Psychosocial determinants of out of school activity participation for children with and without physical disabilities

Parent perceptions of cycle training for children with special education needs and disabilities: What drives intention to cycle?

Background

Young people with Special Educational Needs and Disabilities (SEND) are especially vulnerable to physical inactivity. Research has demonstrated the effectiveness of tailored cycle training for children with SEND, however, it is unclear whether this then results in a greater uptake of cycling.

Aims

To determine parent based perceptions of a SEND cycle training programme, factors which predict intention to cycle more and ongoing barriers to cycling.

Methods

A tailored questionnaire was distributed to parents of children who took part in the cycle training.

Results

Parents reported increased confidence in their child's ability to cycle independently with many also highlighting improvements in confidence and resilience. The outcome of the cycle training (level of enjoyment and change in cycling ability) had a positive influence on intention to cycle more while cycling frequency prior to training had a negative influence. Continuing barriers to cycling were identified which included difficulties accessing specialised equipment and a need for additional on-road cycle training.

Conclusions and implications

This study demonstrates the success of a specialised cycle training programme for children with SEND in terms of improvement to cycling and influences on the intention to cycle more.

Impact of adapted bicycle riding on outcomes for children and adolescents with disabilities: A systematic review

AIM

To review the evidence for the effects of adapted bicycle riding on body structures and functions, activity, participation, and quality of life outcomes in children with disabilities, along with family-level participation outcomes.

METHOD

A systematic review with searches of nine electronic databases to identify studies involving participants with a developmental disability aged 4 to 18 years who used a dynamic adapted bicycle was completed in August 2021. Risk of bias was assessed based on individual study designs. A narrative synthesis integrated the findings of the included studies. Certainty of evidence was synthesized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Ten studies were included with 234 participants. Five studies reported outcomes at the body structures and functions level, ten reported activity-level outcomes, two reported participation-related outcomes, and none assessed quality of life or family participation in social and recreational activities.

INTERPRETATION

Adapted bicycle riding interventions may improve gross motor function, enhance lower-limb muscle strength, and promote physical activity; however, certainty of evidence of effects was rated very low using GRADE. Further research is required to understand the impact of adapted bicycle riding on the participation outcomes of children and adolescents with disabilities and on family-level participation in social and recreational activities.

WHAT THIS PAPER ADDS

Adapted bicycle riding interventions may improve motor functions and physical activity. Evidence about participation outcomes after adapted bicycle riding is limited. Research on adapted bicycle riding interventions in natural settings is needed.

Trajectories of participation, mental health, and mental health problems in adolescents with self-reported neurodevelopmental disorders

PURPOSE

Having a neurodevelopmental disorder (NDD) increases the risk of mental health problems and lower participation. We investigated the trajectories of mental health problems and participation in adolescents with NDD and compared these with trajectories for peers without NDD. In addition, the relationship between participation, mental health (well-being), and mental health problems were investigated.

MATERIALS AND METHODS

Data from a Swedish longitudinal survey study (LoRDIA) was used and adolescents with and without self-reported NDD were followed from 12/13 to 17 years, in three waves. Mental health problems were measured using the Strength and Difficulties Questionnaire, and well-being was measured with the Mental Health Continuum short form.

RESULTS

Adolescents with NDD experience more mental health problems than adolescents without NDD. Hyperactivity, a key feature of NDD, remains stable, while emotional problems and psychosomatic complaints, increase over time for girls, independent of NDD. Participation is stable over time but is more related to well-being than to NDD or mental health problems.

CONCLUSIONS

Gender is an important factor with girls exhibiting more problems. Mental health explains more of the variation in participation than mental health problems and NDD. Probably participation intervention can enhance mental health which may protect from mental health problems.Implications for rehabilitationMental health, i.e., emotional-, social-, and psychological well-being is more strongly related to participation and to reduced levels of mental health problems than having an NDD or not, thus assessing mental health separately from measuring NDD is important.Interventions focusing on participation may lead to higher mental health and having high mental health (flourishing) may facilitate participation.Girls with self-reported NDD seem to have a higher burden of mental health problems, especially if they also are languishing, i.e., having low mental health, therefore a strong focus on this group is needed both in research and clinical practice.Half of all adolescents are flourishing, independently of NDD or not, even if they are experiencing some symptoms of mental health problems, adolescents with NDD who are also languishing, have much higher ratings of mental health problems.

We’ve been Offering It for Years, But Why Do They Come? The Reasons Why Adults Bring Young Children to Public Library Storytimes

While storytime programs for preschool children are offered in nearly all public libraries in the United States, little is known about why adults choose to bring children to participate. This survey study gathered information from 346 parents and caregivers who attended storytime programs at 35 public libraries in three states. Parents and caregivers indicated child enjoyment of hearing stories and participating in activities and the opportunity for children to interact as the primary reasons for attending; however, differences in motivation to attend were noted by community density, relationship to the child, educational level of the adult, and length of attendance. In addition to identifying those aspects of storytimes that resonate most for children and building upon them, librarians should integrate cooperative activities that facilitate interaction. Further, librarians should take stock of their own contexts and modify programs to best address the needs of their specific community.

Longitudinal Trends of Participation in Relation to Mental Health in Children with and without Physical Difficulties

Children with physical disabilities (PD) are known to have participation restrictions when in inclusive settings alongside typically developing (TD) children. The restrictions in participation over time may affect their mental health status. This study aimed to investigate the longitudinal relationship between independence in activities (capability) and frequency of attendance in activities, in relation to perceived mental health status in children with and without PD. The participants were a convenience sample of parents of 77 school children with PD and 94 TD children who completed four assessments with a one-year interval between each assessment. Parents of these children were interviewed with the Functioning Scale of the Disability Evaluation System-Child version (FUNDES-Child). Three dimensions of mental health problems-loneliness, acting upset, and acting nervous-were rated by parents with the Child Health Questionnaire (CHQ). Linear trend was tested by repeated-measure ANOVA. The results revealed different longitudinal patterns of independence and frequency of attendance over time for children with PD and TD. Frequency of attending activities may be more important than independence in performing activities for experiencing fewer mental health problems. The findings highlight the need for supporting children's actual attendance in daily activities which may benefit their later mental health.

Perceptions of Physical Activity Participation Among Adolescents with Autism Spectrum Disorders: A Conceptual Model of Conditional Participation

Adolescents with an autism spectrum disorder (ASD) are less physically active compared to typically developing peers. The reasons for not being physically active are complex and depend on several factors, which have not been comprehensively described from the adolescent’s perspective. Therefore, the aim was to describe how adolescents with an ASD perceive, experience and reflect on their participation in physical activity. Interviews with 24 adolescents diagnosed with high-functioning ASD, aged 12–16 years, were analysed with qualitative content analysis with an inductive approach. They expressed a variety of reasons determining their willingness to participate, which were conceptualized as: Conditional participation in physical activities. The present study presents an alternative perspective on participation in physical activity, with impact on intervention design.

Family factors associated with participation of children with disabilities: a systematic review

AIM

The aim of this review was to synthesize empirical evidence of family factors associated with participation of children with disabilities aged 5 to 12 years to inform the development of family-centred participation-fostering interventions.

METHOD

A systematic search was performed for articles published in English between 2001 and 2017 in MEDLINE, PsycINFO, CINAHL, Scopus, and ASSIA following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality of evidence was appraised using the Research Triangle Institute Item Bank. Family factors associated with participation were identified and assessed using a multistage 'semi-quantitative' approach.

RESULTS

Thirty studies were included in the review. Four non-modifiable 'status' factors consistently associated with participation were parental ethnicity, parental education, family type, and family socio-economic status. Six modifiable 'process' factors with consistent associations with participation were parental mental and physical health functioning, parental self-efficacy beliefs, parental support, parental time, family preferences, and activity orientation.

INTERPRETATION

Rehabilitation professionals should direct their focus towards modifiable family factors as primary targets for family-centred interventions. Strategies that can improve families' access to information, counselling, and community support services are likely to support children's participation by empowering families and optimizing their health and well-being.

WHAT THIS PAPER ADDS

Non-modifiable 'status' and modifiable 'process' factors are important in participation of children with disabilities. Disadvantaged family circumstances shaped by status factors are associated with reduced participation. Key process factors for intervention are parental mental and physical health and parental self-efficacy beliefs. Other important process factors for intervention are parental support and time, family preferences, and activity orientation.

Physical Activity of Children with Physical Disabilities: Associations with Environmental and Behavioral Variables at Home and School

The purpose of this study was to examine the physical activity (PA) of children with physical disabilities (PD) and its associated environmental and behavioral factors at home and at school. One hundred and forty-seven Hong Kong children (mean age = 13.5 ± 2.5 years) with PD from three special schools participated. We used BEACHES (Behaviors of Eating and Activity for Children's Health: Evaluation System) to assess their PA and associated variables at home (before dinner) and during four school settings (before classes, recess, lunch breaks, after classes) on four school days. Overall, the children were typically inactive and spent little time in moderate-to-vigorous physical activity (MVPA), range = 6.3% to 17.0% across settings. At home, children were more active when fathers were present (p < 0.001). At school, prompts to be active contributed to their MVPA% before classes (p < 0.01) and during recess and lunch breaks (both p < 0.001). The presence of a child's mother was positively associated with MVPA% before classes (p < 0.001) and the presence of other children was associated with MVPA% during recess and lunch breaks (both p < 0.05). With children with PD accruing small amounts of MVPA in both home and school settings, multifaceted interventions reflecting both contextual and personal factors should be considered in order to increase the health-enhancing PA of this population.

Characteristics Influencing Diversity of Participation of Children in Activities Outside School

OBJECTIVE

A cross-sectional survey was conducted to determine which personal and environmental characteristics influenced diversity of participation in activities outside school for typically developing children and adolescents.

METHOD

Four hundred twenty-two (215 boys) typically developing Australian children (mean = 11.0 yr) completed the Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activity of Children to describe their participation on five activity types: Recreational, Active Physical, Social, Self-Improvement, and Skill-Based. Linear regression analyses were conducted.

RESULTS

Predictors of participation diversity were age and preference for Recreational (_aR² = .44); preference for Active Physical (_aR²= .19); gender, school type, and preference for Social (_aR² = .19); preference for Skill-Based (_aR² = .25); and gender, school style, socioeconomic score, and preference for Self-Improvement (_aR² = .24).

CONCLUSION

Preference plays a key role in determining the diversity of participation in activities outside school.

ParticiPAte CP: a protocol of a randomised waitlist controlled trial of a motivational and behaviour change therapy intervention to increase physical activity through meaningful participation in children with cerebral palsy

INTRODUCTION

Children with cerebral palsy (CP) participate in leisure-time physical activities (PA) less often, with less intensity and reduced diversity than their typically developing peers. Participation in leisure-time physical activities may be an important source of habitual physical activity (HPA) for children with CP, who as a group have lower levels of HPA and increased sedentary time compared with their typically developing peers. The proposed study aims to compare the efficacy of a participation focused therapy (ParticiPAte CP) to usual care in a pragmatic, randomised waitlist controlled trial.

METHODS AND ANALYSIS

Thirty-six children with CP (18 in each group), classified as Gross Motor Function Classification System levels I to III, aged between 8 and 12 years will be recruited across South East Queensland, Australia. Children will be randomised to receive either ParticiPAte CP or waitlist usual care using concealed allocation. ParticiPAte CP is an individually tailored, goal-directed intervention model of pragmatic participation-focused therapy using a toolbox of evidence-based strategies in the treatment of children with CP. This will include goal-setting; identification of barriers and facilitators to participation goals, strategy formation and planning and communication guided by principles of Self-Determination Theory using strategies of Motivational Interviewing. The intervention comprises 8 weekly sessions of 1 hour duration conducted by a physiotherapist in the child's home or community.

TRIAL REGISTRATION NUMBER

ACTRN12615001064594.

Children with Physical Disabilities at School and Home: Physical Activity and Contextual Characteristics

The purpose of this study was to assess the physical activity (PA) of children with physical disabilities (PD) in school and home settings and to simultaneously examine selected contextual characteristics in relation to PA in those settings. Children with PD (N = 35; Mean age = 15.67 ± 4.30 years; 26 boys) were systematically observed using BEACHES (Behaviors of Eating and Activity for Children’s Health: Evaluation System) at school (before school, recess, lunch break, after class) and at home (before dinner) during four normal school days. The children spent most of their time in all five settings being physically inactive, but had slightly more PA during recess and lunch break periods. Hierarchical multiple regression revealed that selected contextual characteristics explained 18.9–56.0% (p < 0.01) of the variance predicting moderate-to-vigorous physical activity (MVPA) after controlling for demographic variables. Prompts to be active were positively associated with MVPA at school and the presence of fathers and fathers being motivators at home. This study highlights how little PA that children with PD receive and identifies the importance of the provision of prompts for PA at both school and home with this special population.

Leisure participation-preference congruence of children with cerebral palsy: a Children's Assessment of Participation and Enjoyment International Network descriptive study

AIM

To examine participation-preference congruence, regional differences in participation-preference congruence, and predictors of whether children with cerebral palsy participate in preferred activities.

METHOD

The sample (n=236) included 148 males and 88 females aged 10 to 13 years, living in Victoria, Australia (n=110), Ontario (n=80), or Quebec (n=46), Canada. Ninety-nine (41.9%) were classed at Gross Motor Function Classification System (GMFCS) level I; 89 (37.7%) at GMFCS level II/III; and 48 (20.3%) at GMFCS level IV/V. Participants completed the Children's Assessment of Participation and Enjoyment and Preferences for Activity of Children questionnaires. Regional comparisons were performed using one-way analyses of variance and factors influencing participation-preference congruence were explored using multiple linear regression.

RESULTS

The proportion of children doing non-preferred activities in each activity type was generally low (2-17%), with only one regional difference. Higher proportions were not doing preferred active physical (range 23.2-29.1% across regions), skill-based (range 21.7-27.9% across regions), and social activities (range 12.8-14.5% across regions). GMFCS level was the most important predictor associated with not doing preferred activities.

INTERPRETATION

Children with cerebral palsy did not always participate in preferred active physical and skill-based activities. Understanding discrepancies between preferences and actual involvement may allow families and rehabilitation professionals to address participation barriers.

Predictors of Obesity in a US Sample of High School Adolescents With and Without Disabilities

BACKGROUND

Childhood obesity is a major public health concern. Children with disabilities have a higher prevalence of obesity.

OBJECTIVE

We examined factors associated with obesity within a cross-sectional study of US adolescents with and without disabilities.

METHODS

Data were obtained from the 2011 Youth Risk Behavior Survey. Logistic regression models were fitted to assess effects of dietary habits, physical activity, and unhealthy weight control behaviors on obesity. Effect modification by disability status was examined.

RESULTS

Twenty percent (1986 of 9775 participants) reported a disability. Adolescents with disabilities were more likely to be obese (odds ratio [OR] = 1.7; 95% confidence interval [CI]: 1.3-2.1) and have at least 1 unhealthy weight control behavior (OR = 2.0; 95% CI: 1.6-2.5), and were less likely to be physically active (OR = 0.5; 95% CI: 0.4-0.6). Lack of physical activity, increased television watching/video game playing, and unhealthy weight loss behaviors were significantly associated with obesity regardless of disability status (p-for-interaction >.05).

CONCLUSIONS

Successful obesity interventions should target diet, physical activity, and weight control among adolescents with disabilities. Understanding barriers to healthier diet and physical activity for this population is critical to developing effective obesity prevention programs and reducing the prevalence of unhealthy weight control behaviors.

Correlates of physical activity in children and adolescents with physical disabilities: A systematic review

BACKGROUND

The benefits of physical activity (PA) for children with disabilities are well documented, and children with physical disabilities (PD) are often less active than peers with other disability types. Various correlates associated with PA in children with PD have been identified in separate studies, and a thorough analysis of these correlates could aid in understanding and designing interventions that promote children with PD to be more physically active. The purpose of this systematic review was to provide a comprehensive summary of the correlates of PA in children with PD.

METHOD

A systematic search using PubMed, CINAHL, Cochrane Library, PsychINFO, Eric, and EMbase was initiated in October 2014 to identify studies examining the correlates of PA in children with PD aged 6-18years. Two researchers independently screened studies, assessed their methodological quality, and extracted relevant data. The correlates were synthesized and further assessed semi-quantitatively.

RESULTS

A total of 45 articles were included in the detailed review. Several modifiable physical, psychological, and environmental correlates were consistently and positively associated with PA in children with PD. Some non-modifiable correlates (e.g., intellectual ability, parents' ethnicity) were found to be consistently and negatively associated with PA.

CONCLUSIONS

The correlates of PA in children with PD are multifaceted and along many dimensions. This review can have implications for future studies and these may confirm the consistency of variables related to PA. Insights derived from the outcomes may also foster the measurement of the magnitude of associations that could assist the development of future interventions.

Elements contributing to meaningful participation for children and youth with disabilities: a scoping review

PURPOSE

To synthesise research literature describing elements of community recreation and leisure activities that create meaningful participation experiences for children and youth with disabilities.

METHOD

Database searches of Medline, Embase, PsycINFO, ERIC, SportDiscus, CINAHL, Scopus and Web of Science were conducted. Studies describing the experience of participating in a community-based programme or activity from the perspectives of children and youth with a disability aged 0-21 or their parents, and published in English were included. Meta-ethnography was used to synthesise qualitative data, and resulting themes were conceptualised in the International Classification of Functioning, Disability and Health-Child and Youth version. Consultation with stakeholders occurred throughout the review process.

RESULTS

The search identified 9544 articles, of which 20 were included for review. Ten elements contributing to meaningful participation experiences were identified and organised as follows: person-based elements (n = 5; having fun, experiencing success, belonging, experiencing freedom, developing an identity); environment-focused elements (n = 4; authentic friendships, the opportunity to participate, role models, family support) and activity-related elements (n = 1; learning).

CONCLUSIONS

Elements contributing to meaningful leisure participation are interrelated. This review reveals the substantial contribution that meaningful interactions and relationships have in creating and facilitating positive and engaging experiences. Outcomes of this review may assist professionals in the design of targeted interventions to facilitate leisure participation. Implications for Rehabilitation Elements identified in this review may operate as core components of interventions that aim to optimise participation outcomes in community-based leisure activities. Supportive relationships and the availability of services are specific aspects of the environment that needs to be considered by health professionals to facilitate meaningful participation. Understanding the perspectives of the child is critical for assessing needs, preferences and goals relating to leisure participation in the community.

A descriptive study of the participation of children and adolescents in activities outside school

BACKGROUND

Knowledge about patterns of participation can be used to highlight groups of children and adolescents with low attendance, or low involvement in activities and who may therefore be at risk of mental or physical health concerns. This study used the Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activity of Children (PAC) to describe the patterns of participation of children and adolescents in activities outside mandated school in Victoria, Australia.

METHODS

A cross-sectional survey of Victorian children and adolescents was conducted. Eligible participants were aged 6 to 18 years, enrolled in mainstream schools, with sufficient English language skills to complete the questionnaires. Parents of participants completed a demographic questionnaire. Sample representativeness was assessed against Victorian population statistics for gender, school type, language spoken at home and socio-economic status. Data for the CAPE and PAC were summarised using descriptive statistics. Patterns of activity diversity by age were assessed using curve estimation, with additional analyses to describe differences between genders.

RESULTS

Of 9337 potential participants targeted through school advertising, 512 agreed (5.5 % consent rate), and 422 questionnaires were returned (82.4 % response rate). The sample was representative in terms of gender and language. Compared to the Victorian population, a slightly higher proportion of participants attended Government and Catholic schools and there was evidence of marginally greater socioeconomic resources than the population average. A broad range of recreational, active physical, social, skill-based and self-improvement activities were completed by all age groups. There was a reduction in the number and enjoyment of recreational activities with increasing age. In contrast, there was relative stability in intensity, frequency and preference scores across the age-groups for all activity types. Female participants typically took part in more activities (higher diversity scores), more intensely, with higher enjoyment and had higher preferences for each activity type than males, with the exception of active physical activities.

CONCLUSIONS

This study provides evidence of the participation patterns of typically developing children and adolescents in activities outside school. The findings have implications for researchers, clinicians and educators for comparative purposes and to inform future research.

'Participation': a systematic review of language, definitions, and constructs used in intervention research with children with disabilities

AIM

Improving participation of children with disabilities is a priority; however, the participation construct lacks clarity. This systematic review investigated how researchers defined 'participation' and the language used in participation intervention research.

METHOD

Nine health and education databases were searched for intervention studies of children with disabilities that included a participation outcome. Quantitative data were extracted using a customized form, and participation text data were extracted verbatim. Themes were derived using a thematic coding approach. These participation themes were applied to the outcome measures used in the included studies to compare participation language with the methods used to quantify participation changes.

RESULTS

Of the 2257 articles retrieved, 25 were included in this review. Five participation themes and nine subthemes were developed. Two themes, attendance and involvement, were directly related to the participation construct. Three additional themes described related concepts: preferences, activity competence, and sense of self.

INTERPRETATION

Attendance and involvement seem to describe the essence of the participation concept. The related themes may provide important avenues to enhance participation outcomes. This review highlighted the need for researchers to define the construct under investigation clearly and select measures carefully, as measurement choice is the mechanism through which the concept is operationalized in research.