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Play as a coping strategy?: A review of the relevant literature a
a
Michele Capurso & Chiara Pazzagli a
Department of Philosophy, Social & Human Sciences and Education, University of Perugia, Perugia, Italy. Accepted author version posted online: 06 Oct 2014.
To cite this article: Michele Capurso , Chiara Pazzagli (2016) Play as a coping strategy?: A review of the relevant literature, Children's Health Care Vol. 45, Iss. 1, DOI: 10.1080/02739615.2014.948163. To link to this article: http://dx.doi.org/10.1080/02739615.2014.948163
Disclaimer: This is a version of an unedited manuscript that has been accepted for publication. Copyediting, typesetting, and review of the resulting proof will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content.
Play as a coping strategy?: A review of the relevant literature Michele Capurso Department of Philosophy, Social & Human Sciences and Education, University of Perugia, Perugia, Italy. Chiara Pazzagli Department of Philosophy, Social & Human Sciences and Education, University of Perugia, Perugia, Italy Correspondence concerning this article should be addressed to Michele Capurso, Dipartimento di Scienze Umane, Università degli Studi di Perugia, P.zza Ermini 1, 06123 Perugia, Italy (e-mail:
[email protected]). Abstract Despite the fact that coping and play are both considered essential elements of child development, their relationship has seldom been investigated. The present review examined the assessment of children’s coping skills in general and the specific use of play as a coping skill in studies involving children aged 5-12 years. Forty studies published between 2000 and 2013 were analyzed. The review showed that play is not incorporated in 40% of the children’s coping skills instruments. Even when a coping instrument recognized play it was classified as either an avoidant or distracting activity. Future research should investigate children’s play as a coping strategy for managing difficult and stressful situations. Overlooking play as a coping strategy may lead to underestimate its developmental and social potential in pediatric health care. Keywords: Children’s coping, assessment, functions of play.
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Coping is a widely studied aspect of the human ability to adapt to stressful and ever-changing environments and situations. Coping responses vary in the life-span and appear to be linked to the type of problem to be faced, as well as to socio-cultural aspects and the developmental stage of the subject (Aldwin, 2009; Clauss-Ehlers, 2008; Losoya, Eisenberg, & Fabes, 1998; Skinner & Zimmer-Gembeck, 2007). Coping is a recognized form of adaptation and is considered a plastic strategy that develops through the interaction of internal traits and environmental characteristics (Compas, Connor-Smith, Saltzman, Thomsen, & Wadsworth, 2001; Naar-King, Ellis, & Frey, 2003; Skinner & Zimmer-Gembeck, 2007). Most of the initial coping studies were based on Lazarus and Folkman (1984) cognitiverelational theory. The current authors view coping as an active and intentional process, aimed at responding to stressful situations. Coping responses are therefore based on cognitive appraisals of a stressful situations as coping helps regulate emotional responses to those situations and/or helps the person make appropriate action to change that stressful situation. In this sense, the coping behaviour is partly attributable to individual’s perceptions and making sense of the reality, and therefore varies from one person to another. Recently, studies on coping have been extended to children and showed that even infants engage in regulatory actions and start adapting to their environment by means of reflex actions. Initial coping responses are mostly automatic, and voluntary coping strategies begin to emerge only in early childhood (Compas et al., 2001). As children grow older, their coping strategies develop and starts with a progressive shift from behavioral actions to more cognitive-based and emotion-focused coping (Losoya et al., 1998; Spirito, 2003) at the same time the child’s ability to better regulate the coping response according to stressful situations develops (Zimmer-Gembeck & Skinner, 2011). Coping strategies move
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towards the use of emotion-focused forms of coping from age 6 and up (Aldwin, 2009; Altshuler & Ruble, 1989; Band & Weisz, 1988) and then there is a move towards social support seeking increases as there is a shift from parent-centered support to peer-centered support, especially for emotional problems (Crystal, Kakinuma, DeBell, Azuma, & Miyashita, 2008). In general, as children grow older there is an increase in problem-solving abilities and a divergence from distraction strategies from the time children are four years of age (Zimmer-Gembeck & Skinner, 2011). The adaptive importance of coping is fundamental for human well-being. As outlined by Lazarus and Launier (1978), from the psychological point of view, a coping response is even more important than the stressor itself. Effective coping has been associated with significant outcomes in childhood and adolescence, such as academic performance, social functioning, adaptation to stressful life events, internalizing and externalizing behavior, well-being, competence, and resilience (Zimmer-Gembeck & Skinner, 2011). Play is considered an important tool for allowing adaptation and the processing of reality. In fact, play is widely considered a natural form of expression, an arena where cognitive and affective processes are put into place. Play appears to be linked to social and cognitive skill development as well as emotional and behavioral regulation, and coping ability (Frankel, 2009, 2011; HirshPasek & Golinkoff, 2008; Russ, 1988). Research on childhood vulnerability and resiliency has demonstrated that the presence of appropriate play in children is considered one of the protective factors in early life that influence emotional well-being and improves their chances of reaching their potential (Mazzeschi, Salcuni, Di Riso, Lis, & Bonucci, 2008; Russ, 1998).
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Evolutionist and naturalist play theorist Sutton-Smith suggests that play is a crucial component in children, capable of building resilience, as well as a central human value that continues throughout life. Sutton-Smith proposes that play can be contemplated as “a lifelong simulation of the key neonatal characteristics of unrealistic optimism, egocentricity and reactivity, all of which are guarantors of persistence in the face of adversity.” (Sutton-Smith, 2009, p. 231). Play is indeed regarded as a resource for children to face adversity by several researchers (Fearn & Howard, 2012; Saunders, Sayer, & Goodale, 1999). The distinctive features of play, like autonomy, control, and independence (Howard, 2010), allows it to create a low risk environment ideal for the development of skills. Researchers have found that play likely serves multiple interrelating adaptive functions for children, not only in building social and cognitive skills, but also in helping them regulate emotions and behavior as well as fostering flexibility in problem solving (Hirsh-Pasek & Golinkoff, 2008; Pearson, Russ, & Cain Spannagel, 2008). From this framework, numerous researchers consider play an important tool that lets the child reduce tension, anger, frustration, conflict, and anxiety, which is particularly useful in stressful experiences (Haiat, Bar-Mor, & Shochat, 2003). Play is considered a powerful and effective tool used by children to cope with stress (Young & Fu, 1988), and it is therefore linked to coping abilities. Play allows children to create controllable events in an imaginary frame where negative emotions can be freely vented. This leads to increase positive affect while simultaneously reducing anxiety (Christiano & Russ, 1996; Lester & Russell, 2008; Saunders et al., 1999). Strayhorn (2002) and Russ (2004) consider imaginary play to be a tool for fictional rehearsal. In
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fact, when a child is playing, Strayhorn (2002) and Russ (2004) argue that he is actually testing adaptive cognitive, behavioral, and emotional solutions within a creative play frame and such practice may help the child creating patterns of coping with difficult situations that can be later applied in everyday life. In this sense, play opens up new and functional perspectives of coping while avoidance strategies typically do not help the child process difficult thoughts, emotions and experiences (Lester & Russell, 2008). Indeed Rutter (1985) argues that the development of the ability to be adaptable and flexible, acquired through play, helps children to not be overwhelmed by stress, which is exactly one of the main functions of any coping process. From the cognitive and social point of view, several coping functions have been linked to play. According to Tegano, Sawyers, and Moran (1989) and Schaefer and Drewes (2011), the absence of fear of consequences and the freedom experienced in play allows children to come up with original solutions and new discoveries that can help them understand and solve their personal and social problems. The view of play as a tool to acquire and process information emerges from the work of play specialists helping children cope with the hospitalization. For example, studies by Hubbuck (2009) and Haiat, Bar-Mor, and Shochat (2003) suggest that doll and teddy bear play activity can be used to demonstrate and explain medical procedures, allowing children to move from a passive to an active position. Hubbuck (2009) and Haiat et al. (2003) also outline the importance of free play especially within a hospital context, because they believe that this may help children process and consolidate new or complex information. In social situations, the possibility to take different roles in play makes it possible for the child to develop skills like communication, problem solving and empathy (Hughes, 2009). Free social play among peers has been found to relate to the ability of seeing another person’s point-of-view, cooperating, helping,
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sharing, and solving problems (Gleave & Cole-Hamilton, 2012). On the contrary, children who after a trauma lose their aptitude for creative play become hindered in social situations while diminishing their problem-solving capabilities (Lovett, 2010). Given the widely recognized importance of both coping and play as adaptive tools used by children to face new reality and overcome difficulties in everyday life, we expected a clear recognition of the latter in studies on children’s coping. With the present review, the following question was addressed: is play recognized as a coping strategy in children’s coping measurement tools? If so, what coping functions are associated with play?
Method The search presented here was conducted between February 2013 and June 2013. The search strategy employed two scientific databases: Web of Science and PsycInfo. The search was conducted by combining the terms “child/children” with “cope/coping” and with a set of expressions referring to psychometric tools used in psychology (assessment, checklist, scale, questionnaire, inventory, and measure). References of identified articles were also inspected in order to locate pertinent work that may have been missed in the database search. Additionally, published reviews addressing the measurement of children’s coping strategies were scrutinized to identify further relevant publications and to properly address different theoretical point of views. Inclusion criteria for the search of play within coping literature were that the study either (a) presented a new tool to measure coping or used a previously validated measurement instrument
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or investigated coping through some kind of qualitative method; (b) presented original data, (c) included, even partially, children within the 5-15 age range; and (d) was published between June 2000 and June 2013. Review studies were not included directly in the review matrix, but were used as a base to locate other relevant research. Two hundred and thirty-seven articles were found and scrutinized, and from this forty comprising unique children’s coping measurement tools were included in the final review. Articles were arranged using a Matrix Method (Garrard, 2007) by the first author and the second author later controlled this work. Such a method provides a structure and procedure for systematically reviewing scientific literature as it specifies a system to synthesize and thematically index different sources in relation to the subject under review. The review matrix indicates which coping articles were reviewed, how coping was measured, what kind of coping classification was used to interpret the data, and if and how play was recognized as a coping strategy. It allows for the comparison of the coping theory used, which coping situations were used to interpret the data as well as the theories used to conceptualize coping.
Results Structure and construction methodology of the revised tools Of the 40 analyzed instruments, 28 of them (70%) had items derived from previous children’s coping measurement instruments or were deductively constructed from previous coping theory.
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Seven instruments (17.5%) were inductively and/or data-generated, mostly using interviews followed by a content analysis, while the remaining five (12.5%) instruments were constructed following some kind of mixed or eclectic approach, integrating different sources such as children’s interview, clinician experiences and previous literature. Consistency of the analyzed scales was confirmed by confirmatory factor analysis on 26 tools (65 %). The most commonly used coping dimensions in the instruments were avoidance (N=22), social support (N=17), some form of emotional coping such as emotional expression or regulation (N=15), problem solving (N=13), distraction (N=8), active coping (N=6), and aggression (N=4). Additionally, the tools identified 152 unique coping dimensions. The instruments presented in Table 1 were developed for a myriad of purposes. Instrument purpose was deduced via subjects involved (e.g., children with Sickle Cell disease; children of a community hit by an hurricane) or through the type of story used as an initial context of the study. Based on these observations, the situations of application of the instruments were classified into three categories: generic, specific, multi-domain. Generic denotes instruments referring to a general context (e. g., things done when facing a problem; telling about something upsetting happened recently). Specific designates instruments developed for a definite condition or setting (e.g., loneliness; illness). Multi-domain refers to instruments presenting more that three application contexts (e.g., life in the family, school grades, and relationship with friends). Out of 40 reported instruments, 21 of them (52.5%) were specific, while 16 (40%) were generic, and 3
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(7.5%) were multi-domain. Among the specific measurement tools, the situations most often addressed were pain, illness or hospital life (N=9), and school life (N=5).
Presence of play in coping instruments Sixteen (40%) of the reviewed coping measurement tools did not mention play activities while the remaining 24 (60%) tools did consider play as an attempt to avoid a stressful situation or to be distracted from an uncomfortable condition. Taking into consideration the situation in which the coping tools were used, play turns out to be present in 73% of the generic instruments, in 52% of the specific tools, and in 66% of the multi-domain instruments. Specific and diverse types of play are included in the various coping measurement instruments reported in this review as sometimes play is seen as a sports activity (Amirkhan & Auyeung, 2007; Kuo, Roysircar, & Newby-Clark, 2006; Paasivirta et al., 2010; Seiffge-Krenke, Aunola, & Nurmi, 2009) videogame (Eschenbeck, Heim-Dreger, Tasdaban, Lohaus, & Kohlmann, 2012; Wadsworth, Rieckmann, Benson, & Compas, 2004) or some combination therein (de Boo & Wicherts, 2009). Taking the application context of the coping instrument into account lead to a heterogeneous consideration of play. For instance, out of three instruments aimed at measuring children’s coping with pain, only two of them mention play as a form of distraction, whereas play is absent in the two instruments created for children with cancer. While play is seen as a possible form of distraction in case of loneliness, it is not considered an option in case of sadness.
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A few articles that where included in the review represent a noteworthy exception to the classification of play. In an interview study about Emotion Regulation (ER), Endrerud & Vikan (2007) assign play activities to two different types of ER strategy. Play with others is seen as some kind of social interaction, while solitary play is seen as a distraction strategy. A couple of studies recognized play as a complex and multidimensional type of coping emerging from children’s narratives (Capurso & Santangelo, 2013; Capurso & Trappa, 2005) as the instrument used in these studies was a modified version of Duss’ Fairy Tales (1971), in which the subject is presented with an unstructured stimuli and is asked to tell a story. Such stimuli are usually exemplified by some kind of ambiguous image or situation (e.g., a hazy, shaded off or incomplete picture or an unfinished story or a picture representing an ordinary situation to be recounted by the subject). Duss’ Fairy Tales, traditionally classified as projective tools, are now categorized as performance based tools (Mazzeschi, Lis, Calvo, Vallone, & Superchi, 2001; Meyer, 1992). Performance based assessment refers to tools which ask the person to perform specific actions that are to be assessed based on a preset coding system. In the two studies on children’s fear and coping carried out by Capurso and Santangelo (2013) and (Capurso & Trappa, 2005), children created several narrative types where play was used as a distinctive coping behaviour (e.g., cognitive processing, emotional focused copying, evasion, active problem solving). Another interview study on hospital fears of preschool-aged children, recognized several coping strategies for play (Salmela, Salanterä, Ruotsalainen, & Aronen, 2010). In addition to an independent play coping strategy (including items such as video games, going to the playroom, hobby crafts, drawing), the study evidenced that play can also serve as part of the “positive images and humor” (imaginative play and role play); and of course as part
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of using the child’s own comfort toy. Finally, the Children's Coping Assistance Checklist (CCAC) represents a significant exception to the consideration of play as coping. This instrument classifies pretend play as a form of coping addressed to process emotions instead of distraction. Curiously enough, the validation study (Prinstein, La Greca, Vernberg, & Silverman, 1996) used a comparison with another tool, the Kidcope, which on the contrary considers play as a distraction type of coping.
Discussion As evidenced in Table 1, most of the examined instruments designed to measure coping in children either do not mention play or relegate it to diversion or avoidance coping. The presence of play within children’s coping measurement tools appears to be sporadic. As shown by our data, when the tool’s context is taken into account, play appears to be classified in an incongruent manner even by instruments built for the same purpose and context. Such peculiar consideration of play within children’s coping assessment may be caused by several factors. One factor is probably the fact that too many tools are either directly or indirectly derived from adult-driven instruments and theories of coping (Moreland & Dumas, 2008; Ryan-Wenger, 1992). This may easily disregard the child’s way of thinking and acting. For instance in a research on children’s coping, Band and Weisz (1988) found that nearly 40% of the children's responses fell outside adult coping categories as identified by adult coping literature, and new specific categories had to be developed by the authors to properly address children’s responses.
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As argued by Compas et al. (2001, p. 87): “The way in which coping is conceptualized influences methods of measurement and defines the scope of what is included within the rubric of coping. Many of the problems in the field have come from the lack of clarity and consensus regarding the nature of coping during childhood and adolescence” (p. 87). Another factor is that there seems to be a limitation inherited by the deductive method used to construct most of the coping measurement tools. The construction of several of those tools has either been guided by theoretical-driven prior categories elaborated by other researchers or by a survey of questions used in previously elaborated tools. As a result, coping categories are not based on observed reality, but on other scholars’ view of the subject. Such theoretically driven coping categories could blind the researcher from aspects of reality that do not fit with what is expected (Monette, Sullivan, DeJong, & Hilton, 2014). In fact, the widespread use of the deductive method in psychology is problematic when a tool’s use is extended to contexts different from the one that initially generated the tool (Jones, 2011). Another factors limiting children’s coping measurement is traceable in the mutually exclusive options and interpretations allowed by many coping questionnaires. In such instruments, one action is interpreted only as a single type of coping (e.g., “Go out and play” is seen only as distancing from the problem), but in reality one action does not necessary preclude others (e.g., a child may go out and play yet process the problem socially or even subconsciously). On the contrary, some researchers suggest that one kind of action often preludes others (Capurso & Santangelo, 2013).
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The above examples demonstrate that only coping studies based on an inductive research design were able to appreciate the coping potential of play. However, given their inductive nature, these studies did not yield a coping measurement tool. The interview methods used in the above studies are quite consuming in terms of time and human resources needed to perform the interview and to code the answers. Their replication would be costly and therefore inapplicable on a large scale or on a daily basis. Concerning our research questions, the present review has outlined how play is only partially and inconsistently contemplated within children’s coping measurement tools. While play as a form of distraction or withdrawal from the stressful situation is sometimes recognized in children’s coping assessment, several other prospective coping functions of play (e.g., emotional and information processing, problem solving) appear to be overlooked in children’s coping measurement, despite the fact that several studies on children play recognize its importance. Overall, the present review demonstrates a discrepancy between the importance of play in the child’s life and its omission from instruments to assess children’s coping behaviors and strategies. Since the link between young people’s playfulness and coping abilities has been clearly established with different age groups and situations (Fiorelli & Russ, 2012; Hess & Bundy, 2003; Potasz, Varela, Carvalho, Prado, & Prado, 2013; Qian & Yarnal, 2011; Saunders et al., 1999), overlooking children’s play in coping measurement may leave out a fundamental part of the child’s life as play includes both verbal and non-verbal communication, information processing, emotional regulation, role taking and problem solving abilities (Lester & Russell, 2008; Russ, 1998; VanFleet, Sywulak, & Sniscak, 2011). The fact that even the coping
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measurement tools focusing on the same situation (e.g., illness, pain, school) addressed play in different ways clearly demonstrates that play within coping is still inadequately defined. We believe that the theoretical cognitive background of coping theories has led to the neglect of play within coping assessment. Proper consideration of play should not attempt to reduce distinct play behaviors to a single coping category; rather, in order fully to appreciate the potential of play as a coping mechanism, its multifaceted and multidimensional nature should be recognized. The fact that the complex structure of children’s play cannot be assimilated into a cognitive theory (Huizinga, 1949; Sutton-Smith, 2009) should be acknowledged in investigations of children’s coping behaviors and strategies. There are several aspects of the relationship between children’s coping assessment and play that remain unclear and require further research. Firstly, the conceptual link between play and coping remains undetermined. This is probably due to differences in the fundamental nature of these two aspects of human behavior. Play relates to a concept of the world as unregulated and free, a world in which one does not need to follow strict rules; play varies between cultures, ages and locations. Coping is related to volitional cognitive processes, and is generally categorized using mutually exclusive taxonomies. Although some studies relating children’s coping to play behaviors are now being published (e.g., Capurso & Santangelo, 2013; Prinstein et al., 1996; Russ, 1988), a general framework describing and explaining the relationship between play and coping is still needed. Theoretical accounts of these two aspects of behavior barely make contact with each other, because they are couched in very different terms.
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Because play is considered a powerful and effective tool used by children to cope with stress and to regulate emotions (Russ, 2004; Young & Fu, 1988), future research should investigate the relation between coping and playfulness with instruments capable of operationalizing and validating the role of play in coping assessment. The use of systematic observations of play sessions in the assessment of child’s coping skills might be useful for this purpose, and they could follow the example of some scales developed for the measuring of affective expression and self-regulation in children (Russ, Niec, & Kaugars, 2000; Shapiro, Mcphee, Abbott, & Sulzbacher, 1994). Appropriate categories for assessing play content and play frame could be based on established children’s coping categories, such as those elaborated by Zimmer-Gembeck & Skinner (2011). Given the multifaceted nature of play, diverse forms of play might be recognized as separate and sometimes differing coping strategies. Limitations of this review should be noted. The first issue to be considered involves the time range used for the selection of studies involving children’s coping, since only a span of 13 years (2000-2013) was used and the initial search was restricted to two databases. There is the distinct possibility that some instruments have therefore been missed by the present review. However, it should be noted that such hypothetical omission(s) would not change the nature and meaning of the present review. A second issue relates to some general characteristic of research on children’s coping. For example, as mentioned elsewhere in this review, the conceptual link between play and coping is largely uninvestigated and while recent research is attempting to understand better that link there is a deep need for a theoretical account for how they relate. Another related limitation is the sizeable amount of coping strategies identified by different tools, which made categorization of children’s coping difficult. This calls for a consensus on
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what strategies need to be included in children’s coping assessment and how they should be named.
Implications for Practice Clinicians working with children in distress may be interested in children’s coping literature when developing a care plan for children and families. They may be drawn to assessing children’s coping capabilities and styles with one of the many coping measurement tools available. Yet, they should be aware that such instruments tend to overlook the importance of play. Instead of neglecting play, interventions on children’s coping should on the contrary consider it as an important coping strategy. Practitioners could also find themselves working as advocators for children’s play in different settings that require children’s coping capabilities. An example of such setting is the hospital. If children hospital practitioners use one of the many tools to measure children’s coping in a medical setting (see Blount et al., 2008 for a review) they would likely disregard the importance of play. The same would happen in school, where social play could have a key role in conflict resolution and in creating a healthy classroom emotional environment, or role play could help children cope with new and unusual problems. In such situations, a clinician could always add some kind of clinical assessment or use more projective tools to enrich the understanding of children’s coping with a bottom-up approach. Awareness of play as a way of coping should also be brought to the table when evaluating the end result of a program or intervention aimed at increasing children’s coping capabilities. Again,
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using only standardized measurement tools could lead to incomplete results. A search for the presence of play in children’s behavior and a proper acknowledgment of its coping potential should always be performed in such occasions. Another important aspect of play is its universal nature and power. According to Drewes and Schaefer (2010), children’s play is a universal mean of communication and a natural language for children. Landreth (2012) expanded this concept to all children, regardless of their development or disability. These characteristics make it possible for play to transcend linguistic and cultural differences, offering a natural opening to begin working with children from diverse culture or backgrounds (K. O'Connor, 2005). This can be particularly effective when language barriers are present and need to be overcome (Long, 2007). Play can therefore represent an important multicultural bridge in children’s care and coping (Drewes & Schaefer, 2010). Fearn and Howard (2012) outlined how the possibility to play provides children from different cultural settings a natural resource to face intellectual and emotional challenges. It should be noted that the present authors believe that play should not only be considered within play-therapy based intervention, where its therapeutic power is widely recognized and is deeply linked to the specific therapeutic settings in which it is created and where the therapeutic relationship occurs (Landreth, 2012; K. J. O'Connor & Ammen, 2012; Schaefer & Drewes, 2011; VanFleet et al., 2011). Play can and should find a proper place within cognitive-driven processes such as coping and processing real word information in order to face internal (e.g., managing emotions) and external problems.
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Conversely, another important aspect to be taken into consideration is that not all types of play can be regarded as coping attempts. For instance, children with post-traumatic stress disorder (PTSD) display recurring and distressing recollections of the traumatic episode and repetitive, trauma-related play is often part of them (Ammerman, 2006). Similarly, some play behaviors such as intense play, repetitive play, play disruptions, avoidant play, and play expressing negative affect are characteristic of children with a history of trauma (Terr, 1983). A final point to consider is that instruments that assess children’s coping behaviors and strategies often overlook some types of play. In fact, there is no theoretical or practical reason why playing with a video game or with a mobile phone (as was often used in the literature reviewed for this article) should be considered a coping strategy, while playing with LEGO or ‘pretend play’ with medical dolls is not. Play is a fundamental part of a child’s life while effective coping is an essential skill of adulthood. It is clear that healthy development requires both and the use of play as coping is worth further investigation. References Aldwin, C. M. (2009). Stress, coping, and development : an integrative perspective (2nd ed. ed.). New York ; London: Guilford. Amirkhan, J., & Auyeung, B. (2007). Coping with stress across the lifespan: Absolute vs. relative changes in strategy. Journal of Applied Developmental Psychology, 28(4), 298-317. doi: http://dx.doi.org/10.1016/j.appdev.2007.04.002
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33
Table 1 Presence of play and related coping functions in children’s coping measuring instruments
Author, date
(Stratta et al., 2013)
Instrument used (reference if previously validated elsewhere) COPE (Carver, Scheier, & Weintraub, 1989)
Coping dimensions
Background
Positive reinterpretation, mental disengagement, focus on and venting of emotions, instrumental social support, active coping, denial, religious coping, humor, behavioral disengagement, restraint, emotional social support, substance use, acceptance, suppression of competing activities, planning.
The COPE questionnaire was deductively developed based on 13 conceptually different scales. Several of them were based on specific theoretical arguments about functional or not less functional coping strategies.
Presence of play
Identified coping functions of play
No
Context of application Generic
Other scales were included because previous research indicated that the investigated coping tendencies were either positively or negatively related to adaptive coping. CFA*
(Capurso & Santangelo, 2013)
Children’s narratives (projective story) on school related stress situations.
Cognitive or active, emotion focused or social support, avoidant, play-related.
Based on one of Duss’s fables (1971). Children’s stories were inductively interpreted by two independent coders. The same method was also used to investigate hospital related fears in children (Capurso & Trappa, 2005).
Yes
Play-related coping is interpreted as a separate category
Specific (school related fears)
(Marsac, Donlon, Winston, & KassamAdams, 2013)
CCAC - Children's Coping Assistance Checklist
Emotional processing, encouragement to return to roles and routines, distraction.
Items were based on suggested intervention strategies for children transcribed from pamphlets and brochures distributed by disaster relief organizations. Additional items were rationally developed to reflect long-terms type of coping.
Yes
Emotional processing
Specific (post hurricane)
(Eschenbeck et al., 2012)
SSKJ - German Stress and Coping Questionnaire for Children and
Seeking social support, problem solving, avoidant coping, palliative emotion regulation, anger-related emotion
Coping strategies for two common stressful situations (having an argument with a friend and having problems completing homework) were derived from previous studies. CFA
Yes
Media use
Specific (school)
(Prinstein et al., 1996)
34
Adolescents.
regulation, media use.
(Eschenbeck, Kohlmann, Lohaus, & Klein-Heßling, 2006) (MoralesRodríguez et al., 2012)
EAN - Escala de Afrontamiento para Niños (Children’s coping scale)
Indifference, aggressive behavior, hide the problem to others, cognitive avoidance, behavioral avoidance, active solution, communicate with others and search for guidance, positive attitude, unproductive coping, problem-focused coping
EAN’s items were derived from empirical studies and current theoretical reviews related to productive and unproductive coping. Items were selected by experts as representative of the children’s coping. CFA
No
Multidomain
(Chan, 2012)
Self-Reported Coping Scale
Seeking social support, selfreliance/problem solving distancing, internalizing, externalizing.
The scale was based on Roth and Cohen (1986) approach/avoidance conceptualization.
No
Specific (school)
(Causey & Dubow, 1992)
CFA
(Wu, Chin, Chen, Lai, & Tseng, 2011)
PCCS - Pediatric cancer coping scale
Cognitive coping, problemoriented coping, defensive coping.
The PCCS was created using three fonts of information: results of previous studies and clinical practices; existing items from the KIDCOPE scale, and literature reviews.
No
--
Specific (cancer)
(Hernandez, Vigna, & Kelley, 2010)
YCRI - Youth coping responses inventory
Diversion, destructive coping, ameliorative coping.
Authors generated unique items based on common theories of coping and past literature.
Yes
Diversion
Generic
(Paasivirta et al., 2010)
YCITT - Youth Coping In Traumatic Times scale.
Yes
Distraction
Specific (WTC trauma)
CFA Distraction, active, support seeking, avoidance.
The YCITT was specifically devised for a WTC Study. Included coping items were identified through a review of the existing literature.
35
CFA
(Salmela et al., 2010)
Semi-structured child interview.
Presence of parents and other family members, help of the hospital personnel, positive images and humor, play, child’s own safety toy, action that rejects fear, resting and calming down, alleviation of pain and symptoms.
Qualitative research design based on a semistructured child interview supported by pictures. Responses were analyzed by inductive content analysis.
Yes
Different types of play are recognized as a coping strategy
Specific (hospital)
(Li, Chung, Wong, & Ho, 2010)
Coping behaviour checklist for Chinese children
Social support, problem solving, escape/avoidance, distancing, self-control.
The checklist was developed through a two phases study. On phase 1, the checklist was developed by a cross-sectional interview study. Interview’s data were analyzed through content analysis, based on Lazarus and Folkman’s (1984) theory of coping.
Yes
Escape/Avoi dance and Distancing
Generic
Yes
Behavioral Distraction
Specific (loneliness)
In phase 2, the psychometric properties of the new scale were tested. CFA (Besevegis & Galanaki, 2010)
(Maybery, Steer, Reupert, & Goodyear, 2009)
Children’s Interview
KCS - Kids Coping Scale
Problem solving, information seeking, helplessness, escape, self-reliance, support seeking, delegation, social isolation, accommodation, negotiation, submission, opposition.
Single structured interviews. Questions were developed based on two pilot studies and former interviews on children’s loneliness.
Problem-focused coping, emotion-focused coping, seeking social support
Research design was based on the Lazarus and Folkman’s (1984) cognitive transactional theoretical framework. Factor structure, reliability and validity of the scale was explored. CFA.
Responses were coded using the 12 coping families described by Zimmer-Gembeck and Skinner (2011).
36
No
Generic
(Huguet, Miro, Pain-Coping & Nieto, 2009) Questionnaire (PCQ) (Reid, Gilbert, & McGrath, 1998).
Information seeking & problem solution, seeking social support, positive self-statements, behavioral distraction, cognitive distraction, externalizing, internalizing/catastrophizing.
The subscales were derived using cluster analyses of a preliminary version of the PCQ administered to a sample of young adults (Reid et al., 1994). CFA
Yes
(Singh & Bussey, 2009)
PA-CSES - Peer aggression coping selfefficacy scale
Proactive behaviour, avoiding aggressive behavior, avoiding self-blame, victim-role disengagement.
Review of previous literature on effective ways of coping with aggression informed the development of this scale. Some items were specifically formulated for this study. CFA
No
(SeiffgeKrenke et al., 2009)
CASQ - Coping Across Situations Questionnaire (SeiffgeKrenke, 1995)
Active coping, internal coping, withdrawal coping.
Instrument was developed inductively by previous semi- structured interviews with adolescents. CFA
Sport
(Maurice-Stam et al., 2009)
CCSS - Cognitive Control Strategies Scale (Grootenhuis & Last, 2001)
Predictive control, vicarious control, interpretative control, illusory control.
The instrument is based on the No primary/secondary control model of Rothbaum, Weisz, and Snyder (1982). The items were
inf and clinical experience in the care for children with cancer and their families.
Behavioral distraction
Specific (pain)
Specific (aggression ) Withdrawal
Multidomain
Specific (cancer)
CFA (de Boo & Wicherts, 2009)
CCSC-R1 Children’s Coping Strategies Checklist (Tim S Ayers & Sandler, 1999)
Active coping, distraction, avoidance, support seeking.
This self-report inventory measures dispositional coping behaviors or general coping style. Some items were derived from the Behaviorbased Coping Inventory (Wills, 1985). Some additional items were added based on the dimensions of coping identified via a review of literature about coping in children of divorce. CFA.
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Yes
Distraction
Generic
(Pereda, Forns, Kidcope Kirchner, & (Spirito, Stark, & Muñoz, 2009) Williams, 1988)
Distraction, social withdrawal, problem solving, emotional regulation, wishful thinking, cognitive restructuring, selfcriticism, blaming others, social support, resignation.
10 frequently mentioned coping categories in the literature were selected conceptually.
Yes
Distraction
Generic
(Hema et al., 2009)
Youth Narrative (diary)
Ambiguous, no coping, compliance, avoidance, persistence, take care of self, alternate activity, express emotion, solicit help, alternate thinking, aggression, help others, talked over, protest, physical avoidance, cognitive avoidance.
This is a qualitative descriptive study, where diary prompts were used to assess coping styles information from the youth’s perspective. Data were inductively interpreted.
Yes
Alternate activity
Generic
(Maybery et al., 2009; Moreland & Dumas, 2008)
CCS - Coping Competence Scale
Affective coping competence, social coping competence, achievement coping competence.
This instrument is based on the coping competence theory (Blechman, Prinz, & Dumas, 1995; Dumas, 1997) and seeks to account for children’s ability to cope with daily challenges on the basis of developmental research. CFA
No
Generic
(Hermann, Hohmeister, Zohsel, Ebinger, & Flor, 2007)
PRCQ-C - PainRelated Cognitions Questionnaire for Children
Catastrophizing, positive selfstatements, problem-solving.
This tool is directly based on the PCQ (Reid et al., 1998). Items were selected based on extensive literature search using previously defined higher-order coping categories. CFA
No
Specific (pain)
(Amirkhan & Auyeung, 2007)
CSI - Coping Strategy Indicator
Avoidance, seeking support, problem solving.
CSI’s items were empirically and inductively derived from the strategies most often revealed in studies of coping in youth and adults. Confirmatory factor analysis was used for construct validation in large and diverse community samples and contexts. CFA.
Sport
Reliability and Validity of the instrument were analyzed.
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Avoidance
Generic
(Richards & Steele, 2007)
CSCY - Coping Scale for Children and Youth (CSCY; Brodzinsky et al., 1992).
Assistance seeking, cognitivebehavioral, problem solving, cognitive avoidance, behavioral avoidance.
This study used 2 different coping measures.
NO
Generic
CSCY was constructed by members of the research team using items derived from previous research on children's and adults' coping behavior. Specific coping categories were then empirically identified through factor analysis.
(Endrerud & Vikan, 2007)
Interview
Environmental change, social interaction, distraction activities, cognitive techniques, non functional.
This study was designed to test young children’s coping when facing anger, sadness, and fear, and was based on emotion regulation.
Yes
Social interaction Distraction
Generic
Participants’ answers were coded using 5 categories derived from previous studies.
(Wadsworth et al., 2004)
RSQ - Responses to Stress Questionnaire
Primary control, secondary control, disengagement, involuntary engagement, involuntary disengagement.
The RSQ reflects a conceptual model that includes volitional coping efforts and involuntary responses. Some items were selected from existing measures of coping and stress reactivity, while others were developed for this scale. CFA
Yes
Secondary control (Distraction)
Generic
(Finkelstein, Kubzansky, Capitman, & Goodman, 2007)
A-COPE - Adolescent Coping Orientation for Problem Experiences
Self-reliance, social support, solving family problems, avoiding problems, ventilating feelings, seeking diversions, spiritual support, investing in close friends, professional support, engaging in demanding activities, being humorous,
A-COPE
Yes
Seeking diversions,
Generic
(Patterson & McCubbin, 1987)
Items were developed though structured interviews with high school students, followed by factor analysis
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play video games
relaxing.
(Cristina Richaud de Minzi, 2006)
Cuestionario Argentino de Afrontamiento para niños de 8 a 12 años (Argentine coping questionnaire for children 8-12 years old).
Emotional overwhelming, alternative gratification, cognitive avoidance, emotional control, active and problem focused, logical analysis, cognitive restructuring, seeking support.
Items were adapted from previous English questionnaire.
(Kuo et al., 2006)
CCCS - Cross-Cultural Coping Scale
Collective coping, avoidance coping, engagement coping.
(Brdar, Rijavec, & Loncaric, 2006)
SFCS - School Failure Coping Scale
(Hampel, Rudolph, Stachow, LaßLentzsch, & Petermann, 2005)
SVF-KJ - German Coping Questionnaire for Children and Adolescents
(Rijavec & Brdar, 1997)
Yes
Cognitive avoidance
Generic
This scale is aimed at assessing coping as a cultural construct. Items were generated through a review of the literature on general, cross-cultural, and ethnic minority coping. Accordingly, frequently used coping measures were also considered. The dimensions of individualism and collectivism were also considered. CFA
Yes, Sport
Engagement Coping
Specific (parent relationship and peers comment)
Anger, accepting responsibility, comfort and forgetting, seeking social support, inadequate reactions, parents disengagement
A written interview was administered to primary and high school students, in order to create a list of items representing a wide range of possible coping behaviors. The generated list was then shortened by the research team. CFA
No
Minimization, distraction/ recreation, situation control, positive self-instructions, social support, passive avoidance, rumination, resignation, aggression.
This questionnaire was based on precedent coping instruments. Its development was informed by Lazarus and Folkman's (1984) Stress-Coping Model. CFA
Yes
CFA
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Specific (school)
Distraction/R ecreation
Specific (chronic illness, school)
(Petersen, Schmidt, Bullinger, & the, 2004)
CODI - Coping with a Disease
Acceptance, avoidance, cognitive–palliative, distance, emotional reaction, wishful thinking
The instrument was developed using a simultaneous cross-national method, based on a bottom-up development approach starting with the children’s perspectives. Crossnationals focus groups or interviews were conducted and items for the new questionnaire were derived from those data. CFA
No
Specific (illness)
(Roder, Boekaerts, & Kroonenberg, 2002)
Stress and Coping Questionnaire for Children
Approach, avoidance, support seeking, aggression, crying
This self- report measure for children was constructed based on Lazarus and Folkman’s 1984 Stress-Coping Model. Items from previous questionnaire were selected.
No
Specific (asthma and school)
The aim of this tool is to record children's emotional responses and coping strategies relating to specific stressful situations, both asthma-related and school-related. (Powers, Mitchell, Graumlich, Byars, & Kalinyak, 2002)
CSQ - Coping Strategies Questionnaire for Sickle Cell Disease (Gil, 1989)
Diverting attention, Reinterpret pain, Ignoring pain sensations, Calming self-statements, Increased behavior activity, Catastrophizing, Fear selfstatements, Anger selfstatements, Isolation, Resting, Taking fluids, Praying and hoping, Heat or cold massage, Control, Decrease.
CSQ was originally developed through a rational process, beginning with a review of the literature describing and studies involving coping with chronic pain. Cognitive or behavioral coping strategies were identified. CFA
Yes
Distraction
Specific (pain)
(Fabes, Poulin, Eisenberg, & MaddenDerdich, 2002)
CCNES - The Coping with Children's Negative Emotions Scale
Distress reactions, punitive reactions, expressive encouragement, emotionfocused reactions, problemfocused reactions, minimization reactions.
Based on Lazarus and Folkman's (1984) Stress-Coping Model, CCNES was develop to measure the degree to which parents perceive themselves as reactive to young children's negative affect in distressful situations. Six subscales reflect the specific types of coping response parents tend to use with their children
Yes
EmotionFocused parent Reaction
Multidomain
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in stressful situation. CFA
(Landolt, Vollrath, & Ribi, 2002)
HICUPS - How I Coped Under Pressure Scale (T.S. Ayers, Sandier, West, & Roosa, 1996)
Cognitive decision-making, direct problem solving, seeking understanding, positive cognitive restructuring, distracting actions, avoidant actions, cognitive avoidance, problem focused support, emotion focused support.
HICUPS measures situational coping behaviors in response to a specific stressful event. Starting from a semi-structured interview, items were develop via content analysis of the answers, informed by a categorization system based on the existing literature on child and adolescent coping. CFA
Yes (sport) and video games
(Zeman, Shipman, & Penza-Clyve, 2001)
CSMS - Children’s Sadness Management Scale
Inhibition, emotion regulation, disregulated expression.
The elaboration of the CSMS items was informed by a previous instrument that measured anger expression in children. Components analyses allowed the extraction of the three coping styles.
No
Specific (sadness)
(Anshel & Delaney, 2001)
Structured interview
Positive/negative cognitive appraisal, approach/avoidance coping,
A structured interview was used to assess young player's possible causes of acute, hockey-related stress and relative coping strategies. A deductive content analysis was used to classify items into predetermined categories.
No
Specific (hockey sport)
Distraction
Generic
The interview was based on the children's and adolescent’s coping literature. Items from inventories used in previous sport psychology research were also included. (McCarthy, Seraphine, Matheny, & Curlette, 2000)
CRISEE - Coping Resources Inventory Scales for Educational Enhancement (Curlette et al., 1993)
Behavior control, social confidence, academic confidence, family support, peer acceptance, responsibility.
Priginal set of items based on an extensive review of the literature about stress and coping in children were created. CFA
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Yes
Academic Confidence
Specific (school)
(Stanton, Kirk, Cameron, & Danoff-Burg, 2000)
Emotional Approach Coping Scale
Emotional processing, The intent of this scale was to assess coping emotional expression, distressthrough three domains relating to emotional contaminated coping, seeking approach: identification of emotions, social support, problem-focused emotional processing, and emotional coping,
alcoh expression. disengagement, avoidance, Published and author-constructed items mental disengagement humor, reflecting emotional approach coping were turning to religion, positive used. Also included were items from the refraining, acceptance. COPE inventory.
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No
Generic
