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Section 22
Play Behaviors with Abused Children

CEUs Question 22 | CEU Answer Booklet | Table of Contents | Play Therapy CEU Courses
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Abused and neglected children's play behaviors have been studied by many researchers from various theoretical orientations including behavioral, psychodynamic, neurological, cognitive, developmental, and Isolation Play Therapy social work continuing edfamily systems (Howard, 1986; Martin & Beezley, 1977; Terr, 1981). These investigations have contributed to identifying seven characteristic behaviors exhibited by a maltreated child during play. These play behaviors include the following: developmental immaturity, opposition and aggression, withdrawal and passivity, self-deprecation and self-destruction, hypervigilance, sexuality, and dissociation.

Developmental Immaturity
Howard (1986) has suggested that developmental play age be used as an assessment tool for evaluating children for abuse and neglect. In her study of 12 physically abused and 12 nonabused children between the ages of I and 5 years, Howard reported that physically abused children were significantly more developmentally delayed in play age (8.4 months) as compared with the nonabused children. Allen and Wasserman (1985) reported that the cognitive and language delays, which were found in 12 abused and neglected infants (ages 8 to 25 months), also impaired play development and normal maturation. Consequently, abuse and neglect may be manifested as either a loss of recently acquired developmental skills (American Psychiatric Association, 1987) or a failure to learn developmentally appropriate behaviors (White & Allers, 1992).

Opposition and Aggression
Researchers have reported abused and neglected children exhibiting impairing oppositional and aggressive play behaviors. Martin and Beezley (1977) interviewed and observed 50 physically abused children (ages 22 months to 13 years) and gathered information about their behavior from parents, teachers, and social workers. These authors reported that 12 of the 50 children exhibited impairing oppositional and aggressive or passive-aggressive behavior in their play and social interactions. Other researchers also described these children as having developed an action-oriented method to cope with stress (Jones, 1981), having a low tolerance for frustration (Herrenkohl & Herrenkohl, 1981), and being more physically aggressive, hostile, and abusive with others during play (Defrancis, 1969; Reidy, 1977). In their clinical observations of children admitted to acute care pediatric inpatient settings, Chan and Left (1988) reported that for physically or sexually abused children, this behavior may be the acting out of an identification with their abuser. For neglected children, these aggressive behaviors may represent the absence of interpersonal skills resulting from limited or emotionally impoverished interactions with parents or others (White & Allers, 1992). One example of aggressive behavior is the child who pretends the baby doll has been bad, angrily shouts at the doll, and proceeds to pull out the doll's hair.

Withdrawal and Passivity
In her work as a social worker and psychotherapist with abused children, McFadden (1986) described another type of abused and neglected child as "the hider." This child may have learned to withdraw from novel or stressful situations, using isolation and passivity as a means of self-defense. Physically abused children are reported as exhibiting avoidant, fearful, withdrawn play behaviors while being uncooperative and inattentive with adults (Martin & Beezley, 1977). Fagot and her colleagues (1989) observed 15 sexually abused, 11 physically abused, and 10 nonabused children (ages 30 to 58 months) in free play peer groups. They reported that the sexually abused children were more passive but not more negative or antisocial. Rather, these children play alone quietly unless approached by an adult. Once approached, these sexually abused children appeared to be highly compliant to the adult's requests and directions. Children that were reported to be both physically abused and neglected exhibited "antisocial, disruptive and aggressive yet passive behaviors" (Fagot et al., 1989, p. 97).

Self-Deprecating and Self-Destructive Behavior
Researchers have reported that abused and neglected children frequently have low self-esteem and make comments describing themselves as bad or incapable (Martin & Beezley, 1977). Oates, Forrest, and Peacock (1985) compared the self-esteem of 37 physically abused children with 37 nonabused children (ages 4.6 to 14 years) using structured interviews and the Piers-Harris Self-Concept Scale. The results of their study indicated that the abused children had significantly lower self-concepts, were less ambitious, and reported having fewer friends than did the nonabused group. In their clinical work with groups of preschool and latency-age incest victims, Goodwin and Talwar (1989) observed sexually abused girls frequently describing themselves as being ugly, whereas sexually abused boys often viewed themselves as weak. These maltreated children blame themselves for the abuse and internalize parental messages that they are defective or no good (McFadden, 1986). In some cases, the child may identify with the parent's own self-destructive behaviors and may act out these feelings (West, 1983). In the extreme case, these self-deprecating beliefs and self-destructive role models may lead the abused child to use play materials to inflict self-harm (White & Allers, 1992). The self-destructive behaviors differ in their presentation from the oppositional and aggressive play in that the anger demonstrated by the self-deprecating child is generally focused inwardly (White & Allers, 1992). For example, the self-destructive child would be more likely to use a toy truck to hit or jab himself or herself as opposed to swinging it at another child or throwing it against a wall.

Hypervigilance
Martin and Beezley (1977) reported that 11 of 50 physically abused children in their study "were unusually hypervigilant towards their surroundings in scanning for cues and reading the moods of the people about them. Their vigilance and heightened alertness to the environment appeared to be a wariness of external danger" (p. 375). Kempe and Kempe (1978) noted that the frozen watchfulness of physically abused children may signal their expectation of being punished and may hinder their ability to explore or play. Hypervigilance exhibited by sexually abused children seems to be in anticipation of subtle, coercive, and abusive sexual interactions with others (Jones, 1986). Hypervigilance may also be a behavioral manifestation of the sexually abused child's generally heightened state of anxiety. Kolko and Moser (1988) studied 29 sexually and 52 physically abused children (ages 5 to 14 years) from a sample of hospitalized psychiatric patients. Their findings suggest that sexually abused children experience greater levels of fear and anxiety as compared with the nonabused or nonsexually, physically abused children. Hypervigilant behavior was not identified as a characteristic of neglected children in the reviewed research.

Sexual Behavior
Gale, Thompson, Moran, and Sack (1988) studied 37 sexually abused, 35 physically abused, and 130 nonabused children who were younger than 7 years of age. The results of their investigation indicated that inappropriate sexual behavior clearly distinguished the group of sexually abused children from the other groups examined. In his paper describing one center's experiences with sexually abused children, Jones (1986) reported that some of these children had a highly sexualized image of themselves or of other people, including the therapist.

Sexually abused children may assume that any relationship with an adult will include sexual contact. "Such children have often invited therapists to be involved with them sexually or have grabbed the breast or genitalia of their therapists" (Jones, 1986, p. 382). Other inappropriate behaviors demonstrated by sexually abused children include open masturbation, excessive sexual curiosity, and exposure of the genitals (Browne & Finkelhor, 1986). With other children or in solitary play, the sexually abused child may exhibit these sexualized behaviors or language while assuming the role of either the aggressor or the victim (McFadden, 1986). Johnson (1988) found that of the 47 boys (ages 4 to 7 years) identified as having molested children younger than themselves, 49% (n = 23) had been sexually abused. McFadden (1986) reported that another potential manifestation of sexual abuse is the child's rubbing or poking of self in the genital or anal areas with toys or other play materials. Although sexualized behaviors do not seem to be characteristic of the physically abused (Gale et al., 1988) or neglected child, developmentally immature or aggressive behaviors can be acted out in the context of relatively "normal" adolescent sexual exploration and appear sexually inappropriate.

Dissociation
Dissociation is the complex process of altering one's stream of consciousness and has been largely empirically investigated in adult populations (Bernstein & Putnam, 1986). Although this phenomenon has been anecdotally described by authors investigating psychological manifestations of abuse in children, a review of the literature failed to produce existing empirical research on dissociation and children's play. We have observed, however, that dissociative behaviors emerge in the play of abused children and believe the phenomenon is worth noting. In Jones's (1986) account of his experiences and those of eight other psychotherapists treating sexually abused children, he observed that one of the mechanisms these abused children use to deny and avoid the painfulness of their traumatic experience is that of dissociation. He described the dissociative child as being oblivious to the presence of others, in a world of his and her own, "absorbed and seemingly hypnotized" (p. 381).

These children may describe the memory of becoming their favorite teddy bear or comforter while abusive acts were perpetrated on them (Jones, 1986). During stressful or novel play, the dissociative child may appear disconnected from the immediate environment, unaffected by external stimulation, or in a dream-like state (White & Allers, 1992). Although dissociation does not seem to be as well documented and discussed in the childhood physical abuse and neglect literature, we have observed that neglected and nonsexually, physically abused children may also engage in dissociation during play.
- White, JoAnna, & Christopher Allers; Play Therapy with Abused Children: A Review of the Literature; Journal of Counseling & Development; Mar/Apr 1994, Vol. 72, Issue 4.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #8
The preceding section contained information about play behaviors with abused children. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 22
What are the seven characteristic behaviors exhibited by a maltreated child during play? Record the letter of the correct answer the CEU Answer Booklet.

 

CEU Answer Booklet for this course | Play Therapy CEU Courses
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The article above contains foundational information. Articles below contain optional updates.
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