Abstract
Background
Based on the Canadian Model of Occupational Performance and Engagement (CMOP-E), occupational therapists are primarily concerned with three occupational domains: productivity, self-care and play/leisure [1]. Self-care occupations are often targeted in paediatric occupational therapy practice, as they are essential for day-to-day living [2]. Additionally, play occupations are recognized for their important contributions to cognitive, physical, social, and emotional aspects of development [3, 4]. However, a paucity of literature currently exists to explicate the manner in which productivity arises and develops for children and youth. Negative connotations historically ascribed to child labour may account for limited research on productivity in children and youth to date [5].
The term developmental milestones has been defined by Pinquart [6] as “important steps or role transitions associated with entering adulthood” (p. 577). However, milestones specific to occupational development, or occupational milestones, have yet to be established despite the clear link that exists between occupational engagement and health [1, 7], well-being, and justice [8]. Developmental benchmarks for play have been described elsewhere [9], yet less focus has been placed on occupational milestones for self-care and productivity in children and youth. As self-care benchmarks are not the aim of this study, an integrative review was undertaken to summarize what is currently known about the nature and developmental timetable of productive occupations as they evolve in children and youth.
Occupational development
As defined by the Canadian Association of Occupational Therapists (CAOT) [1, 10], occupational development is a “. . . gradual change in occupational behaviour over time, resulting from the growth and maturation of the individual in interaction with the environment . . . ” [1, p. 40]. Participation in occupations is required for an individual to progress along a continuum from novice to mastery, and movement from one end of the spectrum to the other is expected across the lifespan [11]. At the level of the individual, there is a specific rate and order in which individuals typically progress through this continuum [11].
The existing literature uses an interactionist approach to occupational development, which acknowledges the influence of both genetics and environment on an individual’s ability to engage in and master occupations throughout a lifetime [11, 12]. More specifically, an interactionist approach looks at the dynamic relationship between person, environment, and occupation, and the manner in which these relationships influence the changes in an individual’s occupational behaviours [8]. Occupational therapists may benefit from having an evidence-based source that summarizes the expected developmental trajectory of productive occupations across the child and youth age span — one that amalgamates intrinsic and extrinsic influences on occupational development.
Differentiating productivity from play and self-care in children and youth
Play and self-care domains are distinct from productivity. In this review, play and leisure are considered synonymous. Play occupations have been described as “. . . pleasurable, self-motivating, engaging, a child’s private reality, and an end unto itself, making the process of play more important than an end product . . . ” [4, p. 156]. In contrast, self-care occupations are those that consist of looking after one’s self [1], and comprise eating, dressing, bathing, and independently conducting other daily activities related to the maintenance of health and hygiene [2].
In the present study, the terms productivity and work are used interchangeably to identify a unique set of occupations that can be distinguished from play and self-care domains. According to James, work comprises “. . . all activities through which humans provide for their own welfare and contribute to the welfare of the social groups to which they belong” [13, p. 125]. This description mirrors the definition set forth by CAOT, which indicates that productive occupations are those “. . . that make a social or economic contribution, or that provide for economic sustenance . . . ” [1, p. 37].
As an initial guiding point, the authors defined productivity according to this CAOT definition, which emphasizes the individual’s social and/or economic contribution(s) to society [1]. Yet, from a paediatric occupational therapy perspective, productivity is most often linked to school, as school is typically associated with preparation for employment and adult productivity. The scope of productivity, however, extends well beyond scholastic endeavours to encompass occupations such as domestic chores [5] and paid employment [13]. Moreover, children and youth are gradually introduced to the concept of work via graded assignment to household tasks, other responsibilities at home, and school-based activities [13].
Pivotal to this review is understanding the characteristics that make up productive occupations in children and youth. It is purported that continued participation in productive occupations such as chores and school-based activities enables a child to gain “… habits of industry and responsibility … ” [13, p. 126], in addition to fostering time management and scheduling skills. Goodnow [14] further argues that work at this developmental stage constitutes effort or a certain level of difficulty in carrying out a task; is considered useful by the majority of individuals; and includes an interpersonal component, in that relationships with others are pivotal during the process of obtaining one’s goal, or require collaboration with others to attain a targeted endpoint.
As play is central to learning and participation for young children and may be perceived as overlapping with productivity to an extent, distinguishing between play and productive activities presents a challenge to this review. Similarly, self-care occupations such as independently dressing oneself often pose a challenge in that they often contain elements of productivity. Thus, determining the degree to which productive occupations overlap with self-care and play occupations is outside the scope of this review and may be a putative topic for future research. The present study sought to provide a comprehensive outlook on productivity in children and youth in Organisation for Economic Co-operation and Development (OECD) countries, by attributing relative age spans to occupations indisputably deemed by the authors as containing productive characteristics.
The need to profile productivity in children and youth
The nature of productivity in children and youth differs from work conducted in adulthood [5, 14]. A literature review undertaken by Bazyk [15] highlighted the importance of understanding which types of experiences shape Western children and youth perceptions as they relate to achieving meaningful work and autonomous action as an adult. Though several hypothesized conceptualizations of child and youth productivity have been posited in grey and peer-reviewed literature, including the pivotal work conducted by Bazyk [15], paediatric occupational therapists continue to lack an agreed upon definition of productivity that considers the role of person and environmental factors and is unique to both children and youth. The CAOT definition of productivity [1] does not adequately capture the nature of work in children and youth, as it remains unclear the extent to which the paediatric population contributes to society through social or economic means for some productivity-based activities. Thus, occupational therapists are in need of a paediatric-specific definition of productivity, which better reflects the types of occupations that most closely resemble work during this robust period of development. Overall, study findings will provide a better understanding of how productive occupations change as children and youth progress through different stages of development.
One common perspective in paediatrics is that play typically falls within the domain of childhood, whereas productivity is thought to become more of a focus as the child transitions into adulthood [13]. However, this perspective lacks emphasis around the importance of understanding changes in occupational time use across the lifespan. As described in Wiseman, Davis, and Polatajko [16], understanding how occupational performance is altered over time is critical to the field of occupational therapy and warrants further exploration.
Overall objective
An integrative review was conducted to develop a greater understanding of paediatric productivity development. Within this design, data are summarized from both empirical and theoretical literature and may be used to foster theory development, examine the current state of evidence, review existing knowledge and practices, or contribute to practice [17]. Hence, the overall objective of this review was to ascertain what is currently known about the timing and types of productive occupations in 4- to 19-year-olds. Ultimately, this review endeavoured to provide a practice framework for productivity milestones in children and youth.
Methods
An integrative review is a study design that aims to synthesize both quantitative and qualitative research findings in order to enhance understanding of a particular domain [18]. Whittemore and Knafl’s five stage process [18] was followed in order to strengthen rigour, and adhere to post-positivist principles. The five stages include: problem identification, literature search, data evaluation, data analysis, and presentation.
Stage one: Problem identification
A preliminary review of the literature demonstrated a lack of peer-reviewed literature that explicitly summarizes the occupational therapy profession’s knowledge of historical and current productive occupations carried out by children and youth, particularly prior to adolescence. An integrative review was deemed necessary to effectively synthesize all information identified. As school is a common focus of productivity for children and youth, the age at which school begins in kindergarten until completion of secondary education was considered when setting age parameters of this review. While the average age of kindergarten entry varies between and within countries, the general consensus appears to be 4–6 years of age [19, 20]. Children under the age of 4 were also excluded, as preliminary searches on this topic identified that play and productivity are not as easily differentiated within the preschool population as in older youth [21]. Adolescence is defined as a period of transition between childhood and adulthood from ages 10–19 [22]. Thus, this review targeted productive occupations of children and youth between the ages of 4 and 19 where these occupations are more easily differentiated.
Definition of productivity
Productive occupations were defined according to the CAOT [1] defined variables of occupations that make a social or economic contribution to society or the family.
Stage two: Literature search
The following electronic databases were accessed via the Western University Libraries website: the Allied and Complementary Medicine Database (AMED), Scopus, OTseeker, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), SocIndex, PubMed, and Embase.
Search terms
Search terms were established based on the following primary themes: (A) paediatric age descriptors, (B) occupational therapy descriptors, and (C) terminology associated with productivity. The search was not limited according to publication date.
Search strategies and process
Results were examined for their ability to meet inclusion and exclusion criteria. Inclusion criteria: quantitative, qualitative, review, mixed methods, or time use studies published in peer-reviewed journals that included children and youth aged 4–19; studies evaluating productive occupations in children and youth; studies examining child, youth, and parental perceptions on productive occupations; studies exploring self-reported involvement of children and youth in activities related to productivity; studies conducted within countries of the OECD. Studies were not excluded if they included information on leisure and/or self-care occupations, in addition to productivity, however they were not specifically sought out. Exclusion criteria: grey literature; non-English studies; studies discussing productivity occupations in minors with disabilities; and studies that focused on traditional physical and cognitive developmental milestones.
A total of 67 articles were critically appraised and analyzed within this integrative review (Figs. 1 and 2).
Stage three: Data evaluation
Selected articles were evaluated using the methodological quality criteria as outlined by the Occupational Therapy Evidence Based Practice Research Group at McMaster University for quantitative [23] and qualitative [24] designs. The researchers selected this tool for its ability to appraise both quantitative and qualitative articles, and for its clinical focus on occupational therapy.
Stage four: Data analysis
In order to facilitate sequential analysis according to the constant comparative method, the selected articles were first divided into groups based on study design [18, 25]. Open and axial coding ensued, with reviewers combining data into quantifiable age and occupational fragments, while simultaneously examining the contexts that dictate ages at which children and youth participate in productive occupations.
Defining productive occupations
Though some authors explicitly labeled certain occupations as being productive in nature, others were more ambiguous in that they provided no clear differentiation. In cases where discrepancies arose, the reviewers individually undertook the task of interpreting each occupation extracted from an article based on associated contextual, personal, and occupational factors (if provided). The CAOT [1] definition guided each reviewer’s extraction process, and the reviewers reconvened to classify which occupations most accurately reflected the definition of occupations that make a social or economic contribution to society. Six occupational themes emerged as being the core avenues for productive engagement.
Ensuring credibility and confirmability
In the last phase, all researchers engaged in analytic discourse for the final stage of selective coding across all methodologies [25]. The core category revolved around the ages and stages of engagement in productive occupations, and was used to construct a timeline that outlined the ages at which children and youth were already participating, or were believed to be ready to participate, in the six key productive occupational themes identified by the researchers. Throughout the analysis process, reviewers and the research supervisor engaged in triangulation of strategies and emergent findings in order to ensure credibility and confirmability. Confirmability of the entire research process was further enhanced via the creation of a reflexive methodological journal [26].
Results: Occupational timeline: Productivity occupations throughout the paediatric lifespan
Stage five: Presentation
The six occupational categories that emerged were: paid work, school and school-related activities, caring for self and others, household chores, volunteering, and agricultural chores. Caring for self was included as it is linked to reduced economic burden and/or social responsibility of parents and caregivers, thus adhering to the CAOT [1] definition of productivity. Due to discrepancies and the frequent overlap of self-care, leisure, and productive tasks for children and youth, several occupations did not fit into this definition. These occupations were deemed “grey area occupations”, as the authors did not explicitly classify the nature of participation, and the reviewers could not ascertain whether a social or economic contribution was being made. Examples include reading, running errands with parents, computer use, and television viewing.
Using the analyzed literature, a timeline was constructed to display common milestones for initial engagement in six core productive occupations throughout the paediatric lifespan (Fig. 3). Productive occupations extracted from the appraised articles were categorized by age range in order to profile changes in paediatric productivity over time. An increase in the complexity of the occupations being performed, as well as independence in completion of the task, is noted throughout the span of childhood.
Although the timeline provides an overview of the common ages at which engagement begins as well as types of productivity occupations identified in the literature, engagement in these occupations is often dependent on a variety of other factors. Through the iterative coding process, key environmental and personal factors that inform productive milestones in children and youth aged 4–19 emerged, in accordance with the interactionist categories of person, environment, and occupation described in Case-Smith [12] and Davis and Polatajko [11].
Occupational milestones developed for productivity in childhood and youth must be interpreted somewhat loosely, as occupations evolve through the “ … dynamic interaction of person, occupation, and environment … ” [8, p. 23]. As such, the timeline is not proposed to be a rigid perspective on development, but rather a representation of the varying degree to which children and youth experience engagement according to person and environment variables.
Factors impacting timing of participation in productive occupations
The age at which children and youth are most likely to start engaging in productive occupations was found to be influenced by environmental and personal factors, which could result in early, typical, or delayed engagement in productive occupations (Fig. 4). Multiple subfactors were identified for primary environmental and personal factors, as summarized in Fig. 4. Safety considerations were identified within both primary factors as a product of the environment in which the occupation is performed, as well as the person who is carrying out the task.
Environmental factors
Familial factors
The structural makeup of a family can play a role in the timing of engagement in productive occupations. Identified structural influences included family size, marital status of parents, socioeconomic status (SES), and the mother’s employment status.
With regard to family size, the productive occupations that appear to be most influenced include participation in caring for self and siblings, and household chores [34, 55]. Households with multiple children rely more on the children of the household, particularly older siblings, to help watch younger siblings and take care of themselves [44, 45].
The literature suggests that household chores may be influenced by family size; however, it appears as though this influence is correlated with age of the child and whether the child is the eldest sibling [53, 55]. Youth in grade nine who are from larger families (defined as three or more dependents) have been found to spend greater time in household chores compared to peers from smaller families (defined as two or less dependents, including only children) [53, 55]. This finding did not hold true for youth in grade twelve, where no significant differences in household chores amongst small and large families were identified. Older siblings have been found to take on a leadership role amongst their siblings [53], by enforcing equal distribution of work among family members as a means of relieving parental burden [45].
In terms of marital status of parents, engagement in productive occupations has been found to differ amongst children and youth living in single-parent versus two-parent households. Five out of six reviewed articles on this topic found that children in single-parent families spend more time per week in housework than children in two-parent families [5, 50]. This difference in time-use may be attributed to time demands of single-parents, who rely more heavily on their children for help with caring for themselves and their siblings, and housework [5, 45]. One article found that marital status of parents does not have an influence on the amount of time adolescent boys and girls spend in productive occupations [63]; therefore, this variable may need more extensive review.
The literature was unanimous in reporting that children and youth from families of higher SES spend more time on homework and studying than those from families of lower SES [57, 58]. These differences in time-use have been attributed to the idea that families with a higher SES tend to place a larger emphasis on achievement-oriented activities, such as homework [58].
Although participation in paid work was discussed frequently within the literature with regards to SES, the data on time spent participating is inconsistent. Three articles suggest that children and youth from higher SES families spend more time in paid work than lower SES peers [33, 58]. One article did not report any substantial differences in employment rates across SES [39].
The literature suggests that a mother’s employment has mixed effects on engagement in the occupations of paid work and housework. Two articles found a positive relationship between a mother’s hours of work, and the amount of time children spend on housework and in paid work [50, 52]. In contrast, Larson [5] found that youth aged 12 and above with full-time or part-time employed mothers spend less time on household work than those whose mothers are full-time homemakers. Furthermore, Gager [55] found that maternal employment does not significantly influence children’s participation in household tasks, a finding corroborated by Hofferth and Sandberg [27]. The inconsistency of this influencing factor suggests that it needs further exploration.
Parental perceptions
Parental perceptions identified through data analysis primarily pertain to children and youth’s engagement in household chores, caring for self and siblings, and agricultural tasks. Parents consider it their duty to foster responsibility and independence to prepare children for when they leave home, and believe that this is accomplished through involvement in household chores [5, 64]. While parents advocated for early childhood involvement in housework, assignment of chores was often based on their perceived maturity level of the child [52].
Parents report that they enforce participation in productive occupations such as household chores, sibling care, or agricultural tasks, because it is an ‘expectation’ [28]. Secondary to fostering independence and responsibility, 25% of parents also perceive that children’s participation in household chores is essential to family integration [15], believing that developing a special role within the family is an obligation of the child [15, 50]. Whether directly intended or not, involving children and youth in productive occupations, especially household chores, also serves to benefit parents by relieving burden and reducing time-constraints [28, 52]. Parents identified ŧheir level of confidence in their child and neighbourhood safety as important factors when determining whether a child was able to stay home without supervision [49].
Environmental safety considerations
Findings from this review suggest that engagement can be influenced by the riskiness of an occupation, however, more evidence is needed to substantiate a direct relationship between perceived risk and timing of engagement. Participation in agricultural tasks, greater hours of work [65], and chore type [61] were key environmental risk factors identified for childhood injury on farms. Poor workplace safety practices were also largely found to contribute towards elevated safety risk. Neufeld, Wright, and Gaut [60] reported that when farm tasks were deemed to pose safety risks to the child, parents provided their children with safety guidelines. Moreover, Kidd, Townley, Cole, McKnight, and Piercy [66] found that parents attempted to avoid exposing their children to perceived risky situations on the farm (e.g., spraying pesticides).
Societal influences
In post-industrial nations, children and youth’s time spent in both household chores and paid work tends to be less than that of children and youth in developing nations [67, 68]. Productive engagement changes according to technological advances, rising literacy and family wealth rates, and the introduction of universal schooling [68]. With these developments, children and youth have less time available and a decreased need to work both in and outside of the home. Furthermore, the nature of children and youth’s work in post-industrial nations is often regarded as being safer, and better protected by government laws and workplace safety policies [33, 68]. Although work in post-industrial nations is regarded as safer than other areas, this is not always the case for certain groups of children/youth, as the nature of productive occupations of children and youth who belong to an ethnic minority, and/or who live in poverty can be similar to that of their peers in developing societies [33, 67].
There appear to be differences in the nature of productive engagement between post-industrial OECD nations as well. Two studies revealed differences in time use across the occupations of household chores and completing school work. Children and youth in East Asia, including South Korea and Japan, appear to spend less time in household chores and more time on school work compared to their Italian and American counterparts [68, 69]. It also appears that American, Canadian, and Dutch adolescents spend greater amounts of time in paid work compared to those in Belgium, France, Finland, Germany [70], and other European and East Asian countries [69].
Personal factors
Age
Several analyzed studies focused on the relationship between age and engagement in productive occupations. Evidence suggests that participation in housework or domestic activities is one of the earliest forms of productivity to emerge [46]. The majority of analyzed studies found that the type and amount of household chores increases with age [5, 69]. Gager et al. [55] found that participation in household chores tends to decline throughout adolescence as individuals begin to engage in more activities outside of the home, including extracurriculars and paid work.
In relation to paid work and school related activities, age was found to be an important influence on children and youth’s participation. Overall, evidence suggests that paid work often begins between the ages of 12 and 13, and increases throughout adolescence. By age 15, it appears as though the majority of teenagers have worked at some point or are currently employed [15, 71]. With respect to school-related activities, it appears as though time spent at school and on homework-related tasks increases as children age [35, 72]. Age was also found to influence engagement in other productive occupations, including looking after oneself while home alone, caring for others, and agricultural chores; however, no clear trends emerged in the literature with respect to these specific domains of productivity [43, 73].
Gender
The most prominent trends identified were gender disparities with respect to household and farm chore participation. The majority of analyzed studies examining the relationship between gender and housework indicated that girls of all ages spend significantly more time on housework than boys of similar ages and backgrounds [5, 75]. Similarly, Vaage [70] found that the gender gap increased over time periods, with girls consistently completing more household chores than boys between 1990 and 2000. Additionally, several studies reported that boys often engage in more farm chores and physically laborious activities than their female counterparts [31, 66]. However, girls were also found to participate in several farm activities, including yard work, lawn mowing, and animal care [61].
Mixed data was collected in relation to gender and paid work among children and youth. Although many reviewed studies examined the topic of gender differences in paid work, no obvious trend could be identified. Many of the reviewed studies found that boys participate in paid work with more frequency and intensity than girls [31, 68]. However, Soupourmas [59] reported that girls conducted more paid work than boys on school days in 1997, contrary to 1992 when boys spent more time in paid work. Furthermore, Gager et al. [55] found that girls work longer hours in paid labour in both grades nine and twelve. Two studies examining gender and paid work reported no difference between genders in this domain [39, 57]. A focus on more current literature that captures generational changes appears to be warranted.
The majority of analyzed studies found that girls spend more time than boys in school-related activities, including attending class, doing homework, and studying [35, 73]. However, two studies found no significant difference in time spent on school-related activities between genders [39, 75]. Interestingly, only one study reported that boys spent more time on school-related activities than girls, and noted that this trend is not often seen in current literature [76].
Personal safety considerations
No clear pattern emerged with regard to how age impacts safety across the paediatric lifespan. According to two studies, children and youth were more prone to farm-related injuries relative to adults [33, 67]. Similarly, elevated risk was demonstrated for younger children relative to older children [65]. In another study, higher injury rates were reported in males as age increases [62]. Assignment of farm chores to children was found to be influenced by safety considerations including age, size, physical capacity, and ability to follow directions [60, 66]. Additional safety considerations specific to farm studies included birth order, physical development, gender, interest level [61], prior experience, maturity, and degree of responsibility [60]. In terms of determining when to assign household chores, age and amount of practice were described as important safety factors, particularly for advanced chores such as childcare, cooking, shopping, and lawn mowing [52]. With respect to staying home alone without supervision, children’s age and level of maturity were identified as influential safety factors [49].
Child and youth perceptions
Children value carrying out housework for a variety of reasons, including generating income and assisting employed parents in completing domestic chores [47]. In addition, youth appreciate receiving adult approval for initiating involvement in unpaid tasks, and experience a sense of accomplishment afterwards [28]. Children also feel pride in being able to take on added responsibilities beyond parental expectations [28]. Boys, in particular, derive satisfaction from possessing a unique set of skills or taking on a subset of responsibilities within the house [45].
With regard to assigning value to engagement in paid work, Hungerland, Liebel, Liesecke, and Wihstutz [28] found that work was viewed by child participants as an opportunity to gain new and useful experiences, to expand their current repertoire of activities, and to explore potential career avenues. Also noted in the context of paid work (specifically babysitting) was the importance of seeking new experiences, knowledge, and responsibilities during the adolescent years [30].
Lastly, review findings helped in distinguishing between productivity and other occupational domains. From an early age, children begin to distinguish between work and non-work using the features of choice, effort, pleasure, and autonomy [77]. For example, kindergarten children identified five qualifiers to describe work: directed by the teacher, required participation, performed simultaneously with classmates, used the same materials to produce similar products, and completed with sufficient effort [5]. Children in grade one designated tasks as ‘work’ if they involved writing, listening, sitting, and thinking [78]. Chapparo and Hooper [79] found that three conditions determined when self-care became work: when children were directed to do tasks by adults; when the skill was perceived to be too difficult; and when self-care inhibited play. Taken together, findings indicate that autonomy, choice, control, and potential outcomes of participating in work-related activities appear to be major factors that influence children and youth’s perceptions and beliefs about work.
Discussion
This review sought to provide an evidence-based timeline that encapsulates the age(s) at which children and youth typically begin participating in productive occupations. Overall, six types of productive occupations were extracted from critically appraised articles. Only those occupations that almost exclusively fell under the purview of productivity were included. Studies describing trends associated with volunteering in children and youth were not prevalent in the reviewed literature, and could not be detailed here. However, given that volunteering met the criteria for contributing to the economic and social fabric of society, this occupational category was included in the timeline as a key finding.
Each occupation can be classified as self-care, productivity, or play/leisure depending on the meaning ascribed to it by a child, youth, parent, or other pertinent stakeholder. As an illustrative example, whereas one individual may consider reading to be a leisure activity, another individual studying for an exam may classify reading as productive. Thus, it is critical to consider that both personal and environmental factors play a significant role in distinguishing between play and productivity, especially during younger ages where blurring between occupational domains intensifies. It follows that qualitative studies on child, youth, and parental views were included to better understand how productivity is conceptualized during childhood, and to understand how this definition is altered as a typically developing child or youth is exposed to intervening internal and external factors.
Occupational milestones as developmental benchmarks for productive engagement
Overall, findings from this review implicate the necessity of promoting child engagement in productive tasks from as early as age 4 based on perceived benefits of work, as well as other child, youth, and parental perceptions on developmental readiness. Provided that pertinent safety factors are taken into account, productivity serves as a meaningful and vital component of child and youth development. Additionally, age is likely to serve as an indicator for the development of personal functional capacities and also as a benchmark for social laws that restrict and allow formal involvements at a societal level— for instance, when considering child and youth engagement in paid employment.
Paediatricians routinely draw upon developmental surveillance to screen for possible delays in children [80]. Areas that may be assessed through developmental surveillance typically include fine and gross motor, language, cognitive, and psychosocial domains [81], with little emphasis on occupation. Many studies have emphasized the importance of productive engagement from a young age for promoting health and well-being [82], as well as independent living [83]. Thus, occupational milestones for productivity presented here have the potential to aid clinicians in identifying and addressing children and youth at greater risk for occupational dysfunction.
Work-play continuum
Though evidence exists to suggest that children and youth are able to differentiate between work and play from a young age [13], others have reported that children in kindergarten, first, and second grade view select classroom tasks as simultaneously possessing elements of both work and play [5, 84]. The latter hypothesis suggests that overlap between productivity and leisure domains is an inherent property of paediatric occupations, with the extent of overlap dictated by the amount of work or play characteristics attributed to each activity. Therefore, many activities during childhood and youth often contain elements of both play and productivity.
Wing [84] laid out a work-play continuum to assist in classifying young children’s perceptions about work and play, based on the nature of the activity, teacher involvement, and child involvement. Larson [5] framed the work-play continuum presented by Wing [84] through an occupational lens, and in doing so, furthered the profession’s understanding of work and play concepts as they relate to paediatric practice. However, Wing’s [84] work-play continuum was specific to the school context, and included perceptions of children in kindergarten, first, and second grades only, thereby limiting its scope of application. Hence, this review provided insight into the differences between productivity and play as viewed by children and youth across a broadened age span. Further exploration of how these are differentiated in paediatrics is needed.
Redefining productivity across the paediatric lifespan
Cumulative findings from this review regarding children and youth perceptions revealed that this age group differentiates between work, play, and self-care using concepts of autonomy, degree of choice and control, and potential outcomes of completing a given task. In support of this result, James [13] described adult work as primarily being concerned with the welfare of self and others located within one’s social sphere, whereas play in children and youth contains elements of “ … pleasure, relaxation, self-exploration, or self-expression … ” (p. 125). In contrast, self-care comprises “ … looking after the self … ” [1, p. 37]. Thus, this review proposes that productivity in children and youth should be redefined in a way that incorporates the following characteristics: elements of responsibility, time management, effort put forth to complete a task, usefulness, and interaction with others to complete a goal that is externally driven and outcome-focused. In doing so, this review aimed to reconceptualize the way in which therapists currently view productivity in children and youth, while illuminating the need for more research in this largely neglected area of occupational science.
Strengths and limitations
Strengths
Both qualitative and quantitative peer-reviewed studies were critically appraised to capture the holistic construct of productivity across the paediatric lifespan, with the exclusion of grey literature and other data sources. A breadth of databases were utilized during Phase Two to ensure triangulation of search outputs, and searches were conducted to the point of redundancy to attain theoretical saturation of data. The practice of research agreeance served as a method of triangulation to ensure article relevancy [26].
Given the lack of occupational therapy literature specific to paediatric productivity, this review aimed to fill a literature gap by studying productivity specific to this population, and examining occupational milestones rather than traditional developmental milestones. Moreover, results from this review display an overlap of productivity, self-care, and leisure occupations in children and youth. This overlap serves to highlight the importance of practicing in a holistic, occupation-focused manner when working with children and their families.
Limitations
Throughout this review, defining productivity in children and youth was a significant challenge. In reviewed studies, there were discrepancies between authors regarding what features constituted a productive occupation, as well as differences between studies in what occupations were defined as productive. Therefore, the researchers collaborated to define productivity and to reach a consensus regarding the inclusion of occupations according to the CAOT specifications of making a social or economic contribution to society. This may have introduced a source of bias to the review. Occupations such as shopping or running errands with parents, religion, organized activities and lessons, preschool or daycare, reading, and non-school educational activities could be construed as being productive depending on the context. Yet, based on the manner in which these occupations were originally described (either incomplete or contrary to productivity), they could not be integrated into the final timeline with confidence.
Eleven studies were not included in the final data analysis [85–96], given that no extractable data pertaining to environmental, personal, and/or occupation factors could be identified based on the overarching themes that emerged through the constant comparative method. As such, prominent data were summarized from 56 studies, even though 67 studies met the inclusion and exclusion criteria initially outlined by the authors.
Another challenge was a lack of occupational therapy literature available specifically on productivity milestones in the studied population. As a result, this review contains work from other disciplines, including social work, psychology, and family studies, without a clear focus on occupation. Another limitation of this review is the exclusion of infants, toddlers, and preschoolers aged 0–3 as it is often difficult to clearly differentiate between play, productivity, and self-care occupations at these young ages. Lastly, there is evidence to suggest that time-use of children and youth with regards to productive occupations has changed over the past few decades [59, 70]. However, some of the literature utilized in this review dates as far back as 1960, and therefore, may not be entirely representative of current data.
Future directions
Due to a lack of consensus in distinguishing between play, productivity, and self-care occupations, future research should attempt to examine and better define productive milestones within the entire paediatric population, including children aged 0–3. In addition, further studies should aim to more thoroughly examine current trends in children and youth’s time use, as well as more clearly define the spectrum of productive activities for children and youth aged 0–19. Additional research is required to elucidate the full extent of productivity for children and youth, and should include occupations that contain elements of other occupational domains, such as self-care and play/leisure. Moreover, future studies should seek to clarify the ways in which key environmental and personal factors identified in this review continue to shape productivity across the paediatric lifespan. Studies that aim to better understand the nature of productivity in children and youth should examine themes that relate to occupational factors, such as the level of complexity and degree of independence associated with a given occupation, as well as the quantity and quality of changes over time or the mastery of occupational performance. Future studies should also account for the changes in trends related to time-use of children that occur over time to more accurately portray current data. Lastly, additional research is needed to devise a paediatric-specific definition of productivity, which encompasses the developmental changes that occur in occupational engagement over time.
Conclusion
This review has presented several ages and milestones in which children and youth begin engaging in productive occupations. The occupational milestones proposed here may guide clinicians in making use of or implementing age-appropriate productive occupations in the area of paediatric practice. Through this review, it has been established that there are no concrete, age-based milestones that dictate children and youth’s initiation of or participation in a given occupation. Instead, engagement in productive occupations was found to be multifaceted and dynamic, incorporating personal factors such as age, gender, and children and youth perceptions of work, as well as the environmental influences of family structure, societal factors, and parental perceptions. Many factors need to be considered when adopting an occupational development framework in paediatrics as the factors could result in early, typical or delayed occupational development of productivity. Personal and environmental safety considerations were also found to be factors that may influence productive engagement. Ultimately, occupational therapists working with children and youth must strive to adopt an occupational development perspective that extends beyond productivity at school to incorporate a holistic approach to practice, and includes a focus on the full paediatric lifespan.
Conflict of interest
The authors have no conflict of interest to report.