Patterns of participation and enjoyment in adolescents with Down syndrome

Home participation and personal and environmental factors in children and adolescents with Down syndrome

AIM

To describe current home participation (frequency, involvement) and caregiver's desire for change in home participation of children and adolescents with Down syndrome, as well as home environmental factors, and to explore the associations of personal and environmental factors with current participation and caregiver's desire for change.

METHOD

Eighty-two caregivers (mean age = 45 years 10 months) of children and adolescents with Down syndrome (mean age = 10 years 7 months) were surveyed about the child's home participation and environmental factors using the Participation and Environment Measure-Children and Youth. Furthermore, children's personal and environmental factors were collected. Results are reported using descriptive analysis and correlations (Spearman's rank correlation coefficients and Mann-Whitney U test) to describe the relationship between current participation and caregiver's desire for change, with personal and environmental factors as ordinal and nominal variables respectively (p < 0.05).

RESULTS

Children's participation was highest with regard to personal care management and lowest with regard to school-related activities. Most caregivers desired change in homework and household chores. Greater frequency was associated with male sex, caregiver less rigorous social distancing due to the COVID-19 pandemic, and children receiving therapies. Greater involvement was associated with younger age in children and higher environmental support. Older age in children was associated with caregiver's greater desire for change.

INTERPRETATION

Personal and environmental factors correlated with participation in specific ways. Creative strategies to promote participation that consider caregiver's wishes should be undertaken.

Participação em casa e fatores pessoais e ambientais em crianças e adolescentes com síndrome de Down

Objetivo

Descrever a participação em casa atual (frequência, envolvimento) e o desejo do cuidador por mudança na participação em casa de crianças e adolescentes com síndrome de Down, bem como fatores ambientais da casa, e explorar as associações de fatores pessoais e ambientais com a participação atual e o desejo do cuidador por mudança.

Método

Oitenta e dois cuidadores (média de idade = 45 anos e 10 meses) de crianças e adolescentes com síndrome de Down (média de idade = 10 anos e 7 meses) foram entrevistados sobre a participação em casa da criança e fatores ambientais utilizando a Medida de Participação e do Ambiente ‐ Crianças e Jovens. Além disso, foram coletados fatores pessoais e ambientais das crianças. Os resultados são relatados por meio de análise descritiva e correlações (coeficientes de correlação de Spearman ou teste U de Mann–Whitney) para descrever a relação entre a participação atual e o desejo do cuidador por mudança, com fatores pessoais e ambientais, para as variáveis ordinais e nominais, respectivamente (p < 0,05).

Resultados

A participação das crianças foi maior em cuidados pessoais e menor em atividades relacionadas à escola. A maioria dos cuidadores desejava mudança nas lições de casa e nas tarefas domésticas. Maior frequência de participação foi associada ao sexo masculino, distanciamento social menos rigoroso do cuidador devido à pandemia de covid‐19 e crianças recebendo terapia. O maior envolvimento na participação foi associado a uma idade mais jovem nas crianças e a um maior apoio do ambiente. A idade mais avançada das crianças foi associada ao maior desejo por mudança do cuidador.

Interpretação

Fatores pessoais e ambientais são correlacionados com a participação de formas específicas. Devem ser realizadas estratégias criativas para promover a participação e que considerem os desejos do cuidador.

What are the barriers and facilitators to participation of people with Down syndrome? A scoping review

AIM

To determine the barriers and facilitators of active community participation of children, adolescents, and adults with Down syndrome.

METHOD

Searches were completed in five electronic databases to identify original studies about participation of children, adolescents (ages < 18 years), and adults (ages 18-59 years) with Down syndrome. Barriers and facilitators to participation were categorized into four factors: personal, social, environmental, and policy and programme. Findings were analysed and validated by a young adult with Down syndrome and a family member, using the public and patient involvement strategy.

RESULTS

Fourteen studies were included: eight with children and adolescents and six with adults. Of the 14 studies, 10 were qualitative and four quantitative. Most studies (n = 9) investigated participation in physical activities, while only a few examined participation in community/social activities (n = 3), daily activities (n = 2), and leisure activities (n = 1). The most commonly cited barriers and facilitators were the availability of programmes and specialized professionals, transportation, as well as attitudes and behaviours. Physical and psychological characteristics of people with Down syndrome and facilities were also frequently mentioned as barriers. On the other hand, the desire to stay active and personal interest in the activity were among the most frequently reported facilitators.

INTERPRETATION

The participation of people with Down syndrome is mainly influenced by physical or psychological factors, the support and attitudes of parents/caregivers, and the availability of specialized programmes. Given the scarcity of research investigating the participation of people with Down syndrome in community activities, daily activities, and leisure, especially in adults, more studies are still needed.

Quais são as barreiras e facilitadores para a participação de pessoas com Síndrome de Down? Uma Revisão de Escopo

Objetivo

Determinar as barreiras e facilitadores da participação ativa na comunidade de crianças, adolescentes e adultos com Síndrome de Down (SD). Métodos: Foram realizadas buscas em cinco bases de dados eletrônicas para identificar estudos originais sobre a participação de crianças, adolescentes (idades <18 anos) e adultos (idades de 18 a 59 anos) com SD. Barreiras e facilitadores para a participação foram categorizados em fatores: pessoais, sociais, ambientais e de políticas e programas. Os achados foram analisados e validados por um jovem adulto com SD e um membro da família, utilizando a estratégia de Envolvimento do Público e Paciente. Resultados: Quatorze estudos foram incluídos, oito com crianças e adolescentes e seis com adultos. Dos 14 estudos, dez eram qualitativos e quatro quantitativos. A maioria dos estudos (n = 9) investigou a participação em atividades físicas, enquanto apenas alguns estudos examinaram a participação em atividades comunitárias/sociais (n = 3), atividades diárias (n = 2) e atividades de lazer (n = 1). As barreiras e facilitadores mais frequentemente citados foram a disponibilidade de programas e profissionais especializados, transporte, bem como atitudes e comportamentos. As características físicas e psicológicas das pessoas com SD e as instalações também foram frequentemente mencionadas como barreiras. Por outro lado, o desejo de se manter ativo e o interesse pessoal na atividade estavam entre os facilitadores mais frequentemente relatados.

Interpretação

A participação de pessoas com SD é principalmente influenciada por fatores físicos ou psicológicos, o apoio e as atitudes dos pais/cuidadores e a disponibilidade de programas especializados. Dada a escassez de pesquisas investigando a participação de pessoas com SD em atividades comunitárias, atividades diárias e lazer, especialmente em adultos, mais estudos ainda são necessários.

Organised and non-organised activities contribute to overall physical activity levels in adolescents and young adults with Down syndrome: a cross-sectional study

BACKGROUND

Participation in organised and non-organised physical activities among adolescents and young adults with Down syndrome is underexplored. This study aimed to examine differences between organised and non-organised physical activities among adolescents and young adults with Down syndrome.

METHODS

Forty participants with Down syndrome (27 woman; mean age 21.4 ± 4.9 years) were recruited. Data on physical activity participation were collected by self- or proxy-reported questionnaires about attendance, involvement and type of physical activity.

RESULTS

Adolescents and young adults with Down syndrome participated in more organised than non-organised activities (P < 0.05), more often (P < 0.05), but there was no difference in the total time spent participating in these activities overall. Participants spent more time in vigorous physical activity during organised activities (P < 0.05) and spent more time in light physical activity during non-organised physical activities (P < 0.05). Dancing (organised activity) and walking (non-organised activity) were the most reported activities.

CONCLUSIONS

Participation in both organised and non-organised physical activities is important to increase overall physical activity levels of adolescents and young adults with Down syndrome. Future research exploring physical activity preferences may help guide the planning and adaption of community programmes for this group.

The effect of a telehealth exercise intervention on balance in adults with Down syndrome

BACKGROUND

People with Down syndrome often present with balance deficits, which compromise safety during daily activity. While evidence shows that exercise can improve balance in the Down syndrome population, it is unclear if a telehealth method will elicit similar benefits. We aimed to examine the effects of a virtual exercise program on balance in adults with Down syndrome.

METHODS

Eighteen low-active participants with Down syndrome completed a 12-week telehealth exercise program based on the Mann Method. Balance testing took place before and after the intervention, which included: TUG, MCTSIB, FICSIT-4, and FRT. This study was registered as a clinical trial on ClinicalTrials.gov, identifier: NCT04647851.

RESULTS

Significant improvement was seen in the TUG (p = .043), FICSIT-4 (p = .019) and FRT (p = .019). All participants achieved maximum scores on the MCTSIB in pre- and post-testing.

CONCLUSIONS

Balance in low-active adults with Down syndrome significantly improved following the telehealth exercise program, which we attribute to the tailored exercises that address visual/vestibular deficits and hip muscle weakness.

Biopsychosocial Factors Related to Postural Sway During Sit-to-Stand Movement in Children and Adolescents With Down Syndrome: A Cross-Sectional Study

We investigated factors related to postural sway during sit-to-stand movement in children and adolescents with Down syndrome (DS). Our assessment of participants followed the biopsychosocial model. Body function and structure were represented by muscle strength and postural sway during sit-to-stand movement, which were assessed by manual muscle testing and kinetics analysis, respectively. The Gross Motor Function Measure and Pediatric Balance Scale depicted the activity component. In addition, we included these relevant contextual factors: age, Home Observation for Measurement of the Environment, family income, and maternal schooling. A correlation analysis verified a suspected association between biopsychosocial and postural sway variables. There were significant separated correlations between postural sway in the three phases of the sit-to-stand movement, and age, GMFM-88 dimension D, and muscle strength. Thus, postural control in sit-to-stand movement was related to biopsychosocial factors involving different life aspects of children and adolescents with DS, and these factors should be addressed in rehabilitation therapy intended to improve postural control among these individuals.

Functioning of children and adolescents with Down syndrome and the association with environmental barriers and facilitators during the COVID-19 pandemic

PURPOSE

To compare functioning and environmental aspects before and during physical distancing (DPD) and to determine which social, physical, behavioral and functioning aspects of DPD are correlated.

METHODS

Sixteen parents of children/adolescents with Down syndrome (11.38 ± 3.00 years) were surveyed before and DPD. Paired t-tests were used to compare functioning and environmental aspects before and DPD and chi-square tests were used to test associations.

RESULTS

There were increases in the frequency (p < 0.001) and involvement (p = 0.01) in home participation and on the impact, noticed by the parents, of the possibility of child to participate in daily activities (p = 0.036), as well as a reduction in social supports perceived by caregivers (p = 0.049). An association was found between the child's socio-emotional difficulties symptoms and practice of physical activity (p = 0.043) and with parents' satisfaction with the level of child's home participation (p = 0.042).

CONCLUSION

Functioning can be affected in either positive or negative ways.

Communication and Social Interaction Experiences of Youths With Congenital Motor Speech Disorders

PURPOSE

The purpose of this study was to explore the communication and social interaction experiences of adolescents with congenital motor speech disorders due to cerebral palsy or Down syndrome, with the aim of identifying clinical and research needs to support the development and implementation of speech-language interventions.

METHOD

Five male youths (ages 14-18 years) with congenital motor speech disorders and one of their parents participated in face-to-face, semistructured interviews designed to understand communication and social experiences in daily life. Interviews were audio-recorded and orthographically transcribed offline. Content was coded according to topic areas emerging in the data. Themes were developed to illustrate the most salient and representative aspects of participants' experiences according to the phenomenological tradition that recognizes that participants are experts in their "lived experience."

RESULTS

Participants described the youths' day-to-day communication experiences, including facilitators and barriers to successful social interactions. Thematic analysis revealed three main themes: (a) strong core relationships amidst sparse, superficial interactions in daily life; (b) the complicated picture of why; and (c) how speech-language pathologists can help.

CONCLUSIONS

Participants reported that the impact of congenital motor speech disorders on social interactions and experiences became more apparent in adolescence than in earlier childhood. Addressing communication challenges to meet the unique social demands of this period requires tailored interventions that target multiple contributing factors beyond speech impairment, such as social communication skills, negative communication partner attitudes, and participation opportunities. Shifting practice toward a life participation approach to communication intervention stands to substantially improve the long-term social outcomes of adolescents with motor speech disorders.

Does physical activity differ between youth with and without intellectual disabilities?

BACKGROUND

Children and youth with intellectual disabilities (ID) are known to face obstacles to physical activity participation, yet the activity patterns of this population are not well characterized.

OBJECTIVE/HYPOTHESIS

In this study, time spent in moderate to vigorous physical activity (MVPA), type, and frequency of participation in physical activities were assessed in youth with ID and in a comparison group of typically developing (TD) youth.

METHODS

Weekly participation in MVPA in 38 youth with ID and 60 TD youth was assessed via accelerometry. Participants were also administered an interview about the frequency and type of physical activities they engaged in over the past year.

RESULTS

After adjusting for age and sex, youth with ID spent significantly less time in MVPA (33.5 vs. 46.5 min/day, p = 0.03) and were less likely to meet the US Physical Activity Guidelines than TD youth (6% vs. 29%, p = 0.01). Although time in MVPA was lower in youth with ID, females with ID participated in physical activities more frequently than TD females (47.1 vs. 28.2 times/month, p = 0.008) and also reported engaging in a greater variety of physical activities (7.8 vs. 5.2 activities/year, p = 0.01). No differences between males in the frequency of physical activity participation or the number of activities performed were observed. Both groups reported walking/hiking and active video as top activities.

CONCLUSIONS

Findings emphasize the need for targeted efforts to increase MVPA in youth with ID.

Parental perspectives on video game genre preferences and motivations of children with Down syndrome

Purpose

Video games have the potential to improve brain plasticity in people with Down syndrome. However, little has been done to understand video game preferences in this population. The purpose of this paper is to describe a brief exploration of video game preferences in children with Down syndrome.

Design/methodology/approach

An online survey was used to collect information from parents of children with Down syndrome about their child’s favorite video games and why they like video games.

Findings

Children with Down syndrome, as reported by their parents, most frequently play action/adventure games, and have several motivating factors for game play including overcoming challenges to gain reward and having fun engaging in the game world.

Research limitations/implications

The current study only recruited from a small sample of the Down syndrome population and therefore may lack generalizability.

Practical implications

Gaining a better understanding of which aspects of video games appeal to children with Down syndrome. Knowing what they prefer will enable us to design games that are engaging and cognitively beneficial.

Originality/value

This paper proposes the importance of video game play to promote development in children with Down syndrome.

Physical Activity Research in Intellectual Disability: A Scoping Review Using the Behavioral Epidemiological Framework

Through a scoping review, the current state of physical activity research in people with intellectual disability was examined. A search of publications between 2000 and 2014 retrieved 362 articles that met inclusion criteria. Eligible studies were coded according to the Behavioral Epidemiological Framework. Of the articles identified, 48% examined associations between physical activity and health outcomes, 9% developed or tested methodology to measure physical activity, 34% examined factors that influence physical activity, 8% evaluated interventions to change physical activity, and 1% examined the dissemination of physical activity/health promotion programming. The categories with lower proportions of studies represent the need for greater population-specific research in physical activity measurement, interventional designs, and translational programs.

Wii-based exercise program to improve physical fitness, motor proficiency and functional mobility in adults with Down syndrome

BACKGROUND

People with Down syndrome (DS) usually display reduced physical fitness (aerobic capacity, muscle strength and abnormal body composition), motor proficiency impairments (balance and postural control) and physical functional limitations. Exergames can be an appealing alternative to enhance exercise engagement and compliance, whilst improving physical fitness and motor function. This study aims to analyse the effects of a Wii-based exercise program on physical fitness, functional mobility and motor proficiency of adults with DS.

METHODS

Twenty-seven adults with DS were randomly allocated to an experimental group (Wii; n = 14) or control group (n = 13). Participants in the experimental group completed a 2-month Wii-based exercise program, with three 1-h sessions per week that included training games for aerobic endurance, balance and isometric strength. Participants completed assessments regarding anthropometric measures, physical fitness, functional mobility and motor proficiency.

RESULTS

Mixed ANOVA analysis showed a significant group by time interaction for aerobic endurance, explosive leg power and flexibility. Independent samples t-test for change scores indicated significant between-group differences favouring the experimental group regarding speed of limb movement, trunk strength and functional mobility, as well as a trend towards significance on body weight. Mann-Whitney's U test for change scores demonstrated between-group differences favouring the experimental group for visceral fat as well as running speed and agility. Large within-group effect sizes were observed for explosive leg power (d = 1.691), body weight (d = 1.281), functional mobility (d = 1.218), aerobic endurance (d = 1.020), speed of limb movement (d = 0.867) and flexibility (d = 0.818) in the experimental group.

CONCLUSIONS

Our findings suggest that Wii-based exercise can be an effective tool to improve physical fitness, functional mobility and motor proficiency of adults with DS, including crucial measures such as aerobic capacity and lower limb strength. Exergames using Wii Fit or other equipment can be appealing alternatives for adults with DS to engage in regular physical activity, preventing sedentary behaviour and decreasing the risk to develop cardiovascular diseases.

Examination of participation and performance of dancing movement in individuals with Down syndrome

Purpose: Many observations and anecdotes have suggested that individuals with Down syndrome (DS) love music, specifically moving to music. The purpose of this study, with the assumption that the music makes people with DS dance showing more movement than general public's, is to observe the change in movement patterns of people with DS while they dance. Methods: The present study videotaped 10 individuals with DS and 10 mental age-matched (MA) participants dancing in response to five different types of music (e.g. rock fast, rock slow, classical, jazz, pop). Results: Our preliminary results suggest that individuals with DS had significantly more body sway than MA participants. In addition, individuals with DS were more active to the music than MA participants. However, no motor timing deficit was evident. Conclusions: This suggests that individuals with DS actively maintain their posture position in the challenging condition. Furthermore, they clearly enjoyed listening to the music and dancing. Based on our results, we suggest that more research need to be conducted examining the effects of dancing program on postural control, and timing in this population.

Impact of enjoyment on physical activity and health among children with disabilities in schools

BACKGROUND

Enjoyment in school-based physical activity (PA) programs, such as recess or physical education may be important for promoting children's health, but there is a lack of evidence explaining how enjoyment affects health in children with disabilities.

HYPOTHESES

Enjoyment in school-based PA programs will positively influence general health through participating in more daily PA, and this relationship will vary between younger and older children with disabilities.

METHODS

We conducted secondary analysis of data from the 2012 National Youth Fitness Survey. The sample included 241 children with disabilities (age 5-15 years; 129 boys and 112 girls) identified using three criteria: (a) having an impairment, health problem and mobility limitations; (b) needing special equipment; or (c) receiving special education services. Variables extracted were the number of days per week participating for at least 60 min in PA a day; general perceived health; enjoyment in school recess (for ages 5-11 y) or physical education (for ages 12-15 y). Mediation analysis was conducted to test the research hypotheses.

RESULTS

Daily PA participation significantly mediated the relationship between enjoyment in physical education/recess and general health. Children who enjoyed physical education or recess more participated in PA, and those who spent more days being physical active were healthier than their counterparts. However, this mediating relationship, when divided by age groups, was shown for only older group (ages 12-15 y) that received physical education.

CONCLUSIONS

Physical educators should provide enjoyable PA opportunities during physical education classes for students with disabilities for promoting their health.

Qualitative Analysis of Parental Observations on Quality of Life in Australian Children with Down Syndrome

OBJECTIVE

There are many challenges to health, functioning, and participation for children with Down syndrome; yet, the quality-of-life (QOL) domains important for this group have never been clearly articulated. This study investigated parental observations to identify QOL domains in children with Down syndrome and determined whether domains differed between children and adolescents.

METHODS

The sample comprised 17 families whose child with Down syndrome was aged 6 to 18 years. Primary caregivers took part in semistructured telephone interviews to explore aspects of their child's life that were satisfying or challenging. Qualitative thematic analysis was implemented using a grounded theory framework to identify domains. The coded data set was divided into 2 groups (childhood and adolescence) at 3 age cut points to observe whether differences existed between the coded domains and domain elements: (1) 6 to 11 years with 12 to 18 years; (2) 6 to 13 years with 14 to 18 years; and (3) 6 to 15 years with 16 to 18 years.

RESULTS

Eleven domains were identified: physical health, behavior and emotion, personal value, communication, movement and physical activity, routines and predictability, independence and autonomy, social connectedness and relationships, variety of activities, nature and outdoors, and access to services. No differences in domains and domain elements were identified across childhood and adolescence.

CONCLUSION

Our data form a preliminary framework from which to design investigations of the child's perspectives on life quality and suggest a range of necessary supports and services.

The Participation Patterns of Youth with Down Syndrome

PURPOSE

The purpose of this paper was to investigate the participation patterns of children with Down syndrome (DS) using the construct of participation as defined by the International Classification of Functioning Disability and Health (ICF).

METHODS

Sixty-two children with DS were recruited between the ages of 9 and 17 years. All participants were given an interview-administered version of the Children's Assessment of Participation and Enjoyment (CAPE) to measure participation (1).

RESULTS

Children with DS participated the most often, based on frequency, in recreational activities (p < 0.001); social activity types represented the greatest extension into the community based on with whom the children participated with (p < 0.05); finally, physical and social activities represented the greatest extension into the community geographically (p < 0.001). In addition, children with DS are significantly more active in activities that are informal in nature.

CONCLUSION

Children with DS participate in a number of activities; however, the extent of their participation within these activities differs depending on the participation pattern examined. Implications for educational and community-based programs are discussed.

Activity Participation and Sensory Features Among Children with Autism Spectrum Disorders

Sensory features are highly prevalent among children with autism spectrum disorders (ASD) and have been shown to cluster into four patterns of response, including hyperresponsiveness, hyporesponsiveness, enhanced perception, and sensory interests, repetitions and seeking behaviors. Given the lack of large-scale research on the differential effects of sensory response patterns on children's participation in specific activities, this study investigated the extent to which sensory response patterns impacted six dimensions of children's activity participation as measured by the Home and Community Activities Scale among a large, national sample of school aged children with ASD (n = 674). Using mixed model regression, results showed that sensory response patterns differentially impacted dimensions of activity participation, and associations were moderated by a number of child characteristics.

The participation of children and youth with disabilities in activities outside of school: A scoping review

Background.

Participation in occupations is vital for learning and development. Children with disabilities are at risk for decreased participation.

Purpose.

The purpose of this study is to examine peer-reviewed literature about the participation-based experiences of children and youth with disabilities in activities outside of formal preschool and school academics.

Method.

A scoping review was conducted to examine research studies published between 1990 and 2012. Studies included participants from 2 to 18 years who had at least one physical or intellectual/cognitive disability.

Findings.

Forty-nine articles discussing 32 studies and three systematic reviews met the inclusion criteria. Perceptions of and influences on participation were important emerging themes about direct impacts on patterns of participation. A child or youth’s level of functioning, activity level, level of enjoyment, and contextual factors were found to influence their level of successful participation.

Implications.

Occupational therapists can use the findings from this review to consider supports and barriers within interventions to enhance participation in meaningful life situations.

Day occupation is associated with psychopathology for adolescents and young adults with Down syndrome

BACKGROUND

Young adults with Down syndrome experience increased rates of emotional and behavioural problems compared with the general population. Most adolescents with Down syndrome living in Western Australia participate in sheltered employment as their main day occupation. Relationship between day occupation and changes in behaviour has not been examined. Therefore, the aim of this research was to explore any relationship between post school day occupations and changes in the young person's behaviour.

METHODS

The Down syndrome Needs Opinion Wishes database was used for case ascertainment of young adults aged 15 to 32 years with Down syndrome. Families of 118 young people in this population-based database completed questionnaires in 2004, 2009 and 2011. The questionnaires addressed both young person characteristics such as age, gender, presence of impairments, behaviour, functioning in activities of daily living, and family characteristics such as income and family functioning. Post-school day occupations in which the young people were participating included open and sheltered employment, training and day recreation programs. Change in behaviour of young adults who remained in the same post-school day occupation from 2009 to 2011 (n = 103) were examined in a linear regression model adjusting for confounding variables including age, gender, prior functioning and behaviour in 2004 and family income.

RESULTS

In comparison to those young adults attending open employment from 2009 to 2011, those attending day recreation programs were reported to experience worsening in behaviour both in the unadjusted (effect size -0.14, 95% CI -0.24, -0.05) and adjusted models (effect size -0.15, 95% CI -0.29, -0.01).

CONCLUSIONS

We found that the behaviour of those participating in open employment improved compared to those attending other day occupations. Further examination of the direction of this association is required.

Actual leisure participation of Norwegian adolescents with Down syndrome

This article reports the actual participation in leisure activities by a sample of Norwegian adolescents with Down syndrome aged 14. Representing a first generation to grow up in a relatively inclusive context, they live with their families, attend mainstream schools, and are part of common community life. Leisure information was obtained in individual, structured parent interviews, and added to existing longitudinal data from a project following the sample. Generally, the leisure activity may be viewed as varying along a continuum-reaching from formal, organized, and assisted activity participation outside home, to informal, self-organized, and independent participation at home. Formal leisure activities were either organized "for all" or "adapted for disabled." The adolescents' leisure appears as active and social. However, social participation largely involved parents and family, while socializing with other adolescents mainly took place within formal activities adapted for disabled. Clearly, formal and informal activities provide rather different opportunities for social encounters and assistance.

Household task participation of children and adolescents with cerebral palsy, Down syndrome and typical development

This cross-sectional study compared patterns of household task participation (e.g., performance, assistance and independence) of youth with cerebral palsy (CP), Down syndrome (DS) and typical development (TD). Parents of 75 children and adolescents were interviewed to report on their youths' active engagement in daily self-care and family-care tasks, using the children helping out: responsibilities, expectations and supports (CHORES) questionnaire. Groups were equivalent in age (mean=9.3 years; SD=2.2 years), sex (male=39; female=36), respondent education, presence of maid, and number of siblings at home, but differed on child cognitive function and family socioeconomic status, with the DS and the CP groups scoring lower than the TD group but not different from each other. ANOVA revealed group differences on CHORES performance of self-care tasks (p=0.004), on total participation score (p=0.04) and on assistance scores (p<0.02). Post hoc comparisons showed that TD group scored higher than CP and DS groups on performance and assistance in self-care tasks and total assistance; TD and CP groups were similar on total performance and assistance in family-care tasks. The groups also differed on independence indices; the TD index was greater than the CP and DS, and the CP index was greater than the DS. Parents from the three groups did not differ on ratings of importance regarding their children's household participation (p=0.416). In spite of observed differences, children and adolescents with CP and DS are actively engaged in daily self-care and family-care tasks; their participation at home is not prevented by the presence of their disabilities.

Objective assessment of sedentary time and physical activity throughout the week in adolescents with Down syndrome. The UP&DOWN study

This study aimed to examine the patterns of sedentary time and physical activity (PA) throughout the week in adolescents with Down syndrome (DS). The study comprised 109 adolescents with DS (68 males and 41 females) aged 11-20 years, participating in the UP&DOWN study, but only a total of 100 adolescents provided valid data. Sedentary time and total, light, moderate, vigorous, and moderate-to-vigorous PA (MVPA) were measured by accelerometers. There were no significant differences in the time spent in sedentary time and PA levels between weekdays vs. weekend days, as well as between school time vs. after school-time periods (all p>0.05). Adolescent males engaged in more total PA, moderate PA, vigorous PA and MVPA than females on weekend days (all p<0.05). Differences between age groups showed that sedentary time increases and PA decreases with advancing age in all analyses, so that the oldest groups were more sedentary and less active (all p<0.05). Only 43% of adolescents with DS met the PA recommendations of ≥60min/day of MVPA. Our findings show valuable information to be considered in future interventions aiming to decrease sedentary time and increase PA levels in adolescents with DS.

Practical and social skills of 16-19-year-olds with Down syndrome: independence still far away

Survival of children with Down syndrome (DS) has improved considerably, but insight into their level of daily functioning upon entering adulthood is lacking. We collected cross-sectional data from a Dutch nationwide cohort of 322 DS adolescents aged 16-19 (response 62.8%) to assess the degree to which they master various practical and social skills, using the Dutch Social competence rating scale and the Children's Social Behavior Questionnaire. Up to 60% mastered some of the skills required for independent functioning, such as maintaining adequate standards of personal hygiene and preparing breakfast. Less than 10% had achieved basic skills such as basic cooking and paying in a shop. It is difficult for DS people to master all the skills necessary to live independently. Ninety percent of adolescents with DS experience significant problems in social functioning.

The Assistance to Participate Scale to measure play and leisure support for children with developmental disability: update following Rasch analysis

BACKGROUND

The Assistance to Participate Scale (APS) was designed to measure the primary carer's estimate of the amount of assistance that their school-aged child with a disability requires to participate in play and leisure activities. Previous research suggests that the 8-item APS has good internal consistency. The construct validity of the scale is supported by strong correlations with instruments measuring similar constructs and discrimination between groups of children with developmental disability, based on extent of need for caregiver assistance.

AIM

The aim of this current study was to undertake further evaluation of the psychometric properties of the APS using Rasch analysis.

METHOD

Rasch analysis was conducted using the RUMM2030 program to assess the APS items in terms of their overall fit to the Rasch model, individual item fit, response format, targeting and dimensionality.

RESULTS

Rasch analysis showed good fit to the model, with no misfitting items and good internal consistency (PSI = 0.85). There was no differential item functioning across mothers' age, education level or child's age. Dimensionality testing supported the combination of all items to create a total score. Most items showed disordered thresholds, suggesting some inconsistencies in the way respondents used the response scale options.

CONCLUSIONS

The APS has been subjected to substantial psychometric testing during development and evaluation, revealing a sound, brief and easy-to-use scale. The APS has a number of potential clinical and research uses measuring the amount of additional assistance that children require from their primary care giver to participate in play activities.

Current status of the Matson Evaluation of Drug Side Effects (MEDS)

The Matson Evaluation of Drug Side Effects (MEDS) is currently the best established and most researched measure of drug side effects in the intellectual disability (ID) literature. Initial research was conducted on its psychometric properties such as reliability and validity. More recent research studies have used the measure to determine the interactive effects of severity of drug side effects on adaptive and social behaviors as well as symptoms of commonly medicated psychiatric conditions among persons with ID. Most recently the MEDS has been used to study potential risk factors of psychotropic drugs. The present study was written to review the current status of MEDS research in the broader context of psychotropic drug side effect research in general.

Participation of children with intellectual disability compared with typically developing children

We compared participation in out-of-school activities between children with intellectual disability and children with typical development using the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children questionnaires. Thirty-eight pairs of children were matched for age (mean age 12.3 ± 2.7 years), sex (17 female, 21 male), location (32 metropolitan, 6 regional) and socioeconomic background (mean SEIFA score 1021 ± 70 and 1024 ± 66). When compared to their typically developing peers, children with intellectual disability participated in fewer Active-Physical and Skill-Based activities and in more Recreational activities. Children with intellectual disability participated less frequently in Skilled-Based activities, had a higher preference for Recreational and Self-Improvement activities, enjoyed Self-Improvement activities more, and participated in a higher proportion of Social activities at home and in a lower proportion of Recreational, Active-Physical, Skill-Based, and Self-Improvement activities alone. These differences may be due to reduced physical, cognitive and social skills in children with intellectual disability, or a lack of supportive environments.

Measuring physical activity in children and youth living with intellectual disabilities: a systematic review

Accurate assessment of physical activity is necessary in determining levels of physical activity in children living with intellectual disability (ID) and assessing effectiveness of intervention programmes. A systematic review of measures of physical activity in children with ID was undertaken using the PRISMA guidelines. MEDLINE-PubMed, Scopus, CINAHL Plus with Full Text and SPORT Discus (up to May 2012) databases were searched and articles were identified. The following inclusion criteria were used; articles in English which reported original research and measured physical activity levels in children with ID, and participants of school age (5-18 years). Searches were limited to articles from peer-reviewed journals and those available in full text. The search identified 5087 titles. Seventy-eight articles were retained for full review and 30 met the inclusion criteria. The review identified a clear deficiency in the number of validity and reliability studies of tools used to quantify physical activity in children with ID. Objective measurement of physical activity provided consistent results. Despite the differences in study design and methodological quality, there was agreement among studies that children with ID were significantly less active compared to children without disabilities. Refusal to wear instruments, movement limitations in children with ID, and positioning of devices were common issues. Future studies should focus on determining the validity and reliability of tools used to assess physical activity in children with ID.

Strength and agility training in adolescents with Down syndrome: a randomized controlled trial

The purpose of this study was to investigate the effects of a proposed strength and agility training program of adolescents with Down syndrome. Ninety-two adolescents were recruited and evenly randomized to two intervention groups (exercise group vs. control group). The mean age for the exercise and the control group was 10.6±3.2 and 11.2±3.5 respectively. The exercise training program consisted of a 5-min treadmill exercise and one 20-min virtual-reality based activity administered three times a week for 6 weeks. Pre- and post-test measures were taken for muscle strength and agility performance. The measured muscle included hip extensor, hip flexor, knee extensor, knee flexors, hip abductors, and ankle plantarflexor. A handheld dynamometer was used to measure the lower extremities muscle strength, and agility performance was assessed by the strength and agility subtests of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition. The exercise group had significant improvements in agility (p=0.02, d=0.80) and muscle strength of all muscle group (all p's<0.05, d=0.51-0.89) assessed in comparison to the control group after the 6-week intervention. Knee muscle groups including both flexors and extensors had the greatest gains among all the muscles measured. A short-term exercise training program used in this study is capable of improving muscle strength and agility performance of adolescents with DS.