diff --git a/packages/react/cypress/component/LazyVideo.cy.tsx b/packages/react/cypress/component/LazyVideo.cy.tsx
index d7b5dc5..351f446 100644
--- a/packages/react/cypress/component/LazyVideo.cy.tsx
+++ b/packages/react/cypress/component/LazyVideo.cy.tsx
@@ -84,6 +84,31 @@ describe('Accessibility controls', () => {
     cy.get("button").and("have.css", "left");
   })
 
+  it('controls affect playback', () => {
+
+    const onPauseSpy = cy.spy().as("onPauseSpy")
+    const onPlaySpy = cy.spy().as("onPlaySpy");
+
+    cy.mount(
+      <LazyVideo
+        src="https://placehold.co/300x200.mp4"
+        alt="Accessibility controls test"
+        onPause={onPauseSpy}
+        onPlay={onPlaySpy}
+      />
+    );
+
+    cy.get("video").isPlaying();
+    cy.get("[aria-label=Pause]").click();
+    cy.get("video").isPaused();
+    cy.get("[aria-label=Play]").click();
+    cy.get("video").isPlaying(); // The second time
+
+    cy.get("@onPauseSpy").should("have.been.calledOnce");
+    cy.get("@onPlaySpy").should("have.been.calledTwice");
+
+  })
+
   it("allows a different position to be set", () => {
     cy.mount(
       <LazyVideo
@@ -92,8 +117,8 @@ describe('Accessibility controls', () => {
         accessibilityControlsPosition='top right'
       />
     );
-    cy.get("button").should("have.css", "top")
-    cy.get("button").and("have.css", "right");
+    cy.get("[aria-label=Pause]").should("have.css", "top")
+    cy.get("[aria-label=Pause]").and("have.css", "right");
   });
 
   it('allows the controls to be hidden', () => {
@@ -104,7 +129,7 @@ describe('Accessibility controls', () => {
         hideAccessibilityControls
       />
     );
-    cy.get("button").should('not.exist')
+    cy.get("[aria-label=Pause]").should("not.exist");
   })
 
   it('can have custom icons', () => {
@@ -116,7 +141,7 @@ describe('Accessibility controls', () => {
         pauseIcon={() => <span>Pause</span>}
       />
     );
-    cy.get('button').contains('Pause')
+    cy.get("[aria-label=Pause]").contains("Pause");
   })
 
 })
diff --git a/packages/react/src/LazyVideo/AccessibilityControls.tsx b/packages/react/src/LazyVideo/AccessibilityControls.tsx
index ff5966d..0abc4cb 100644
--- a/packages/react/src/LazyVideo/AccessibilityControls.tsx
+++ b/packages/react/src/LazyVideo/AccessibilityControls.tsx
@@ -12,39 +12,39 @@ const minAccessibleBtnSize = 24
 // How far from the edge to position the button
 const positionGutter = '1em'
 
-type AccessibilityControlsProps = Pick<LazyVideoProps,
-  'paused' |
-  'playIcon' |
-  'pauseIcon' |
-  'hideAccessibilityControls' |
-  'accessibilityControlsPosition'> & {
-    play: () => void
-    pause: () => void
-}
+type AccessibilityControlsProps = Pick<
+  LazyVideoProps,
+  | "playIcon"
+  | "pauseIcon"
+  | "hideAccessibilityControls"
+  | "accessibilityControlsPosition"
+> & {
+  isVideoPaused: boolean;
+  play: () => void;
+  pause: () => void;
+};
 
 // Adds a simple pause/play UI for accessibility use cases
-export default function AccessibilityControls({ play,
+export default function AccessibilityControls({
+  play,
   pause,
-  paused,
+  isVideoPaused,
   playIcon,
   pauseIcon,
   hideAccessibilityControls,
-  accessibilityControlsPosition
+  accessibilityControlsPosition,
 }: AccessibilityControlsProps): ReactElement | null {
-
   // If hidden, return nothing
-  if (hideAccessibilityControls) return null
+  if (hideAccessibilityControls) return null;
 
   // Determine the icon to display
-  const Icon = paused
-    ? playIcon || PlayIcon
-    : pauseIcon || PauseIcon;
+  const Icon = isVideoPaused ? playIcon || PlayIcon : pauseIcon || PauseIcon;
 
   return (
     <button
-      onClick={paused ? play : pause}
-      aria-pressed={!paused}
-      aria-label={paused ? "Play" : "Pause"}
+      onClick={isVideoPaused ? play : pause}
+      aria-pressed={!isVideoPaused}
+      aria-label={isVideoPaused ? "Play" : "Pause"}
       style={{
         // Clear default sizes
         appearance: "none",
@@ -52,6 +52,9 @@ export default function AccessibilityControls({ play,
         lineHeight: 0,
         padding: 0,
 
+        // Make it look clickable
+        cursor: "pointer",
+
         // Position the button
         position: "absolute",
         ...makePosition(accessibilityControlsPosition),
@@ -60,7 +63,6 @@ export default function AccessibilityControls({ play,
       <Icon />
     </button>
   );
-
 }
 
 // Make the styles for positioning the button
diff --git a/packages/react/src/LazyVideo/LazyVideoClient.tsx b/packages/react/src/LazyVideo/LazyVideoClient.tsx
index 7bf2a94..855664f 100644
--- a/packages/react/src/LazyVideo/LazyVideoClient.tsx
+++ b/packages/react/src/LazyVideo/LazyVideoClient.tsx
@@ -3,7 +3,7 @@
 
 import { useInView } from 'react-intersection-observer'
 import { useMediaQueries } from '@react-hook/media-query'
-import { useEffect, type ReactElement, useRef, useCallback, type MutableRefObject } from 'react'
+import { useEffect, type ReactElement, useRef, useCallback, type MutableRefObject, useState } from 'react'
 import type { LazyVideoProps } from '../types/lazyVideoTypes';
 import { fillStyles, transparentGif } from '../lib/styles'
 import AccessibilityControls from './AccessibilityControls'
@@ -31,12 +31,18 @@ export default function LazyVideoClient({
   position,
   priority,
   noPoster,
-  paused,
+  paused, // Used to control externally
+  onPause,
+  onPlay,
   playIcon,
   pauseIcon,
   hideAccessibilityControls,
   accessibilityControlsPosition,
 }: LazyVideoClientProps): ReactElement {
+
+  // Track the actual video playback state
+  const [isVideoPaused, setVideoPaused] = useState(true)
+
   // Make a ref to the video so it can be controlled
   const videoRef = useRef<HTMLVideoElement>();
 
@@ -81,6 +87,35 @@ export default function LazyVideoClient({
     paused ? pause() : play();
   }, [paused]);
 
+  // Update internal play/pause state
+  useEffect(() => {
+    const videoElement = videoRef.current;
+
+    const handlePlay = () => {
+      setVideoPaused(false);
+      onPlay && onPlay();
+    };
+
+    const handlePause = () => {
+      setVideoPaused(true);
+      onPause && onPause();
+    };
+
+    // Add listeners
+    if (videoElement) {
+      videoElement.addEventListener("play", handlePlay);
+      videoElement.addEventListener("pause", handlePause);
+    }
+
+    // Cleanup
+    return () => {
+      if (videoElement) {
+        videoElement.removeEventListener("play", handlePlay);
+        videoElement.removeEventListener("pause", handlePause);
+      }
+    };
+  }, []);
+
   // Simplify logic for whether to load sources
   const shouldLoad = priority || inView;
 
@@ -122,7 +157,7 @@ export default function LazyVideoClient({
         {...{
           play,
           pause,
-          paused,
+          isVideoPaused,
           playIcon,
           pauseIcon,
           hideAccessibilityControls,
diff --git a/packages/react/src/ReactVisual.tsx b/packages/react/src/ReactVisual.tsx
index cb02e13..953dca5 100644
--- a/packages/react/src/ReactVisual.tsx
+++ b/packages/react/src/ReactVisual.tsx
@@ -29,6 +29,8 @@ export default function ReactVisual(
     sourceTypes,
     sourceMedia,
     paused,
+    onPause,
+    onPlay,
     playIcon,
     pauseIcon,
     hideAccessibilityControls,
@@ -90,6 +92,8 @@ export default function ReactVisual(
             priority,
             noPoster: !!image, // Use `image` as poster frame
             paused,
+            onPause,
+            onPlay,
             playIcon,
             pauseIcon,
             hideAccessibilityControls,
diff --git a/packages/react/src/types/lazyVideoTypes.ts b/packages/react/src/types/lazyVideoTypes.ts
index f9a01ce..a7e9195 100644
--- a/packages/react/src/types/lazyVideoTypes.ts
+++ b/packages/react/src/types/lazyVideoTypes.ts
@@ -9,6 +9,8 @@ export type LazyVideoProps = Pick<ReactVisualProps,
   'sourceMedia' |
   'style' |
   'paused' |
+  'onPause' |
+  'onPlay' |
   'playIcon' |
   'pauseIcon' |
   'hideAccessibilityControls' |
diff --git a/packages/react/src/types/reactVisualTypes.ts b/packages/react/src/types/reactVisualTypes.ts
index 94f64eb..4d7010b 100644
--- a/packages/react/src/types/reactVisualTypes.ts
+++ b/packages/react/src/types/reactVisualTypes.ts
@@ -22,6 +22,8 @@ export type ReactVisualProps = {
   sourceMedia?: SourceMedia[];
 
   paused?: boolean;
+  onPause?: () => void;
+  onPlay?: () => void;
   playIcon?: ComponentType;
   pauseIcon?: ComponentType;