionsandreadinesstolearn:relationshipsbetweenclassroompeerplayand
learningbehaviorsandconduct.JEducPsychol.200092:458465

23.RaverCC,ZiglerEF.Socialcompetence:anuntappeddimensioninevaluatingHeadStartssuccess.EarlyChildResQ.199712:363385

24.WentzelKR.Socioemotionalprocessesandinterpersonalrelationships:implicationsforunderstandingmotivationatschool.JEducPsychol.199991:76
97

25.FantuzzoJ,McWayneC.Therelationshipbetweenpeerplayinteractionsinthefamilycontextanddimensionsofschoolreadinessforlowincomepreschool
children.JEducPsychol.200294:7987

26.CoolahanK,FantuzzoJ,MendezJ,McDermottP.Interactivepeerplayandreadinesstolearn:relationshipsbetweenplaycompetenciesandclassroom
learningbehaviorsandconduct.JEducPsychol.200029:141152

27.PellegriniAD,BoydB.Theroleofplayinearlychildhooddevelopmentandeducation:issuesindefinitionandfunction.In:SpodekB,ed.Handbookof
ResearchontheEducationofYoungChildren.NewYork,NY:MacMillan1993:105121

28.McWayneCM,FantuzzoJW,McDermottPA.Preschoolcompetencyincontext:aninvestigationoftheuniquecontributionofchildcompetenciestoearly
academicsuccess.DevPsychol.200440:633645

29.FantuzzoJ,BulotskyR,McDermottP,MoscaS,LutzMN.Amultivariateanalysisofemotionalandbehavioraladjustmentandpreschooleducational
outcomes.SchPsycholRev.200332:185203

30.FantuzzoJ,SekinoY,CohenHL.Anexaminationofthecontributionsofinteractivepeerplaytosalientclassroomcompetenciesforurbanheadstart
children.PsycholSch.200441:323336

31.LaddGW.Havingfriends,keepingfriends,makingfriends,andbeinglikedbypeersintheclassroom:predictorsofchildrensearlyschooladjustment.Child
Dev.199061:10811100

http://pediatrics.aappublications.org/content/119/1/182 13/24
 3/2/2017 TheImportanceofPlayinPromotingHealthyChildDevelopmentandMaintainingStrongParentChildBonds|FROMTHEAMERICANACADEMYOFP

32. FisherEP.Theimpactofplayondevelopment:ametaanalysis.PlayCult.19925:159

33. EliasMJ,ArnoldH.TheEducatorsGuidetoEmotionalIntelligenceandAcademicAchievement:SocialEmotionalLearningintheClassroom. Thousand

Oaks,CA:CorwinPress2006

34. ZinsJE.BuildingAcademicSuccessonSocialandEmotionalLearning:WhatDoestheResearchSay?NewYork,NY:TeachersCollegePress2004

35. PellegriniAD,BohnCM.Theroleofrecessinchildrenscognitiveperformanceandschooladjustment.EducRes.200534:1319

36. PellegriniAD.Recess:ItsRoleinEducationandDevelopment.Mahwah,NJ:ErlbaumAssociates2005

37. TheNoChildLeftBehindActof2001:executivesummary.Availableat:www.ed.gov/nclb/overview/intro/execsumm.pdf.AccessedJune22,2006

38. DillonS.Schoolscutbacksubjectstopushreadingandmath.NewYorkTimes .March26,20061:1

39. NationalPTA.Recessisatrisk,newcampaigncomestotherescue.Availableat:www.pta.org/ne_press_release_detail_1142028998890.html.Accessed
June22,2006

40. ToppinoTC,KassermanJE,Mracek,WA.Theeffectofspacingrepetitionsontherecognitionmemoryofyoungchildrenandadults.JExpChild
Psychol.199151:123138

41. CouncilonPhysicalEducationforChildren.Recessinelementaryschools:apositionpaperfromtheNationalAssociationforSportandPhysical
Education.2001.Availableat:www.aahperd.org/naspe/pdf_files/pos_papers/current_res.pdf.AccessedJune22,2006

42. GurianM,StevensK.TheMindsofBoys:SavingOurSonsFromFallingBehindinSchoolandLife.SanFrancisco,CA:JosseyBass2005

43. PellegriniAD,KatoK,BlatchfordP,BainesE.Ashorttermlongitudinalstudyofchildrensplaygroundgamesacrossthefirstyearofschool:implications
forsocialcompetenceandadjustmenttoschool.AmEducResJ.200239:9911015

44. HardyDF,PowerTG,JaedickeS.Examiningtherelationofparentingtochildrenscopingwitheverydaystress.ChildDev.199364:18291841

45. RosenfeldAA,WiseN.TheOverScheduledChild:AvoidingtheHyperparentingTrap. NewYork,NY:StMartinsGriffin2000

46. ElkindD.TheHurriedChild:GrowingUpTooFastTooSoon.3rded.Cambridge,MA:Perseus2001

47. HirshPasekK,GolinkoffRM.EinsteinNeverUsedFlashCards:HowOurChildrenReallyLearnAndWhyTheyNeedToPlayMoreandMemorizeLess.
Emmaus,PA:RodaleInc2003

48.LutharSS.Thecultureofaffluence:psychologicalcostsofmaterialwealth.ChildDev.200374:15811593

49. LutharSS,BeckerBE.Privilegedbutpressured?Astudyofaffluentyouth.ChildDev.200273:15931610

50. LareauA.UnequalChildhoods:Class,Race,andFamilyLife.Berkeley,CA:UniversityofCaliforniaPress2003

51. WarnerJ.PerfectMadness:MotherhoodintheAgeofAnxiety. NewYork,NY:RiverheadBooks2005

52. AndereggD.WorriedAlltheTime:RediscoveringtheJoyinParenthoodinanAgeofAnxiety. NewYork,NY:FreePress2003

53. VillaireT.Familiesonthego:activeorhyperactive?OurChild.200328:45

54. HallowellEM.TheChildhoodRootsofAdultHappiness:FiveStepstoHelpKidsCreateandSustainLifelongJoy. NewYork,NY:BallantineBooks2002

55. CampaignforAmericasMentalHealth.Findinghopeandhelp:collegestudentanddepressionpilotinitiative.Availableat:
www.nmha.org/camh/college/index.cfm.AccessedJune22,2005
http://pediatrics.aappublications.org/content/119/1/182 14/24
 3/2/2017 TheImportanceofPlayinPromotingHealthyChildDevelopmentandMaintainingStrongParentChildBonds|FROMTHEAMERICANACADEMYOFP

56.VoelkerR.Stress,sleeploss,andsubstanceabusecreatepotentrecipeforcollegedepression.JAMA.2004291:21772179

57. VoelkerR.Mountingstudentdepressiontaxingcampusmentalhealthservices.JAMA.2003289:20552056

58.SherryA,BentonSA,RobertsonJM,TsengW,NewtonFB,BentonSL.Changesincounselingcenterclientproblemsacross13years.ProfPsycholRes
Pr.200334:6672

59. UniversityofMichiganDepressionCenter.Depressiononcollegecampuses.Availableat:www.med.umich.edu/depression/college_2005_general.htm.
AccessedJune22,2006

60. USPublicHealthService.ReportoftheSurgeonGeneralsConferenceonChildrensMentalHealth:ANationalActionAgenda. Washington,DC:

DepartmentofHealthandHumanServices2000.Availableat:www.hhs.gov/surgeongeneral/topics/cmh/childreport.htm.AccessedJune22,2006

61. CapizzanoJ,ToutK,AdamsG.Childcarepatternsofschoolagechildrenwithemployedmothers:areportfromtheUrbanInstitute.Availableat:
www.urban.org/publications/310283.html.AccessedJune22,2006

62. ThackerL.CollegeUnranked:EndingtheCollegeAdmissionsFrenzy. Cambridge,MA:HarvardUniversityPress2005

63. JonesM,GinsburgKR,JablowM.LessStress,MoreSuccess:ANewApproachtoGuidingYourTeenThroughCollegeAdmissionsandBeyond. ElkGrove

Village,IL:AmericanAcademyofPediatrics2006

64. USDepartmentofEducation.Schoolsandaftercare:21stcenturycommunitylearningcenters.Availableat:www.ed.gov/programs/21stcclc/index.html.
AccessedJune22,2006

65. JagoR,BaranowskiT,BaranowskiJC,ThopsonD,GreavesKA.BMIfrom36yearsofageispredictedbyTVviewingandphysicalactivity,notdiet.IntJ
Obes(London).200529:557564

66.BrowneKD,HamiltonGiachristisC.Theinfluenceofviolentmediaonchildrenandadolescents:apublichealthapproach.Lancet.2005365:702710

67.StrasburgerVC,DonnersteinE.Children,adolescents,andthemedia:issuesandsolutions.Pediatrics.1999103:129139

68. ZimmermanFJ,ChristakisDA.Childrenstelevisionviewingandcognitiveoutcomes:alongitudinalanalysisofnationaldata.ArchPediatrAdolesc
Med.2005159:619625

69. SweeneyJF,SweeneyDD.Frequentvisitorstotheschoolnurse:theschoolpsychologistsrole.Paperpresentedat:NationalAssociationofSchool
PsychologistsAnnualConventionWashington,DCApril18,2001

70.ReynoldsLK,OKoonJH,PapademetriouE,SzczygielS,GrantKE.Stressandsomaticcomplaintsinlowincomeurbanadolescents.JYouth
Adolesc.200130:499514

71.TaylorL,AdelmanHS.Schoolavoidancebehavior:motivationalbasesandimplicationsforintervention.ChildPsychiatryHumDev.199020:219233

72. KearneyCA,AlbanoAM.Thefunctionalprofilesofschoolrefusalbehavior:diagnosticaspects. BehavModif.200428:147161

73.NeumeisterKLS.Interpretingsuccessesandfailures:theinfluenceofperfectionismonperspective.JEducGifted.200427:311335

74.RiceKG,LapsleyDK.Perfectionism,coping,andemotionaladjustment.JCollStudDev.200142:157168

75.RiceKG,VergaraDT,AldeaMA.Cognitiveaffectivemediatorsofperfectionismandcollegestudentadjustment.PersIndividDif.200640:463473

76.CastroJR,RiceKG.Perfectionismandethnicity:implicationsfordepressivesymptomsandselfreportedacademicachievement.CulturDiversEthnic
MinorPsychol.20039:6478

http://pediatrics.aappublications.org/content/119/1/182 15/24
 3/2/2017 TheImportanceofPlayinPromotingHealthyChildDevelopmentandMaintainingStrongParentChildBonds|FROMTHEAMERICANACADEMYOFP

77. AccordinoDB,AccordinoMP,SlaneyRB.Aninvestigationofperfectionism,mentalhealth,achievement,andachievementmotivationinadolescents.
PsycholSch.200037:535545

78. FlettGL,HewittPL,OliverJM,MacdonaldS.Perfectionisminchildrenandtheirparents:adevelopmentalanalysis.In:FlettGL,HewittPL,eds.
Perfectionism:Theory,Research,andTreatment.Washington,DC:AmericanPsychologicalAssociation2002:89132

79.BesharatMA.Parentalperfectionismandchildrenstestanxiety.PsycholRep.200493:10491055

80.BesserA,FlettGL,HewittPL.Perfectionism,cognition,andaffectinresponsetoperformancefailurevs.success.JRationEmotCognBehavTher.200422
:301328

81.SoenensB,ElliotAJ,GoossensL,VansteenkisteM,LuytenP,Duriez,B.Theintergenerationaltransmissionofperfectionism:parentspsychologicalcontrol
asaninterveningvariable.JFamPsychol.200519:358366

82. AblardKE,ParkerWD.Parentsachievementgoalsandperfectionismintheiracademicallytalentedchildren.JYouthAdolesc. 199726:651667

83. ElliottM,GoldbergJ,PriceC.Perfectionism:WhatsBadAboutBeingTooGood?Minneapolis,MN:FreeSpiritPublishing1999

84. StruthersCW,PerryRP,MenecVH.Anexaminationoftherelationshipamongacademicstress,coping,motivation,andperformanceincollege.Res
HigherEduc.200041:581592

85. BolinAU.Selfcontrol,perceivedopportunity,andattitudesaspredictorsofacademicdishonesty.JPsychol.2004138:101114

86. PerryAR,KaneKM,BernesserKJ,SpickerPT.TypeAbehavior,competitiveachievementstriving,andcheatingamongcollegestudents. Psychol

Rep.199066:459465

87. deAndaD,BradleyM,ColladaC,etal.Astudyofstress,stressors,andcopingstrategiesamongmiddleschooladolescents.SocWorkEduc.199719:87
98

88.PopeDC.Thegradetrap:studentsperspectivesondoingschool.KnowlQuest.200230:1618

89. BlanksteinKR,WinkworthGR.Dimensionsofperfectionismandlevelsofattributionsforgrades:relationswithdysphoriaandacademicperformance.J
RationEmotCognBehavTher.200422:271299

90. BensonPL.AllKidsAreOurKids:WhatCommunitiesMustDotoRaiseCaringandResponsibleChildrenandAdolescents. SanFrancisco,CA:Jossey

Bass1997

91.PowerTG.Stressandcopinginchildhood:theparentsrole.ParentSciPract.20044:271317

92. ReivichK,ShattA.TheResilienceFactor:7EssentialSkillsforOvercomingLifesInevitableObstacles.NewYork,NY:BroadwayBooks2002

93. SimpsonAR,RoehlkepartainJL.Assetbuildinginparentingpracticesandfamilylife.In:LernerRM,BensonPL,ed.DevelopmentalAssetsandAsset
BuildingCommunities:ImplicationsforResearch,Policy,andPractice.NewYork,NY:KluwerAcademic/Plenum2003:157193

94.GinsburgKR,JablowM.AParentsGuidetoBuildingResilienceinChildrenandTeens:GivingYourChildRootsandWings.ElkGroveVillage,IL:
AmericanAcademyofPediatrics2006

95. UngarM.Theimportanceofparentsandothercaregiverstotheresilienceofhighriskadolescents.FamProcess.200443:2341

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