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A Study on the Level of Participation and Influencing Factors of School-aged Children and Adolescents with Disabilities
Kim, Ah-Ram
1, Park, Hae Yean
2, Kim, Jung-Ran
3, Park, Ji-Hyuk
4*1Department of Occupational Therapy, Graduate, Yonsei University
2Depaertment of Dementia Prevention and Rehabilitation, College of Human Service, Catholic Kwandong University
3, 4Department of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University
*Corresponding author: [email protected] ABSTRACT
Aim: To indentify the participation level of school- aged disabled children and adolescents in the Republic of Korea and investigate the factors influencing their participation.
Methods: Participants were 72 disabled children and adolescents aged 8-19, living in the community. Open- ended questionnaires, organized by researchers, were used to investigate personal factors. The Family Assessment Device and the Child and Adolescent Scale of Participation (Korean version) were used to evaluate family functions and the level of participation and environmental factors, respectively. Data analysis included correlation analysis and stepwise multiple regression analysis through the SPSS Version 21.0.
Results: The home-participation regression model included family function and educational environment as significant influence factors. The community-participation regression model included family function and the educational environment as significant influence factors. The school-participation regression model included family function while the family and community activities regression model included the educational environment and family function as significant influence factors.
Conclusion: This study means that Korea provided basic data that can be used in clinical sites for occupational therapy. Therefore, the results of this study are expected to provide useful data for clinical and research purposes in Korean occupational therapy.
Keywords
Adolescent; CASP; Children; Participation; Participation factor
Introduction
Participation is considered key to children's development, health, and quality of life [1]. It helps children form friendships, develop skills and abilities, express creativity, and achieve mental and physical health [2]. It also offers children the opportunity to learn and develop their social skills through a variety of adult-child and peer interactions [3]. On the other hand, disabled children, as compared to their normal peers, have a reduced frequency of participation and diversity of activities, and perform activities in relatively narrow areas based on informal or home- based activities [4]. As a result, disabled children lack the benefits of participation [5].
Family functions are important for the participation of school-age children and adolescents. A family is a complex network that, upon birth and within a family member, grows into an individual, and also interacts depending on the family and environment [6]. For children, a family is the most important and closely connected social environment that divides physical and psychological space. This promotes children’s activities and has an important influence on the formation of their self-concepts and development of self-awareness, social responsibility, and learning [7]. For children and adolescents, families are important candidates for participation in activities [8-9]. Family values and preferences play an important role in the types and frequency of activity participation by children and adolescents [9, 10].
A family function is to reduce the stress situation, and families with high family functions form a family bond and can cope with and overcome the family crisis [11]. However, families with disabilities function at a low level throughout the sub-area of family functions, including problem-solving, communication, roles, affective responsiveness, behavioral control, and general functions [12]. As a result, failure to maintain a family function affects the entire family and results in negative changes in family balance and child activity [13]. On the other hand,
the higher the family function of a disabled child, the lower the burden of disability and, the higher the quality of life, and the more the emotional support, the more the child's stress is mediated, and activity is promoted [14].
Prior studies have found that participation is influenced by personal, family, and environmental factors. The personal factors include age, gender, diagnosis and education levels. Family factors include family income and family functions. The environmental factors include environmental resources and environmental support [5, 15-18].
However, these studies included subjects living in a particular country or region. Further research examining other dimensions of influence not previously studied, should be conducted in countries or regions where no research has been conducted, to narrow the differences in geographical and cultural backgrounds [5].
Prior research suggests that the higher the motor function of children in individual factors, the more frequently female children participated in various activities [19]. The study on family factors showed that children with higher family incomes participated in play and development activities [20]. The older an individual gets, the more frequently one has to engage in home activities, including leisure activities, transportation, and housework [17].
Moreover, children showed high participation when families preferred to participate in activities [21]. In the study on environmental factors, the higher the support of physical and environmental factors, the higher the participation in activities, play, and transportation in the community [19, 22]. Environmental factors consist of environmental resources and environmental support. Environmental resources include the physical environment, buildings, topography, accessibility and equipment. Environmental support includes a system for transport [22].
In Korea, research is being conducted on children's participation assessment tools and participation however, there is a lack of research directly examining the factors influencing the participation of disabled children and adolescents.
Studies investigating the influencing factors require more research in diverse situations and settings to narrow the differences in regional and cultural backgrounds. It is necessary to check whether the factors identified in the overseas studies are appropriate for the Korean situation. Therefore, the purpose of this study proposed to identify the level of participation of disabled children and adolescents aged 8-19 years in Korea and investigate the impact factors affecting their participation level.
Methods
Participants and Procedure:
Participants were children and adolescents recruited from the Republic of Korea. The inclusion criteria were: (a) aged 8-19 years and parents provided consent, (b) diagnosed with developmental problems, (c) have no health problems such as seizure, and (d) are in a treatment institution and live in the community. Initially, the therapists at the rehabilitation hospital approached the families to provide information about the study and obtain their permission.
After obtaining consent, parents completed a set of three questionnaires, as described below. The Y University Institutional Review Board approved this study.
Measures:
Personal factors and family factors were measured using a closed-ended questionnaire. The closed-ended questionnaire organized for research purposes by researchers was used to obtain data regarding participants’ socio- demographic information, personal factors, and family factors. Personal factors included questions concerning gender, age, level of education, and disability types. Family factors consisted of questions about family relationships, family income, and residence.
The family function was measured using the Family Assessment Device (FAD) [23]. The FAD is a 60-item self- report or parent-report questionnaire that assesses of family function (e.g., problem-solving, communication, roles) on 4-point Likert scale, from 1 being "strongly agree" to 4 being "strongly disagree". The higher the score, the lower the family function. The FAD has demonstrated good reliability (test-retest reliability of 0.71) and good consistency (internal consistency of 0.78).
Participation factors and environmental factors were measured using the Child and Adolescent Scale of Participation (CASP) [24]. The CASP specifically measures children’s extent of participation and restrictions in home, school and community life situations and activities compared to same-age peers as reported by family caregivers. It comprises 20 items divided into four sub-sections: (1) Home Participation, (2) School Participation, (3) Community Participation, and (4) Home and Community Living Activities. Each item addresses a broad participation domain with examples provided for each domain. The 20 items are rated on a 4-point scale (4=Age expected, 3=Somewhat restricted, 2=Very restricted, 1=Unable) or as ‘Not applicable.’. The higher the score, the higher the participation.
http://annalsofrscb.ro 16665 The FAD has demonstrated good reliability (intraclass correlation coefficient = 0.94) and good consistency (internal consistency of α ≥ 0.96).
Data Analysis
Data were analyzed using SPSS 21.0 (Statistical Package for Social Science 21.0). The participants' personal factors, family factors and their correlations with participation were analyzed. Personal factors, FAD total scores, and CASP scores were analyzed using the Pearson Correlation. Personal factors (educational environment, disability types) and family factors (family functions, family income) were found to be significantly correlated. Stepwise multiple regression analyses were conducted to determine how personal, family and environmental factors influenced participation. Initial examination of simple correlations revealed that gender, age, and environmental factors did not have a significant association with any participation outcome and, therefore, were not entered into the models. The regression model examined each aspect of participation. An overall R² was reported (in percentage) to evaluate the extent to which the examined variables could explain the variance of participation.
Results
Participant Characteristics:
As shown in Table 1, of the 80 consenting families, 72 returned the questionnaires to the researcher resulting in a total return rate of 90%. Participants included 44(61.1%) and 28(38.9%) male and female children and adolescents, respectively. Participants’ average age was 12.72±3.29 years. The educational environment included 43 (59.7%) ordinary schools and 29 (40.3%) special schools. The most commonly reported type of disabilities included cerebral palsy (29.2%), followed by intellectual disability (27.8%), autism spectrum disorder (16.7%), developmental disability (15.3%) and other disability (11.1%).
Table 1. Participant characteristics (N=72)
. N %
Gender
Male 44 61.1
Female 28 38.9
Age (years)
8-10 23 31.9
11-13 18 25.0
14-16 17 23.6
17-19 14 19.4
Mean(M±SD) 12.72±3.29
Educational environmental
Ordinary school 43 59.7
Special school 29 40.3
Disability type
Cerebral palsy 21 29.2
Developmental disability 11 15.3
Intellectual disability 20 27.8
Autism spectrum disorder 12 16.7
Other disability 8 11.1 The CASP score according to participant’s general characteristics:
As shown in Table 2, the average participation score for all participants was 62.31 points. Concerning gender, male (62.76 points) children and adolescents scored higher on average than female (61.61 points) children and adolescents.
Concerning age, groups aged 8~10 years (66.09 points) had the highest average scores, followed by those aged 17-19 (63.04 points), 14-16 (61.62 points), and 11-13 (57.57 points) years. Regarding the educational environment, ordinary schools (70.55 points) scored higher than special schools (50.09 points). In disability types, cerebral palsy (69.70 points) had the highest average score, followed by other disability (69.69 points), developmental disability (67.27 points), intellectual disability (59.19 points), and autism spectrum disability (45.10 points).
Table 2. The CASP score according to participant's general characteristics (N=72)
Mean score Gender
Male 62.76
Female 61.61
Age (years)
8-10 66.09
11-13 57.57
14-16 61.62
17-19 63.04
Educational environmental
Ordinary school 70.55
Special school 50.09
Disability type
Cerebral palsy 69.70
Developmental disability 67.27
Intellectual disability 59.19
Autism spectrum disorder 45.10
Other disability 69.69
Total score mean 62.31
Participant’s average scores in the CASP domains:
As shown in Table 3, the CASP consisted of 20 items divided into four sub-sections:(1) Home Participation, (2) School Participation, (3) Community Participation and (4) Home and Community Living Activities. The total scores in the home participation, school participation, community participation, and home and community living activities domains were 30, 20, 25, and 25 points, respectively. The participants 25, and 25 point in these four domains were 19.19, 12.29, 15.29, and 14.18 points, respectively.
Table 3. Participant's average score in the CASP domains (N=72)
CASP domain Average Score
Home participation (30) 19.91
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Community participation (20) 12.29
School participation (25) 15.92
Home and community living activities (25) 14.18
Correlation between influencing factors and participation in participant:
Considering the correlations between personal factors and participation presented in Table 4, ordinary schools were more influential than special schools in the educational environment. Disability types had the highest level of cerebral palsy, followed by other disability, developmental disability, intellectual disability, and autism spectrum disability. Gender and age showed a statistically significant correlation (p < .01). The educational environment and disability types showed no statistically significant correlation (p < .05).
Considering the correlations between family factors and participation, the better the family function and the higher the family income, the more the participants participated. There was a statistically high correlation between family function and family income.
Considering the correlations between environmental factors and participation, environmental support shows a higher correlation than environmental resources. However, there was no significant correlation in general.
Table 4. Correlation between influencing factors and participation in participant (N=72)
Pearson
Correlation ρ-value
Personal factors
Gender -.028 .816
Age -.021 .861
Educational environmental -.543** .000
Disability type -.234* .048
Family factors
Family function -.639** .000
Family income .307** .009
Environment factors
Environmental support -.025 .834
Environmental resources -.056 .638
Factors influencing the participation of participant:
As shown in Table 5, considering the factors influencing home participation, the second model had the best explanatory power in a stepwise multiple regression analysis. The factors influencing family participation were family functions and the educational environment. Disability types and family income were excluded. The explanatory power of participation among variables was 49.9%.
Considering the factors influencing school participation, the first model had the best explanatory power in stepwise multiple regression analysis. The factors influencing school participation were family functions. Educational environmental, family income and disability types were excluded. The explanatory power of participation among variables was 36.3%.
Considering the factors influencing community participation, the second model had the best explanatory power in a stepwise multiple regression analysis. The factors influencing community participation were family functions and the
educational environment. Disability types and family income were excluded. The explanatory power of participation among variables was 40.4%.
Considering the factors influencing home and community living activities, the second model had the best explanatory power in a stepwise multiple regression analysis. The factors influencing home and community living activity were educational environments and family functions. Family income and disability types were excluded. The explanatory power of participation among variables was 35.6%.
Table 5. Factors influencing the participation of participants (N=72)
B β t(ρ)
Home participation 44.021 13.765(.000)
Personal factor
Disability type -.677(.501)
Educational environmental -4.259 -.310 -3.093(.003) Family factor
Family income -.003(.997)
Family function -6.937 -.493 -4.319(.000)
F(ρ) 34.395(.000)
R² .499
Community participation 25.757 11.787(.000)
Personal factor
Disability type -1.610(.112)
Educational environmental -2.533 -.294 -2.693(.009) Family factor
Family income -.303(.763)
Family function -3.793 -.430 -3.934(.000)
F(ρ) 23.421(.000)
R² .404
School participation 33.737 11.871(.000)
Personal factor
Disability type -.095(.925)
Educational environmental -.735(.465)
Family factor
Family income .376(.708)
Family function -6.655 -.602 -6.310(.000)
F(ρ) 39.810(.000)
R² .363
Home and community living activities 29.501 9.941(.000)
Personal factor
Disability type -.028(.978)
Educational environmental -4.081 -.363 -3.194(.002)
Family factor Family income -.222(.825)
Family function -3.679 -.319 -2.810(.006)
F(ρ) 19.046(.000)
R² .356
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Discussions
Occupational therapy requires assessment to identify the difficulties in the social and physical environment that impedes participation and to gain real-life experience to establish meaningful goals for individuals. Therefore, this study proposed to comprehensively analyze the correlation and effects of influencing factors related to the participation of school-aged disabled children and adolescents in Korea and provide occupational therapists with data on setting effective goals and mediating to improve participation. This study collected survey and evaluation data on the participation of children and adolescents, along with data on personal, family, and environmental factors, which were identified as important factors in the preceding study. Based on the data collected, the factors influencing participation were identified and analyzed through correlation analysis of each influencing factor and stepwise multiple regression analysis.
Participation of disabled children and adolescents correlated significantly with the educational environment and disability types in individual factors. When comparing the educational environment of ordinary and special schools, disabled children and adolescents attending ordinary schools participated more. In the disability types, participants with cerebral palsy had the highest participation, followed by developmental disability, intellectual disability, and autism spectrum disability. These results are consistent with a prior study that reported that children with other types of disabilities, including learning disabilities or cognitive disabilities, showed significant limitations on overall participation compared to children with cerebral palsy, depending on the type of disorder [25].The result is also consistent with other studies suggesting that, children with intellectual abilities show more participation in learning, computers and sports games at school [26-27]. However, there was no significant correlation between age and gender. Regarding age, the inconsistency of research results with prior research may be due to the high correlation between disability types rather than age. Participation is not significantly influenced by age [28-30]. For children with acquired brain damage and cerebral palsy, the results are consistent with previous studies showing a higher correlation between disability types than age [31-32]. In previous studies involving gender, participation was influenced by gender, and overall, girls were more involved than boys [21, 32]. However, for gender, the inconsistency between the previous and the present study was related to the representativeness of the study participants. The previous study involved cerebral palsy children aged 8 to 12 years [21], while another study included children with cerebral palsy, dystrophy, and brain-damaged children, aged between 6 and 14 years [32].
However, this study included children and adolescents with cerebral palsy, developmental disorders, intellectual disabilities, autistic spectrum disorders, and other disorders, aged 8 to 19 years. The preceding studies targeted relatively young children, and there are differences in age and disability types in this study. Future studies should, recruit those who represent school-age children and adolescents, including teenagers and, disabled children such as age and sex expenses, when sampling targets.
Among family factors, there was a significant correlation between family function and family income. The better the family function, the more the disabled children and adolescents participated. This is consistent with prior studies that suggest that family functions increase difficulty in activities participation [9], reduce community participation [33], and that better family functions reduce children's stress and promote activities [14]. The higher the family income, the higher the participation of disabled children and adolescents. Children with low family income have low participation in activities, self-development, and social activities [21]. It is consistent with the results that children with higher family income participate more in play and development activities [20]. Previous studies support the result that family income has a significant impact on participation [21, 34-35].
Among environmental factors, environmental resources and environmental support showed no significant correlation with participation. These results are inconsistent with the results of previous research, due to the differences in cultural and environmental characteristics. Culture has problems such as difficulty in measuring, ambiguity, etc., and simply comparing culturally can help us understand the cultural characteristics of the country or community in question. However, studies show that there are difficulties and differences in explaining relationships to social phenomena such as democracy and social participation [36].The difference in environmental characteristics found in studies performed in certain communities in the United States is the result of differences in physical barriers, building architectural features, topography and accessibility, and policies compared to those in the country [22].
Further studies should examine other factors, including physical barriers, architectural features, topography and accessibility, and policies.
The results of the factors influencing participation were analyzed by dividing them into the home, community, school, and home and community living activities. In the correlation analysis, the educational environment, disability types, family function, and family income showed significant correlations. These factors were included and analyzed.
The family function was identified as a common and important factor in all areas of participation. Disabled children and adolescents were generally less involved in informal activities at home and less involved in activities based on official communities than in communities [6, 37]. In general, teenagers participate in active physical and leisure activities with their peers [38]. However, adolescents with disabilities generally participate in family and activities more than their peers [39]. This is disabled children and adolescents and more families to participate in activities.
Therefore, family functions are important for the participation of disabled children and adolescents, and imbalances cause barriers to participation [33, 40]. The imbalance in family functions increases the difficulty of participating in activities [9] and causes a reduction in community participation [33]. These studies show that family values and preferences play an important role in the type and frequency of activity children and adolescents participate in [9-10].
A study suggests that children are strongly involved in activities when their family prefers to do so [21]. For children and adolescents, the family is also an important applicant for the activity [8-9]. The higher the family function of a disabled child, the lower the burden of disability and the higher the quality of life, the less stress the child has, and the more activity it stimulates [14].
On the other hand, factors that were not correlated with age, gender, environmental resources and environmental support factors were not included in any regression model. The results of this study, which were not included in the regression model due to poor correlations, were inconsistent with the prior studies. Through this, it was confirmed that gender, age, environmental resources, and environmental support are not absolute factors influencing the participation of school-aged disabled children and adolescents in Korea.
Further research examining other dimensions of influence not previously studied, should be conducted in countries or regions where no research has been conducted, to narrow the differences in geographical and cultural background [5]. This study was conducted in the context and setting of Korea to narrow the gap between regional and cultural backgrounds. To narrow the gap between the preceding studies, additional research, including participation at various levels, is needed in addition to the factors identified in the preceding research to suit the Korean situation.
This study has several limitations. First, the number of participants studied was small, and the number of disability was biased to one type to generalize the study results. In further studies, larger sample size and participants of various disability types and age groups should be selected to generalize the research results. Second, the study participants were selected from the center of disabled children and adolescents in certain areas. Future studies, should select the same percentage of study participants from various regions to reflect the characteristics of disabled children and adolescents in Korea. Third, the influencing factors were derived through the literature review however, the assessment and survey to measure the factors, and the age range of the subjects differed from previous studies.
Children and adolescent participation may potentially have other factors and limitations, suggesting that consistency should be enhanced using various standardized assessments to account for their association with physical activity and condition. Finally, since the assessment tools used in this study were parent-report questionnaires completed by the caregivers of the study participants, an accurate evaluation may be difficult due to the biased viewpoints of the respondents to present higher participation. For research with accurate evaluation, parents must be objective and accurate in their children's level of interaction with the study subjects.
Despite these limitations, this study is meaningful in its systematic study of the factors affecting the participation of disabled children and adolescents from personal, family and environmental aspects. It suggests that care services should be provided considering all the factors surrounding the children as well as the family and environment.
Additionally, the findings are meaningful in that they provide meaningful basic data that can be used by occupational therapists in planning and mediating treatment to promote effective participation in Korean children and adolescents.
Conclusion
Prior studies have found that participation is influenced by personal, family, and environmental factors. Based on these studies, the present study examined the factors influencing the participation of Korean disabled children and adolescents. Participants included 72 disabled children and adolescents. Data were analyzed using correlation and stepwise multiple regression analysis. This study was also intended to provide a basis by investigating the factors influencing participants’ participation.
This study shows that the factors identified through previous studies are different from the actual situation in Korea.
Analysis of the factors influencing school-age youth requires research, including not only personal, family and
http://annalsofrscb.ro 16671 environmental factors but also other dimensions of influence factors for the Korean environment. However, this study systematically investigated the personal, family, and environmental factors influencing the participation of Korean school-age youth. This means that Korea provided basic data that can be used in clinical sites for occupational therapy. Therefore, the results of this study are expected to provide useful data for clinical and research
purposes in Korean occupational therapy.
Acknowledgement
None
Declaration of conflicts of interest
The authors have no conflict of interest to declare
Research ethics and patient consent
The study was conducted after obtaining approval from Yonsei University’s Institutional Review Board in accordance with research ethics (Approval number: 1041849-201902-BM-027-02).
References (APA 6
thedition)
[1]
Dahan-Oliel, N., Shikako-Thomas, K., & Majnemer, A. (2012). Quality of life and leisure participation in children with neurodevelopmental disabilities: A thematic analysis of the literature. Quality of Life Research, 21(3), 427-439. http://doi.org/10.1007/s11136-011-0063-9[2]
Law, M., & King, G. (2000). Participation! every child’s goal. Today’s Kids in Motion, 1, 10-12.[3]
Lau, E. Y. H., & Cheng, D. P. W. (2016). An exploration of the participation of kindergarten-aged Hong Kong children in extra curricular activities. Journal of Early Childhood Research, 14(3), 294-309.http://doi.org/10.1177/1476718X14552873
[4]
Tonkin, B. L., Ogilvie, B. D., Greenwood, S. A., Law, M. C., & Anaby, D. R. (2014). The participation of children and youth with disabilities in activities outside of school: A scoping review: Étude de délimitation de l’étendue de la participation des enfants et des jeunes handicapés à des activités en dehors du contextescolaire. Canadian Journal of Occupational Therapy, 81(4), 226-236.
http://doi.org/10.1177/0008417414550998
[5]
Di Marino, E., Tremblay, S., Khetani, M., & Anaby, D. (2018). The effect of child, family and environmental factors on the participation of young children with disabilities. Disability and Health Journal, 11(1), 36-42.http://doi.org/10.1016/j.dhjo.2017.05.005
[6]
Barnhill, L. R. (1979). Healthy family systems. Family Coordinator, 94-100.[7]
Goldenberg, H., & Goldenberg, I. (2012). Family therapy: An overview.[8]
Buttimer, J., & Tierney, E. (2005). Patterns of leisure participation among adolescents with a mild intellectual disability. Journal of Intellectual Disabilities, 9(1), 25-42. http://doi.org/10.1177/1744629505049728[9]
LaVesser, P., & Berg, C. (2011). Participation patterns in preschool children with an autism spectrum disorder. OTJR: Occupation, Participation and Health, 31(1), 33-39. http://doi.org/10.3928/15394492- 20100823-01[10]
Heah, T., Case, T., McGuire, B., & Law, M. (2007). Successful participation: The lived experience among children with disabilities. Canadian Journal of Occupational Therapy, 74(1), 38-47.http://doi.org/10.2182/cjot.06.10
[11]
Lavee, Y., & Olson, D. H. (1991). Family types and response to stress. Journal of Marriage and the Family, 786-798. http://doi.org/10.2307/352751[12]
Suk, M. S. (2013). A comparative study of family function between the disabled family and the non-disabled family: An application of the McMaster model. Korean Journal of Family Welfare, 18(2), 105-131.[13]
Minuchin, S. (2013). The family in therapy. In Counseling and Family Therapy With Latino Populations (pp.74-84). Routledge.
[14]
Cohen, S., & Wills, T. A. (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310. http://doi.org/10.1037/0033-2909.98.2.310[15]
Earde, P. T., Praipruk, A., Rodpradit, P., & Seanjumla, P. (2018). Facilitators and barriers to performing activities and participation in children with cerebral palsy: Caregivers' perspective. Pediatric Physical Therapy, 30(1), 27-32. http://doi.org/10.1097/PEP.0000000000000459[16]
Khetani, M. A., Albrecht, E. C., Jarvis, J. M., Pogorzelski, D., Cheng, E., & Choong, K. (2018). Determinants of change in home participation among critically ill children. Developmental Medicine & Child Neurology, 60(8), 793-800. http://doi.org/10.1111/dmcn.13731[17]
Milićević, M., & Nedović, G. (2018). Comparative study of home and community participation among children with and without cerebral palsy. Research in Developmental Disabilities, 80, 74-83.http://doi.org/10.1016/j.ridd.2018.06.010
[18]
Roberts, J. M. A., Adams, D., Heussler, H., Keen, D., Paynter, J., Trembath, D., ... & Williams, K. (2018).Protocol for a prospective longitudinal study investigating the participation and educational trajectories of Australian students with autism. BMJ Open, 8(1). http://doi.org/10.1136/bmjopen-2017-017082
[19]
Law, M., King, G., Petrenchik, T., Kertoy, M., & Anaby, D. (2012). The assessment of preschool children's participation: Internal consistency and construct validity. Physical & Occupational Therapy in Pediatrics, 32(3), 272-287. http://doi.org/10.3109/01942638.2012.662584[20]
Chiarello, L. A., Bartlett, D. J., Palisano, R. J., McCoy, S. W., Fiss, A. L., Jeffries, L., & Wilk, P. (2016).Determinants of participation in family and recreational activities of young children with cerebral palsy. Disability and Rehabilitation, 38(25), 2455-2468. http://doi.org/10.3109/09638288.2016.1138548
[21]
Law, M., King, G., King, S., Kertoy, M., Hurley, P., Rosenbaum, P., ... & Hanna, S. (2006). Patterns of participation in recreational and leisure activities among children with complex physical disabilities. Developmental Medicine & Child Neurology, 48(5), 337-342.http://doi.org/10.1017/S0012162206000740
[22]
Khetani, M., Marley, J., Baker, M., Albrecht, E., Bedell, G., Coster, W., ... & Law, M. (2014). Validity of the Participation and Environment Measure for Children and Youth (PEM-CY) for Health Impact Assessment (HIA) in sustainable development projects. Disability and Health Journal, 7(2), 226-235.https://doi.org/10.1016/j.dhjo.2013.11.003
[23]
Epstein, N. B., Baldwin, L. M., & Bishop, D. S. (1983). The McMaster family assessment device. Journal of Marital and Family Therapy, 9(2), 171-180. https://doi.org/10.1111/j.1752-0606.1983.tb01497.x[24]
Bedell, G. (2009). Further validation of the Child and Adolescent Scale of Participation (CASP). Developmental Neurorehabilitation, 12(5), 342-351. http://doi.org/10.3109/17518420903087277[25]
Beckung, E., & Hagberg, G. (2002). Neuroimpairments, activity limitations, and participation restrictions in children with cerebral palsy. Developmental Medicine & Child Neurology, 44(5), 309-316.http://doi.org/10.1111/j.1469-8749.2002.tb00816.x
[26]
Fauconnier, J., Dickinson, H. O., Beckung, E., Marcelli, M., McManus, V., Michelsen, S. I., ... & Colver, A.(2009). Participation in life situations of 8-12 year old children with cerebral palsy: Cross sectional European study. BMJ, 338. https://doi.org/10.1136/bmj.b1458
http://annalsofrscb.ro 16673
[27]
Imms, C., Reilly, S., Carlin, J., & Dodd, K. (2008). Diversity of participation in children with cerebral palsy. Developmental Medicine & Child Neurology, 50(5), 363-369. https://doi.org/10.1111/j.1469- 8749.2008.02051.x[28]
Oates, A., Bebbington, A., Bourke, J., Girdler, S., & Leonard, H. (2011). Leisure participation for school-aged children with Down syndrome. Disability and Rehabilitation, 33(19-20), 1880-1889.http://doi.org/10.3109/09638288.2011.553701
[29]
Orlin, M. N., Palisano, R. J., Chiarello, L. A., KANG, L. J., Polansky, M., Almasri, N., & Maggs, J. (2010).Participation in home, extracurricular, and community activities among children and young people with cerebral palsy. Developmental Medicine & Child Neurology, 52(2), 160-166. https://doi.org/10.1111/j.1469- 8749.2009.03363.x
[30]
Wuang, Y., & Su, C. Y. (2012). Patterns of participation and enjoyment in adolescents with Down syndrome. Research in Developmental Disabilities, 33(3), 841-848. https://doi.org/10.1016/j.ridd.2011.12.008[31]
Law, M., Anaby, D., DeMatteo, C., & Hanna, S. (2011). Participation patterns of children with acquired brain injury. Brain Injury, 25(6), 587-595. http://doi.org/10.3109/02699052.2011.572945[32]
Mc Manus, V., Corcoran, P., & Perry, I. J. (2008). Participation in everyday activities and quality of life in pre- teenage children living with cerebral palsy in South West Ireland. BMC Pediatrics, 8(1), 50.http://doi.org/10.1186/1471-2431-8-50
[33]
Parkes, J., McCullough, N., & Madden, A. (2010). To what extent do children with cerebral palsy participate in everyday life situations?. Health & Social Care in the Community, 18(3), 304-315.https://doi.org/10.1111/j.1365-2524.2009.00908.x
[34]
Anaby, D., Law, M., Hanna, S., & Dematteo, C. (2012). Predictors of change in participation rates following acquired brain injury: Results of a longitudinal study. Developmental Medicine & Child Neurology, 54(4), 339- 346. https://doi.org/10.1111/j.1469-8749.2011.04204.x[35]
Shattuck, P. T., Orsmond, G. I., Wagner, M., & Cooper, B. P. (2011). Participation in social activities among adolescents with an autism spectrum disorder. PloS One, 6(11), e27176.http://doi.org/10.1371/journal.pone.00217176
[36]
De Mooij, M., & Hofstede, G. (2010). The Hofstede model: Applications to global branding and advertising strategy and research. International Journal of advertising, 29(1), 85-110.http://doi.org/10.2501/S026504870920104X
[37]
Klaas, S. J., Kelly, E. H., Gorzkowski, J., Homko, E., & Vogel, L. C. (2010). Assessing patterns of participation and enjoyment in children with spinal cord injury. Developmental Medicine & Child Neurology, 52(5), 468- 474. https://doi.org/10.1111/j.1469-8749.2009.03552.x[38]
Kang, L. J., Palisano, R. J., Orlin, M. N., Chiarello, L. A., King, G. A., & Polansky, M. (2010). Determinants of social participation—with friends and others who are not family members—for youths with cerebral palsy. Physical Therapy, 90(12), 1743-1757. https://doi.org/10.2522/ptj.20100048[39]
King, G., Law, M., Hurley, P., Petrenchik, T., & Schwellnus, H. (2010). A developmental comparison of the out‐of‐school recreation and leisure activity participation of boys and girls with and without physical disabilities. International Journal of Disability, Development and Education, 57(1), 77-107.http://doi.org/10.1080/10349120903537988
[40]
Majnemer, A., Shevell, M., Law, M., Birnbaum, R., Chilingaryan, G., Rosenbaum, P., & Poulin, C. (2008).Participation and enjoyment of leisure activities in school‐aged children with cerebral palsy. Developmental Medicine & Child Neurology, 50(10), 751-758. https://doi.org/10.1111/j.1469-8749.2008.03068.x
