Participation of children on the autism spectrum in home, school, and community

Made to feel different: Families perspectives on external responses to autism and the impacts on family well-being and relationships

LAY ABSTRACT

The influence of the environment on different groups of people with disabilities has rarely been studied in the context of neurodevelopmental disabilities, such as autism, in adolescence. This study explored how external responses to autism affect the experiences, outcomes and family relationships of autistic adolescents and their family members, including siblings and parents. This study adds to the knowledge of factors that contribute to the social disadvantage and exclusion autistic adolescents and their families face in their communities. Interviews with 30 participants from families with an autistic adolescent show that external factors greatly impact the well-being of autistic adolescents and their families. The school environment, including sensory overload, bullying and negative interactions with teachers, was found to be a key factor that negatively influenced mental health and family relationships. The study also revealed that isolation and stigma are major concerns for families, indicating the importance of public awareness campaigns to increase understanding of autism. In addition, the lack of adequate support and services presented significant challenges for families. The study emphasises the importance of person-centred approaches to providing services, which involve including autistic individuals and their families in designing and delivering support.

Parents' Perceptions: Environments and the Contextual Strategies of Parents to Support the Participation of Children and Adolescents with Autism Spectrum Disorder-A Descriptive Population-Based Study from Switzerland

Environments have a modifying effect on the participation of children and adolescents with autism spectrum disorder (ASD) in all areas of life. This cross-sectional study investigated parental perspectives on supportive or hindering environments and the daily contextual strategies parents used to enhance their children's participation. Qualitative and quantitative data gathered from 115 parents from German-speaking Switzerland using the participation and environment measure-child and youth (PEM-CY) were analyzed. Results revealed 45 environmental supports and barriers at home, at school, and in the community. Contextual strategies were identified in combination with people, activities, time, objects, and places. Parental perspectives on participation and their contextual strategies should be considered in environmental-based interventions to support the participation of children and adolescents with ASD.

Associations Between Parenting Stress and Quality Time in Families of Youth with Autism Spectrum Disorder

Increased stress among parents of youth with ASD has been well-documented. However, research on aspects of the parent-child relationship and subsequent links to parenting stress is limited. We assessed parents (N = 511) of youth with ASD to examine relations between parenting stress and parent-child quality time (amount of quality time, shared enjoyment, synchronicity). Elevated parenting stress was associated with less time spent engaging with youth in shared activities and decreased parent and child enjoyment during shared interactions. Parents with elevated stress reported engaging in shared activities and experiencing synchronicity with their child less often than parents below the clinical threshold. Future research should emphasize longitudinal efforts examining the directionality of this relationship to better inform family-focused intervention.

Parents' perceptions: Participation patterns and desires for change for children and adolescents with autism spectrum disorder-A descriptive population-based study from Switzerland

BACKGROUND

Low participation in youth with autism spectrum disorder (ASD) has been reported, but age-related and contextual information is rare.

OBJECTIVE

This study aimed to describe, from parental perspectives, two patterns of participation and parental desires for change of children (age: 5-11) and adolescents (age: 12-17) with ASD in Switzerland.

METHOD

A cross-sectional design used the German version of the Participation and Environment Measure-Child and Youth to describe and juxtapose the participation results of 60 children and 55 adolescents with ASD in 45 activities at home, school and in the community and parental desires for change.

RESULTS

Participation patterns differed between settings and age groups. Both groups were found to participate most at home, followed by school, whereas community participation was either low or nonexistent. Children were more involved at home than adolescents, while school involvement was higher than participation frequency in both age groups. Community participation frequency was generally low but higher in children than in adolescents, while involvement was similarly low in both groups. Half the parents expressed desire for change with three tendencies: (1) widespread desire for change at home due to high support needs, (2) parents of adolescents expressed more desire for change in all settings than those of children and (3) all parents mainly desired to increase participation frequency and involvement.

CONCLUSIONS

This study informs research and social, health and community service providers to further reshape their programmes to meet parental needs and increase the participation of youth with ASD.

Participation of Children With Autism During COVID-19: The Role of Maternal Participation

BACKGROUND

Little is known about participation during adverse times.

OBJECTIVES

This study described participation of children with autism aged 6 to 13 during COVID-19 pandemic and examined the extent to which child factors, mother's own participation, and environmental barriers/supports explain child participation in home and community.

METHOD

A total of 130 mothers completed the Participation and Environment Measure for Children and Youth, the Health Promoting Activities Scale, functional issues checklist, and sociodemographic questionnaire.

RESULTS

Children's participation frequency and involvement were significantly higher at home than in the community. In both settings, mothers desired change in 71% of activities. Multiple regression models indicated that child's age and mother's participation frequency significantly explained child's home involvement (R2 = 21%), where mother's participation (frequency) had a unique contribution (ΔR2 = 10.4%) at home but not in the community.

CONCLUSION

Findings imply the importance of maternal participation to child's participation at home and suggest redirecting attention for enhancing family participation as a whole.

Content validity of the instrument 'Picture My Participation' for measuring participation of children with and without autism spectrum disorder in mainland China

BACKGROUND

Picture My Participation (PMP) is a valid instrument for measuring participation of children with disabilities, but it has not yet been evaluated for its content validity for children with autism spectrum disorders (ASD) in mainland China.

AIM

To explore the content validity of the simplified Chinese version of PMP (PMP-C; Simplified) for children with ASD and typically developing (TD) children in mainland China.

METHODS

A sample of children with ASD (n = 63) and TD children (n = 63) recruited through purposive sampling were interviewed using the PMP-C (Simplified), which contains 20 items of everyday activities. Children rated attendance and involvement on all activities and selected three most important activities.

RESULTS

Children with ASD selected 19 of 20 activities as the most important activity while TD children selected 17 activities. Children with ASD used all scale points for rating attendance and involvement on all activities. TD children used all scale points for rating attendance and involvement in 10 and 12 of 20 activities, respectively.

CONCLUSION

The contents of 20 activities of PMP-C (Simplified) were relevant for all children and especially for children with ASD for assessing participation in community, school and home activities.

Parent-reported environmental factors and strategies to support home and community participation in children on the autism spectrum

PURPOSE

Participating in home and community activities can be influenced by environmental factors and parent strategies. Children on the autism spectrum are reported to participate less in home and community activities than their neurotypical peers. Little is known about environmental factors that may influence their participation, and ways parents support their child's participation.

MATERIALS AND METHODS

Parents of children on the autism spectrum aged 5-6 years (n = 72) and 10-11 years (n = 94) completed the Participation and Environment Measure for Children and Youth. This study reports on the perceived support, barriers, and resources in the home and the community environment. Parents reported strategies they used to support their child's participation in home and the community.

RESULTS

Home environmental factors were identified as more supportive by the parents of younger children. The sensory quality of activities and social demands were factors identified as making community participation harder for both groups. Parents used a range of different strategies in the home and the community to support their child's participation.

CONCLUSIONS

Identifying environmental barriers and supports to participation can assist in developing interventions to support meaningful participation in activities for children on the autism spectrum.Implications for rehabilitationSkills required for the activity and preferences of children on the autism spectrum are important considerations when supporting their participation in activities.When exploring a child's level of participation, it may be helpful to ask parents about what their child can do with or without their support.The sensory quality of the environment is a consideration when supporting the participation of children on the autism spectrum in community activities.As sensory processing is an individual experience, the impact of sensory elements of the environment may differ for individuals.

Participation Patterns of Israeli Children with and without Autism, and the Impact of Environment

AIMS

Participation is vital to children's quality of life, yet it is often limited for those with autism spectrum disorder (ASD). An improved understanding of the factors that may support or hinder their participation is important. This study aims to explore the participation patterns of children with and without ASD in the home, school, and community settings, as well as to explore the impact of environmental factors on the participation of children with ASD.

METHODS

78 parents of children aged 6-12, attending mainstream educational settings (30 with ASD; 48 without ASD) completed the Participation and Environment Measure for Children and Youth and a demographic questionnaire.

RESULTS

Children with ASD were rated significantly lower than children without ASD in participation, and their parents expressed a greater desire to change their participation while reporting lower overall environmental support. Among the ASD group, significant differences in participation were found across the three settings, with the highest participation scores at home. Environmental factors that support or limit children's participation were identified.

CONCLUSIONS

The results highlight the importance of environmental factors in children's participation. It is essential to evaluate different environmental settings; identifying the supportive and limiting environmental factors will enhance interventions for children with ASD.

Participation-related constructs and participation of children with additional support needs in schools

AIM

To investigate associations between participation-related constructs and participation frequency and involvement in inclusive schools.

METHOD

In this cross-sectional study, teachers of children with additional support needs, including intellectual disability, autism, and learning difficulties, completed measures. Participation-related constructs were measured using the School Participation Questionnaire; participation frequency and involvement were measured using the Participation and Environment Measure for Children and Youth. A series of multilevel linear mixed-effects regression models with maximum likelihood estimates and bootstrap confidence intervals with p-values were obtained. Final models included participation-related constructs and participation, controlling for demographic and diagnostic confounders (including age, sex, language, level of school support, and autism).

RESULTS

Six hundred and eighty-eight children (448 [65.1%] males; mean age 8 years 7 months [range 4 years 10 months-12 years 13 months, standard deviation 2 years 1 months]) were assessed by 252 teachers. Across a series of models, participation-related constructs were consistently associated with more intensive participation (competence, environment, identity p < 0.001; symptoms p = 0.007), independent of confounders. More frequent participation remained associated with three of four participation-related constructs (competence, identity p < 0.001; environment p = 0.021). Age (p = 0.046), language (p = 0.002), and level of school support (p = 0.039) also remained significantly associated with frequency of participation.

INTERPRETATION

Children with additional support needs in inclusive schools may have several participation barriers. Policies and interventions to improve participation are needed.

WHAT THIS PAPER ADDS

Across a series of models, participation-related constructs were associated with frequency and intensity of participation. Only participation-related constructs were associated with participation intensity. Demographic and diagnostic variables were associated with frequency, not intensity, of participation. Teacher assessment is valid for assessment of participation and participation-related constructs.

Integrated parent-child music classes for preschoolers with and without autism: Parent expectations and experiences

Integrated recreational programs designed to support neurodiverse children and their families are important vehicles for community participation. In this mixed-methods study, we investigated the mechanisms by which parent-child music classes for autistic and neurotypical children can support community participation. Parents of autistic (n = 33) and typically developing (TD; n = 28) preschoolers were interviewed about their expectations for and experiences of participating in a 12-week psychoeducational parent-child music program. Parents completed ratings of momentary affect and social connection, and researchers coded children's behavioral engagement during classes at multiple time points throughout the program. Primary motivations for enrolling in an integrated music class included children's interest in music and opportunities for child socialization. Parent-focused reasons were less frequently endorsed as primary motivations for participation. Yet, momentary ratings indicated that music classes supported parents' affect regulation and social connection with other parents at the level of individual classes and across the program. These in-class experiences were echoed by interviews following program completion, which additionally highlighted the use of new parenting strategies through the musical activities. Since parental emotional experiences of activities, supportive community relationships, and parenting confidence are all linked with increased community participation, integrated music classes may support participation and satisfaction with community experiences.

Instructors' Perspectives of Social and Motor Influences on Participation in Children With Autism Spectrum Disorder

Participation is key to childhood development and is essential for health and well-being; yet children with Autism Spectrum Disorder (ASD) participate less in social and physical activities compared to their typically developing peers and little is known about how social and motor challenges impact participation patterns. Purpose: The current research garnered experiential insights of the quality and quantity of participation, through the lens of instructors (N = 9) working with a child or children with ASD. Method: Semi-structured qualitative interviews were conducted to capture a comprehensive and informative profile of how social and motor functioning of children with ASD influence involvement in social and physical activities. Results: Thematic analysis revealed consistent viewpoints in four main areas: (1) Viewpoints extend beyond the World Health Organization definition of participation; (2) Participation depends on who is involved; (3) Although motivation, confidence, and competence in social/motor domains underlie participation, social challenges were perceived as the greatest barrier; (4) While acknowledging the benefits of participation, it is necessary to be cognizant of the required supports. Throughout these themes, the notion of heterogeneity was made very clear. Conclusion: Collectively, perspectives offer descriptive insight which may be useful when designing opportunities for participation in social and physical activities among children with ASD.

Motor Skills are Associated with Participation of Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) generally have a delay in the development of motor skills when compared to typical children, however, to date, no study has investigated whether motor limitations can interfere in the participation of these children. The objectives of this study were: verify if the motor skills can explain the frequency, the percentage of number of activities, the involvement and the desire to change in participation at home, school and community of children with autism spectrum disorder (ASD) and; identify if contextual factors would modify the association between motor skills and participation outcomes. The participation and the motor skills were evaluated in 30 children with ASD between 5 and 10 years old. Participation outcomes were measured by the Participation and Environment Measure-Children and Youth (PEM-CY) and the motor skills were assessed by the Timed Up and Go, Timed Up and Down Stairs, Test of Gross Motor Development-2nd edition and Pediatric Balance Scale. The results of the study demonstrated that the motor skills of the locomotion, objects control, change position and balance explained participation outcomes of children with ASD classified from mild to moderate, between 5 and 10 years old. Moreover, the sex variable modified the association between the motor skills and the school participation, with girls performing less activities at this setting.

Difference in home participation patterns and environmental factors between Korean children with and without disabilities

PURPOSE

To identify the participation patterns of Korean children with and without disabilities at home, and the environmental factors affecting their participation.

MATERIALS AND METHODS

The Korean Participation and Environment Measure for Children and Youth were applied to 184 caregivers of children aged 5 to 13 years in South Korea. To explore home participation patterns and environmental factors at the item level, analysis of covariance, Pearson's chi-square tests, and radar plots were used.

RESULTS

The largest group differences in participation frequency were in "school preparation" and "homework" and those at involvement level were in "indoor play and games," "getting together with other people," "school preparation," and "homework." More caregivers of children with disabilities desired changes in their children's participation in all activities. They also perceived that "physical, cognitive, and social demands of typical home activities," "supplies," and "money" hindered children's home participation.

CONCLUSIONS

The findings provide information about how Korean children participated in home-based activities, whether their caregivers desired changes in their participation, and what environmental factors impede their home participation. These can help service providers understand the interaction between participation and environmental factors and offer insight into where their service goals should be focused for the successful participation of children with disabilities at home.Implications for RehabilitationAs children with disabilities spend much time at home, their parents need to consider both how many times their children participate and how much they get involved in home-based activities.Rehabilitation service providers need to focus on whether parents are satisfied with their children's participation in home activities to decide where much effort is needed for meaningfully occupying children's time at home.The goal of rehabilitation services can be to mitigate a poor fit between children's abilities and the demands of activities for successful participation in home activities.Measuring not only the quantity of participation but also the quality of participation is helpful for setting a collaborative goal with parents to improve the participation of children with disabilities at home.

The intersection of gross motor abilities and participation in children with autism spectrum disorder

Many children with autism spectrum disorder (ASD) demonstrate movement difficulties in addition to problems with social communication and interactions, and repetitive or restrictive behaviors. The goal of early intervention for children with disabilities is to promote participation in routines and activities, but little is known about the role gross motor abilities contribute to participation for young children with ASD. The purpose of this study was to examine relationships between gross motor abilities and participation in preschool-aged children with ASD. Twenty-two children with ASD participated in the study. Gross motor skills were measured using the Peabody Developmental Motor Scales, Second Edition. Participation was measured using the Preschool Activity Card Sort. Children who had greater gross motor skills also demonstrated greater participation in self-care, high demand leisure, and social interaction activities. Results also identified activities that may be difficult for preschoolers with ASD. Findings suggest that early childhood intervention providers consider the impact of gross motor deficits within the context of participation in daily routines and activities.

The Impact of Anxiety on the Participation of Children on the Autism Spectrum

Anxiety is common in children on the autism spectrum, however its impacts are not fully understood. Participation is an important outcome, linked to the health and wellbeing of children. This study examined the relationship between anxiety and participation using parent reports for 131 children on the autism spectrum, aged 6-13 years. Hierarchical multiple regressions explored child and family factors in relation to participation in Home and Community settings. Anxiety was a unique, significant predictor of the frequency of children's participation (but not involvement in activities) in both settings, when controlling for autism characteristics, communication skills and family income. Anxiety symptomatology may contribute to the less frequent participation of children on the autism spectrum in home and community activities.

Form, Function and Feedback on the School Refusal Assessment Scale-Revised in Children on the Autism Spectrum

School refusal is more prevalent in children on the autism spectrum than among their peers. The function of school refusal can be explored using the school refusal assessment scale-revised (SRAS-R) but its relevance to children on the spectrum has not been investigated. Parents of 121 children (M age 11.9 years) on the autism spectrum completed the SRAS-R and provided feedback on it applicability. Confirmatory factor analysis suggests unsuitability of the original four-factor structure proposed for neurotypical students. Only 41.7% of parents considered the questionnaire an adequate method for reporting on school refusal in children on the autism spectrum with the majority (90%) identifying additional questions to evaluate factors associated with school refusal in autism.

The experience of participation: eliciting the views of children on the autism spectrum

PURPOSE

Children on the autism spectrum are reported to participate less in leisure activities than their peers. Little is known about what participation means for this group and the child's voice has been largely absent, partly due to methodological limitations. To address this limitation, alternative methods of eliciting children's perspectives are needed. The aim of this study is to elicit children's views about their participation experiences using a multi-method approach, and children's feedback on the method.

METHODS

Four children on the autism spectrum (9-13 years) used a video recording device to collect data over a 1-week period on their participation in activities. The children recorded an in-the-moment narrative to describe the activity and their in-the-moment experiences. A follow-up individualised interview was conducted, allowing children to present their unique views on their activity participation and feedback.

RESULTS

The children's differing perspectives identified participation as a transactional and dynamic process. Involvement was described as an individual and subjective experience, with participation influenced by personal, social, and physical factors. Children viewed the research experience positively. Recording while participating "in-the-moment" was challenging.

CONCLUSION

The first-person perspective provided unique insights into the children's participation experiences. This approach has the potential to inform methodological practices.IMPLICATIONS FOR REHABILITATIONChildren can describe their experience of participation and identify internal and external factors that influence their participation.Participation is a transactional and dynamic process.Video provides a useful method for children to record their "in the moment" experiences.Children's video recordings provide a stimulus for interview discussions in both research and clinical practice.

Activity Participation and Sensory Processing Patterns of Preschool-Age Children With Autism Spectrum Disorder

IMPORTANCE

A dearth of information is available on the relationship between activity participation and sensory processing patterns in preschool-age children with autism spectrum disorder (ASD).

OBJECTIVE

To investigate differences in activity participation and sensory processing patterns between preschool-age children with ASD and typically developing (TD) children.

DESIGN

Cross-sectional.

SETTING

Clinics, hospitals, early intervention centers, and preschools in Tainan, Taiwan.

PARTICIPANTS

Forty children with ASD and 40 TD children (ages 36-71 mo).

OUTCOMES AND MEASURES

The Childhood Autism Rating Scale (2nd ed., Standard Version), Assessment of Preschool Children's Participation, and Short Sensory Profile 2 (SSP-2).

RESULTS

Compared with TD children, children with ASD had significantly lower scores on participation diversity in activities across areas of play, physical recreation, and social activities and higher scores in each of the four sensory quadrants. For children with ASD, participation in social activities was significantly negatively correlated with SSP-2 quadrant scores.

Conclusions and Relevance

These findings have implications for how preschool-age children with ASD typically engage in daily activities and suggest that some sensory processing patterns may be associated with participation in social activities.

WHAT THIS ARTICLE ADDS

Occupational therapy practitioners can facilitate activity participation for preschool-age children with ASD by using their strengths and the activities that they find interesting; practitioners should consider the role of sensory systems to promote activity participation in natural settings.

Listening to parents to understand their priorities for autism research

Involving the autism community in research increases the real-world translation and impact of findings. The current study explored the research priorities of parents of school-aged children on the autism spectrum across the home, school, and community settings. A combination of content analysis of an online questionnaire (n = 134) and Q-sort methodology (n = 9) was used. The most commonly identified research priorities in the online questionnaire were child health and well-being (home setting), socialisation and social support (school), and community awareness and understanding of autism (community). The Q-sort method highlighted different top priorities, with understanding the parent, sibling, child and family impact and stress the highest ranked priority for home, teacher/staff education and support for the school, and recognizing and supporting anxiety for the community. The implications of the findings are discussed in relation to shifting the framework of autism research to align research agendas with parental priorities.

Exploring the Participation Patterns and Impact of Environment in Preschool Children with ASD

Participation in everyday activities at home and in the community is essential for children's development and well-being. Limited information exists about participation patterns of preschool children with autism spectrum disorder (ASD). This study examines these participation patterns in both the home and community, and the extent to which environmental factors and social communication abilities are associated with participation. Fifty-four parents of preschool-aged children with ASD completed the Participation and Environment Measure for Young Children and the Autism Classification System of Functioning: Social Communication. The children had a mean age of 48.9 (8.4) months. Patterns of participation were studied using descriptive statistics, radar graphs, and Spearman correlations. Children with ASD participated in a variety of activities at home and in the community, but showed a higher participation frequency at home. Parents identified different barriers (e.g., social demands) and supports (e.g., attitudes) in both settings. There was a moderate positive association between children's social communication abilities and their levels of involvement during participation and the diversity of activities. This study highlights the importance of social communication abilities in the participation of preschool children with ASD, and the need to support parents while they work to improve their child's participation, especially within their communities.

Parents' perceptions and concerns about physical activity participation among adolescents with autism spectrum disorder

The parents of adolescents with autism spectrum disorder have a vital and proactive role in encouraging healthy physical activity habits, and they possess important knowledge about the adolescents’ needs when it comes to enhancing participation in physical activity. But promoting healthy physical activity habits in adolescents can be difficult. The purpose of this study was thus to describe parents’ perceptions of their adolescent child’s participation in physical activity and to describe the parental role in promoting such participation. Twenty-eight parents of adolescents aged 12–16 years with autism spectrum disorder were interviewed. The interviews were analyzed using an inductive content analysis approach. The parents described how challenging participation in physical activities could be for their adolescents. Despite this, they wanted to see their children participate more in physical activity but found the promotion of physical activity to be an overwhelming task that was difficult to cope with on their own. The results reveal a need for support and collaborative efforts among different actors to give these issues increased priority in order to promote the adolescents’ physical activity participation.

Exploring Caregiver Perspectives of Social and Motor Skills in Children With Autism Spectrum Disorder and the Impact on Participation

Participation is a key aspect of quality of life and is essential for children's well-being, yet children with disabilities are at risk for lower participation in social activities. For children with autism spectrum disorder (ASD), social skills may present a significant obstacle for participation in activities of daily life; however, motor skill development may also serve an important contributing factor. Nevertheless, the link between social and motor skills in children with ASD is not fully understood. The current research implemented semistructured interviews to garner descriptive insights from caregivers (N = 17) into the social and motor skills of 5- to 9-year-old children with ASD and the impact on participation in social activities. A constant comparative method was used to generate a coherent and thematic representation of caregivers' experiences. Thematic analysis revealed core consistencies in three areas: (1) caregivers viewed participation differently than their children; (2) participation levels of children with ASD are context specific; (3) challenges with social skills were perceived to present a greater obstacle to participation than motor skills. Overall, the notion that ASD is a heterogeneous disorder was made very apparent. Although caregivers believe there to be immense value in current treatment and intervention options, the availability and access to such options was a major barrier. The effectiveness of intervention programming designed to increase participation is contingent on understanding factors that affect participation. Implications concerning caregivers' perspectives are discussed.

The Relationship between Affiliate Stigma in Parents of Children with Autism Spectrum Disorder and Their Children's Activity Participation

Children with autism spectrum disorder (ASD) are reported to participate less in everyday activities, and their parents face stigma on account of having a child with ASD, which they often internalize as affiliate stigma. Studies have examined the impact of affiliate stigma on parents’ psychological well-being and social behaviors, but little is known about how affiliate stigma impacts their children’s activity participation. This study aimed to investigate the relationship between parents’ affiliate stigma and activity participation of their children with ASD. Sixty-three parents of children with ASD (aged 2–6 years) were recruited. They completed questionnaires, which captured affiliate stigma, their child’s participation (frequency and involvement) in home, preschool, and community activities, and demographic characteristics. Results indicated that these parents had a moderate level of affiliate stigma, which did not correlate with the frequency of their children’s participation in activities. However, the parents’ affiliate stigma was found to have negative impacts on their children’s involvement in overall community participation and participation in one particular activity at home. The findings highlight the importance of destigmatization of parents of children with ASD in order to promote their children’s participation in community activities.

Exploring Anxiety at Home, School, and in the Community Through Self-Report From Children on the Autism Spectrum

Research investigating anxiety in children on the autism spectrum usually reports caregiver rather than self-report perspectives. This study aimed to document children's own descriptions of their anxiety symptomatology by combining profiles on a standardized autism-specific self-report measure of anxiety (ASC-ASD-C) with the answers from closed- and open-answer questions about anxiety across home, school, and community settings. Across the sample of 113 children on the spectrum aged 6-14 years, the two most frequently endorsed items on the ASC-ASD-C were from the Uncertainty and Performance Anxiety subscales, and the least endorsed were both from the Anxious Arousal subscale. Almost all (96.5%) of the children on the spectrum reported experiencing anxiety in at least one setting, with 40.7% reporting anxiety in all three contexts (home, school, and community). Approximately half of the sample felt their anxiety goes unrecognized by others at school and almost 60% felt it was unrecognized by others when out in the community. The proportion of children reporting having someone to help reduce their anxiety differed across home (86%), school (76%), and community (45%) settings. This highlights the importance of understanding anxiety and its impact, not only within the context of autism but also for each particular child. Autism Res 2020, 13: 603-614. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: There has been a lot of research focusing on anxiety and autism, but most of it has used parent reports, rather than asking the child themselves. This study summarizes data from 113 children on the autism spectrum, aged 6-14 years. It reports the symptoms of anxiety that these children most and least commonly experience. The results suggest only 40-50% of children feel that others are able to recognize their anxiety at school and when out in the community, suggesting that more training is needed to help adults in these settings to recognize and support anxiety.

The perspectives of parents of youth with disabilities toward physical activity: A systematic review

BACKGROUND

Parents' perceptions of physical activity (PA), in particular, are critically important because children with disabilities are often dependent on their families to be able to engage in physical activities. Thus, adapted physical activity scholars have acknowledged the need for research addressing the perceptions of parents of youth with disabilities regarding their child's PA engagement.

PURPOSE

The purpose of this review was to examine published research literature pertaining to parents' perspectives toward physical activity of youth with disabilities by describing study characteristics and major findings.

METHODS

Electronic database searches were conducted to identify relevant articles published between January 2007 and January 2018.

RESULTS

Thirty-two articles met all inclusion criteria, and relevant data such as participant characteristics, theories, measurements, and dependent variables were extracted from them. Of the 32 studies, 26 were descriptive, and six were correlational. Seventeen studies explicitly stated a theoretical or conceptual framework.

CONCLUSIONS

Major findings suggest that parents have reported multiple motives to engage their children with disabilities in physical activity. However, numerous barriers (e.g., lack of program, lack of time, children's disability) were reported that negatively impact physical activity participation. As such, parents are calling for the need for training provided by qualified professionals to enhance participation for their children with disabilities.

Investigating the participation of children on the autism spectrum across home, school, and community: A longitudinal study

BACKGROUND

The World Health Organization recognizes that meaningful participation in one's community empowers individuals. Children and adolescents on the autism spectrum consistently report lower participation than their typical peers in activities, and this appears to continue into adulthood. The aim of this study was to investigate the participation of children on the autism spectrum over a 3-year period across home, school, and community.

METHOD

Caregivers of 84 participants aged 9-10 years at Year 1 completed the Participation and Environment Measure for Children and Youth (PEM-CY) at three annual data collection points. The PEM-CY is a 25-question measure of the child's level of involvement in home, school, and community activities. Distribution frequencies were calculated for each time point.

RESULTS

Although participation in the majority of items across home, school, and community remained stable, the longitudinal data suggest that children change the types of socializing activities across time. Over the 3 years, there was a decline in physical activity (both organized and unstructured) and in participation in school activities.

CONCLUSION

This decline in participation as children move into adolescence is concerning. Further, reduced participation at this phase of development may potentially limit future participation opportunities throughout adolescence and into adulthood. Further exploration of the participation trajectories of children on the autism spectrum is needed.

Participation patterns of adolescents with autism spectrum disorder compared to their peers: Parents’ perspectives

Introduction

Although participation is an important outcome of rehabilitation interventions and a critical indicator of quality of life, few studies have focused on the participation patterns of adolescents with autism spectrum disorder in their daily activities or the environmental factors that influence such participation. This study aims to describe the participation characteristics of adolescents with autism spectrum disorder compared with typically developing peers in home, school and community and to identify supporting or hindering environmental features.

Method

The Participation and Environment Measure for Children and Youth was administered to 59 parents of adolescents ( M = 14.51 years) with autism spectrum disorder and a control group of 188 parents of typically developing adolescents in Israel, and the results were compared.

Results

Adolescents with autism spectrum disorder showed lower participation levels at home and school, and much lower levels in the community, preferring solitary activities that involve technology. Their typically developing peers participated in more activities that involved social interaction skill. In addition, parents of adolescents with autism spectrum disorder rated more environmental factors as barriers in all environments.

Conclusion

Participation gaps between adolescents with autism spectrum disorder and their typically developing peers should be considered when developing interventions, allocating services and creating policies to meet the unique needs of adolescents with autism spectrum disorder.

The Interdependence of Motor and Social Skill Development: Influence on Participation

Participation is a major outcome area for physical therapists serving young children with disabilities. Contemporary models of disability such as the International Classification of Function, developmental theories such as the system perspective, and evidence-based early childhood practices recognize the interdependence of developmental domains, and suggest that change in 1 area of development influences change in another. Physical therapy provided in naturally occurring activities and routines, considered the preferred service delivery method, promotes participation of young children with disabilities. Research indicates that: (1) children develop skills, become independent, and form relationships through participation; and (2) with developing skills, children can increasingly participate. The purpose of this Perspective article is to synthesize the literature examining the relationship between motor skill development and the social interaction dimension of participation in young children. Current research examining the influence of motor skill development on social interactions in children with autism spectrum disorder will be discussed, exemplifying the interdependence of developmental domains. Implications for physical therapist practice and recommendations for future research are provided.

Development and psychometric evaluation of the Chinese version of the Participation and Environment Measure for Children and Youth

Purpose: To adapt the Participation and Environment Measure for Children and Youth for use with Chinese children and youths, and to investigate its psychometric properties.Materials and methods: The Participation and Environment Measure for Children and Youth was translated into Chinese using a cultural adaptation process. Parents of 69 children aged 5-12 years with disabilities and 319 children without disabilities completed the questionnaires. Internal consistency, test-retest reliability, factorial structure, and known-group validity were examined using Cronbach's alpha, intraclass correlation coefficient, confirmatory factor analysis and t-test, respectively.Results: We added and/or replaced activities with culturally-relevant activities in the Chinese version. Internal consistency was acceptable for most of the scales (0.55-0.86). Test-retest reliability of the summary scores was moderate to high (0.70-0.84). Data-model fit was confirmed in a one-factor structure for the participation scales and a two-factor structure for the environment scales. There were also significant differences in the summary scores between 65 gender- and age-matched pairs of children with and without disabilities on the school participation scales and all the environment scales.Conclusion: This study provides psychometric evidence supporting the use of the Participation and Environment Measure for Children and Youth to assess Chinese children's participation and environmental supports/barriers.Implications for rehabilitationThe Chinese version of the Participation and Environment Measure for Children and Youth was developed through a rigorous translation and cultural adaptation process.There is evidence for the reliability (internal consistency and test-retest reliability) and construct validity (factorial structure and known-group validity) of the Chinese version of the Participation and Environment Measure for Children and Youth.The Chinese version of the Participation and Environment Measure for Children and Youth can be used to assess children's participation in home, school and community settings and to identify environmental barriers that require further intervention.

Participation, supports, and barriers of Korean children and youth with and without disabilities in the school environment

Background: This study compared participation patterns of Korean children with and without disabilities at school and examined perceived environmental supports and barriers to their school participation.Methods: One hundred eighty four parents of Korean children, aged 5 to 13 years, with and without disabilities completed the Korean Participation and Environment Measure for Children and Youth. The item-level scores of Korean Participation and Environment Measure for Children and Youth were compared between children with and without disabilities using Analysis of covariance and Pearson chi-square tests.Results: In comparison with typically developing children, children with disabilities were less frequently participated and involved and their parents were more likely to desire the change of children's participation in all school activities. Parents of children with disabilities reported that child's physical, cognitive, and social demands, relationship with peers, programs and services, policies and procedures, and money are environmental barriers and personal and public transportation are environmental supports to school participation.Conclusions: Findings help to better understand school participation patterns of Korean children with disabilities and environmental supports and barriers to their participation. The knowledge can be used to support collaboration among school-related professionals for successful participation of children with disabilities at school.Implications for rehabilitationParents of children with disabilities need to focus on both how many times their children participate in school activities and how they get involved in those activities.Educators and therapists should consider in which types of change in school participation parents of children with disabilities are interested to select target activities and to modify them for successful school participation.Educators, therapists, and parents of children with disabilities should analyze the poor fits between functional limitation of children with disabilities and the physical, cognitive, and social demands of school activities for successful school participation.Using information about school participation patterns and environmental supports/barriers can support to better understand children with disabilities and strengthen partnerships among educators, therapists, and parents of children with disabilities for successful inclusion into school contexts.

Participation profiles and the barriers and facilitators that impact on participation of children with Autism Spectrum Disorders living in regional and remote Western Australia

BACKGROUND

Autism Spectrum Disorder (ASD) is a heterogeneous condition, influencing participation in activity and occupation. Approximately, 1% of Australian children have an ASD diagnosis, with many of these families living in remote and regional areas. Given the environments role in facilitating or hindering participation, there is a need to understand how geographical location impacts the participation profiles of children with ASD.

OBJECTIVE

This study aims to describe the participation profiles, and environmental barriers and facilitators to participation for children with ASD living in regional or remote Western Australia.

METHODS

A total of 32 families completed a questionnaire pack including a socio-demographic questionnaire and the Participation and Environment Measure - Children and Youth.

RESULTS

Children with ASD had reduced participation in community activities. Within the home, children most commonly participated in computer and video games, and in school settings, children participated rarely in non-classroom and extracurricular activities. Parents reported a desire for their children to decrease time spent engaging in video games and increase time spent in the community, socializing, engaging in extracurricular activities, and completing chores. Parents reported a number of barriers to participation across community, home, and school settings.

CONCLUSION

Children with ASD living in regional areas had restricted participation profiles and a number of barriers to participation as reported by their parents. There is a need for additional support and services in non-metropolitan areas for families of children with ASD to increase participation. This study also highlights the need to expand the definition of participation in the International Classification of Functioning, Disability and Health to include aspects of involvement.