The impact of coping behaviors on perceived competence and social anxiety in the everyday social engagement of autistic adolescents

LAY ABSTRACT

Individuals who cope well with challenges may engage in social situations more successfully. We examined how well autistic adolescents coped, depending on how competent they felt and how much anxiety they experienced during social activities. We included 133 individuals (82 autistic, 51 neurotypical) between the ages of 10 and 16 years. Participants carried a mobile device that prompted them seven times a day for 7 days to record what they were doing, how competent they felt and how much anxiety they experienced. We used the Coping Inventory to understand how well participants coped with environmental challenges and met their needs for growth. Autistic adolescents were more likely than neurotypical peers to feel anxious while doing activities with adults. Autistic adolescents who had more difficulty coping with challenges were more likely to feel anxious when doing leisure activities with peers. Interestingly, autistic adolescents who coped better with challenges tended to feel less competent in social situations. However, those better able to meet their needs for growth tended to perceive their social competence positively. These findings can help practitioners develop strategies and programs to reduce the negative social experiences of autistic adolescents by helping them cope better.

Performance Analysis of Driving Ability (P-Drive): Investigating Construct Validity and Concordance of Australasian Data

On-road assessment is optimal for determining medical fitness-to-drive but unreliable if determined by global pass/fail decisions alone. Occupational therapists need standardized, psychometrically sound on-road scoring procedures. Performance Analysis of Driving Ability (P-Drive) is a promising on-road test developed in Sweden, but it has not been standardized for Australasia. We investigated the psychometric properties and concordance with an on-road decision of data gathered with the Australasian version of P-Drive. P-Drive was administered to older and cognitively impaired drivers (N = 134) aged 18 to 91 years (mean age 68) who were referred to 10 driving clinics in Australia and New Zealand to determine driving performance. Rasch analysis provided evidence for construct validity and concordance of the data gathered. An optimal cut-off score of 85 was set, yielding evidence of good sensitivity at 88% and specificity at 88%. The Australasian version of P-Drive produces valid and reliable data regarding on-road driving performance.

Activity-Based Therapy for Mobility, Function and Quality of Life after Spinal Cord Injuries-A Mixed-Methods Case Series

(1) Background: Despite inconclusive evidence on the benefits of activity-based therapies (ABTs) in people with spinal cord injuries, implementation has occurred in clinics worldwide in response to consumers' requests. We explored the clinical changes and participants' perceptions from engaging in an ABT program in the community. (2) Methods: This mixed-methods study involved a pragmatic observational multiple-baseline design and an evaluation of participants' perceptions. Fifteen participants were included. Outcome measures were balance in sitting using the Seated Reach Distance test, mobility using the Modified Rivermead Mobility Index and quality of life using the Quality of Life Index SCI version pre- and post-participation in an ABT community-based program. Linear mixed models and logistic regressions were used to analyse the effects of intervention. Semi-structured interviews explored participants' perceptions using inductive thematic analysis. (3) Results: There was an increase of 9% in the standardised reach distance (95% CI 2-16) for sitting balance, 1.33 points (95% CI: 0.81-1.85) in mobility and 1.9 points (0.17-2.1) in quality of life. Two themes emerged from the interviews: (1) reduced impact of disability and an increased sense of life as before, and (2) the program was superior to usual rehabilitation. No adverse events related to the intervention were observed. (4) Conclusion: ABT delivered in the community improved clinical outcomes in people with a chronic SCI. High levels of satisfaction with the program were reported.

Evaluation in Ayres Sensory Integration® Praxis Tests: Construct Validity and Internal Reliability

IMPORTANCE

Assessment of praxis using valid and reliable measures is important for understanding factors affecting occupational participation.

OBJECTIVE

To evaluate evidence of construct validity and internal reliability of data gathered with four newly developed praxis tests.

DESIGN

Comparative descriptive design.

SETTING

Homes, schools, and therapy practices across the United States.

PARTICIPANTS

A control group consisting of 163 children without any concerns or diagnoses and a case group of 145 children with sensory integration difficulties, ages 3 to 12 yr.

OUTCOMES AND MEASURES

Rasch analyses to evaluate construct validity, and Student's t tests to evaluate group differences.

RESULTS

Total test scores and most item scores conformed to Rasch model expectations. Group differences were significant; the control group scored higher. Internal reliability was strong.

CONCLUSIONS AND RELEVANCE

Findings support the validity and internal reliability of the four praxis tests. What This Article Adds: This study adds to the growing body of evidence for validity and reliability of the Evaluation in Ayres Sensory Integration® tests.

Virtual Risk Management-Exploring Effects of Childhood Risk Experiences through Innovative Methods (ViRMa) for Primary School Children in Norway: Study Protocol for the ViRMa Project

BACKGROUND

Research indicates that risky play benefits children's risk assessment and risk management skills and offers several positive health effects such as resilience, social skills, physical activity, well-being, and involvement. There are also indications that the lack of risky play and autonomy increases the likelihood of anxiety. Despite its well-documented importance, and the willingness of children to engage in risky play, this type of play is increasingly restricted. Assessing long-term effects of risky play has been problematic because of ethical issues with conducting studies designed to allow or encourage children to take physical risks with the potential of injury.

OBJECTIVE

The Virtual Risk Management project aims to examine children's development of risk management skills through risky play. To accomplish this, the project aims to use and validate newly developed and ethically appropriate data collection tools such as virtual reality, eye tracking, and motion capturing, and to provide insight into how children assess and handle risk situations and how children's past risky play experiences are associated with their risk management.

METHODS

We will recruit 500 children aged 7-10 years and their parents from primary schools in Norway. Children's risk management will be measured through data concerning their risk assessment, risk willingness, and risk handling when completing a number of tasks in 3 categories of virtual reality scenarios: street crossing, river crossing, and playing on playground equipment. The children will move around physically in a large space while conducting the tasks and wear 17 motion-capturing sensors that will measure their movements to analyze motor skills. We will also collect data on children's perceived motor competence and their sensation-seeking personality. To obtain data on children's risk experiences, parents will complete questionnaires on their parental style and risk tolerance, as well as information about the child's practical risk experience.

RESULTS

Four schools have been recruited to participate in data collection. The recruitment of children and parents for this study started in December 2022, and as of April 2023, a total of 433 parents have consented for their children to participate.

CONCLUSIONS

The Virtual Risk Management project will increase our understanding of how children's characteristics, upbringing, and previous experiences influence their learning and ability to handle challenges. Through development and use of cutting-edge technology and previously developed measures to describe aspects of the children's past experiences, this project addresses crucial topics related to children's health and development. Such knowledge may guide pedagogical questions and the development of educational, injury prevention, and other health-related interventions, and reveal essential areas for focus in future studies. It may also impact how risk is addressed in crucial societal institutions such as the family, early childhood education, and schools.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/45857.

Scale of Parental Playfulness Attitude (PaPA): Psychometric Properties With Latino Caregivers in the United States

IMPORTANCE

Parent-child play is a beneficial and meaningful co-occupation. Therapists who want to optimize parent-child play for Latino- and Latina-American dyads need valid, reliable measures to assess caregiver playfulness in addition to preexisting measures of child playfulness.

OBJECTIVE

To evaluate data collected from Latino-American caregivers with the Scale of Parental Playfulness Attitude (PaPA), a 28-item parent self-report to determine its construct validity, internal reliability, and cross-cultural validity.

DESIGN

Quantitative exploratory design applying a latent-trait psychometric model.

SETTING

Online survey.

PARTICIPANTS

Convenience sample of 50 Spanish-speaking parents from the mainland United States recruited via snowballing (88% mothers, ages 24-47 yr; M = 34.8 yr; 82% first-generation Americans). The inclusion criteria were age ≥18 yr; literate in Spanish; primary caregiver to a child age 2.5-7 yr. Data from an existing sample of 50 parents dwelling in Puerto Rico were used to examine cross-cultural validity.

OUTCOMES AND MEASURES

Rasch analysis demonstrated evidence for adequate construct validity: positive point-measure correlations, 93% fit of items, logical item hierarchy, and good progression of the rating scale. Range and mean for parent playfulness exceeded those of the items; principal-components analysis revealed one contrast of 4.46 eigenvalues, bringing unidimensionality into question. Evidence suggested excellent internal reliability (person-reliability index = 0.85, strata = 3.55) and good cross-cultural validity (25 of 28 items formed a similar hierarchy for parents dwelling in the mainland United States and Puerto Rico).

CONCLUSIONS AND RELEVANCE

Although the PaPA can be used to assess caregiver playfulness with culturally diverse Latino-American dyads, further research is required. What This Article Adds: This study provides evidence for the construct validity and internal reliability of a tool that measures parent playfulness in the context of parent-child play. The PaPA is an important tool for occupational therapists working with Latino-American families.

Evaluation in Ayres Sensory Integration® (EASI) Tactile Perception Tests: Construct Validity and Internal Reliability

IMPORTANCE

Assessment of tactile perception is foundational for addressing aspects of occupational performance.

OBJECTIVE

To evaluate the construct validity and internal reliability of four new tactile perception tests.

DESIGN

Causal comparative groups design.

SETTINGS

Homes, schools, and therapy practices across the United States.

PARTICIPANTS

Children ages 3 to 12 yr: typically developing (n = 174) and those with sensory integration concerns (n = 153).

OUTCOMES AND MEASURES

Rasch analyses to evaluate construct validity; analysis of covariance to evaluate group differences.

RESULTS

The Rasch model confirmed evidence of construct validity for each of the four tests. The typically developing group scored significantly higher than the clinical group on all tests (η2p = .040-.105, p < .001). Person reliability indices and strata indicated moderate to strong internal reliability (Rasch person reliability indices = .69-.87; strata = 2.33-3.82).

CONCLUSIONS AND RELEVANCE

The Evaluation in Ayres Sensory Integration® (EASI) Tactile Perception Tests are reliable and valid measures for assessing tactile perception in children ages 3 to 12 yr. Findings suggest that these tests are likely to be clinically useful and appropriate for children in this age range and may provide critical information regarding underlying sensory functions necessary for optimal occupational performance. What This Article Adds: This article provides data supporting the reliability and validity of the EASI Tactile Perception Tests in a U.S.

SAMPLE

These assessments can be used by therapists trained in their administration to assess tactile functions that may affect participation in activities, tasks, and occupations.

Play and Mothers' Relationships With Children in the Context of Breast Cancer

This interpretative phenomenological study explored play experiences between mothers who had completed, or were receiving treatment for, breast cancer and their young children and disease-related factors influencing those experiences. Six Puerto Rican mothers who had young children at the time of their primary treatment were interviewed. Interviews were recorded, transcribed, and analyzed through constant comparative method. Two themes emerged: (a) "changes and challenges," which contextualized disease-related factors affecting the maternal role; and (b) "play and relationships with children" described play moments and how treatment affected these. Participants emphasized the benefits of playing and relating with their children while in treatment. Play as a co-occupation and an effective means to connect mothers with their children must be considered in the practice of occupational therapy. Future studies with more diverse samples of mothers at different stages of the disease are warranted to expand this exploratory work.

Predicting Fitness to Drive for Medically At-Risk Drivers Using Touchscreen DriveSafe DriveAware

IMPORTANCE

Occupational therapists require valid cognitive fitness-to-drive tools to advise drivers in this high-stakes area.

OBJECTIVE

To examine the psychometric properties and predictive validity of data gathered with the touchscreen DriveSafe DriveAware (DSDA).

DESIGN

Prospective study that compared a screening tool with a criterion standard.

SETTING

Ten community- and hospital-based driver assessment clinics in Australia and New Zealand.

PARTICIPANTS

Older and cognitively impaired drivers (N = 134) ages 18 to 91 years (Mage= 68) who were referred for an assessment to determine the impact of a medical condition on driving. The inclusion criteria were a valid driver's license, vision within license authority guidelines, completion of at least 1 year of high school, and English as a first language.

OUTCOMES AND MEASURES

The results of the touchscreen DSDA, a standardized assessment of awareness of the driving environment and one's own driving abilities, were compared with those of a standardized occupational therapist-administered on-road assessment.

RESULTS

Rasch analysis provided evidence for the construct validity and internal reliability of data gathered with the touchscreen DSDA. Optimal upper and lower cutoff scores were set to trichotomize drivers into three categories: likely to pass an on-road assessment, likely to fail an on-road assessment, and further testing required. Specificity of the touchscreen DSDA was 86%, and sensitivity was 91%; positive predictive value was 83%, negative predictive value was 92%, and overall accuracy of classification was 88%.

CONCLUSIONS AND RELEVANCE

Evidence supports the utility of the touchscreen DSDA for accurately predicting which participants require on-road assessment. What This Article Adds: The touchscreen DSDA is a promising screen for occupational therapists and other health professionals to use in conjunction with other clinical indicators to determine whether drivers require further assessment.

Cognition Mediates Playfulness Development in Early Childhood: A Longitudinal Study of Typically Developing Children

IMPORTANCE

Play, children's central occupation, and playfulness, its behavioral manifestation, are the foci of occupational therapy intervention. However, information about the development of playfulness behavior and the role of cognitive function is limited.

OBJECTIVE

To explore the development of playfulness and its relation to cognitive functioning from infancy to toddlerhood.

DESIGN

Longitudinal study with data collected at ages 6 mo, 18 mo, and 24 mo.

SETTING

Laboratory (age 6 mo) and home (ages 12 and 18 mo).

PARTICIPANTS

Eighty-six typically developing children drawn from a convenience sample of 109 low-risk families of middle to upper socioeconomic status.

MEASURES

The Mullen Scales of Early Learning (MSEL) to assess cognitive functioning and the Test of Playfulness (ToP) to assess children's playfulness.

RESULTS

ToP scores were significantly higher at age 24 mo than at age 6 mo, t(88) = -60.30, p < .001, 95% confidence interval (CI) [-1.47, -1.38]. Correlation analysis revealed that the more playful the infant was at age 6 mo, the higher their cognitive functioning was at age 18 mo and the more playful they were at age 24 mo. Toddlers with higher cognitive performance at age 18 mo demonstrated more playful behavior at age 24 mo (β = 0.120, SE = 0.05, 95% CI [0.0377, -0.2276]).

CONCLUSIONS AND RELEVANCE

Children's playfulness is evident as early as age 6 mo and continues to develop through toddlerhood, depending on their cognitive growth. Occupational therapists play a key role in working with families with young children, promoting cognitive development to further the development of playfulness behaviors. What This Article Adds: Understanding the development of playfulness and exploring its relationship with cognitive functioning in typically developing children fills important gaps in occupational therapy knowledge and contributes to delivery of early intervention, especially when cognition or playfulness are at risk. Our findings confirmed that cognitive functioning contributes to the development of playfulness.

Evaluation in Ayres Sensory Integration® (EASI) Vestibular and Proprioceptive Tests: Construct Validity and Internal Reliability

IMPORTANCE

Vestibular and proprioceptive functions play a critical role in occupational performance and participation. Assessment of these functions in a reliable and valid manner is part of a comprehensive assessment in the Ayres Sensory Integration® frame of reference, commonly applied in pediatric occupational therapy.

OBJECTIVE

To report on reliability and validity of six tests of vestibular and proprioceptive functions of the Evaluation in Ayres Sensory Integration (EASI).

DESIGN

We used Rasch analyses to examine and modify the number of items and scoring categories on the six tests and known-groups analysis to examine group differences. We evaluated internal consistency using Cronbach's α and Rasch person reliability.

PARTICIPANTS

The sample contained typically developing children (n = 150) and children with sensory integration concerns (n = 84); all participated voluntarily. Outcomes and Measures: The EASI is used to measure sensory and motor functions in children ages 3 to 12 yr. The six tests of vestibular and proprioceptive functions were analyzed in this study.

RESULTS

Data from >96% of items conformed to the expectations of the model. We found statistically significant group differences (ps < .001-.128; ds = 0.20-1.31), with the typically developing children group scoring significantly higher on all but one test, and moderate to strong evidence of internal consistency (Rasch person-reliability indices ≥ 0.80; strata > 3) for five of six tests.

CONCLUSIONS AND RELEVANCE

The EASI vestibular and proprioceptive tests have strong construct validity and internal reliability, indicating that they are psychometrically sound clinical measures. What This Article Adds: The development of occupational therapy assessments with strong psychometric properties, such as the EASI tests of vestibular and proprioceptive functions, enhances clinical practice and research by elucidating the factors affecting participation in accurate and dependable ways so that occupational therapy interventions can be focused and effective.

The impact of caregiver stigma on real-life social experience of Taiwanese adolescents with autism spectrum disorder

LAY ABSTRACT

Caregivers of people with autism spectrum disorder commonly experience stigma. As a result, they may avoid contact with others, in turn, influencing their child's social participation. This study aimed to explore the impact of stigma perceived by the caregivers on the everyday social experience of Taiwanese adolescents with autism spectrum disorder. We asked 76 adolescents with autism spectrum disorder who did not have intellectual disability (69 males, aged 10-16 years) to carry a mobile device for 7 days. The device prompted them 7 times each day to record who they were interacting with, what they perceived, and how they felt about their social interactions. In addition, we asked their caregivers to complete the Affiliate Stigma Scale to measure their experience of stigma. We found that participants whose caregivers perceived high levels of stigma were more likely to spend time with family members and less likely to be interested in interacting with people at school. Those participants also were more likely to experience anxiety while interacting with family. Our study suggests that it is important for clinicians to implement support services for adolescents with autism spectrum disorder and help caregivers in managing stigma to promote their child's social participation.

Everyday Life Participation Using Powered Wheelchair Standing Devices by Boys With DMD

Powered wheelchair standing devices (PWSDs) allow supported standing for activity; however, little is known about their use. To understand factors affecting use of supported standing for participation among boys with Duchenne muscular dystrophy (DMD) and characteristics of successful users, we gathered data over 7 days from boys who had used PWSDs for 24 months, using a smartphone application. We used descriptive statistics to identify factors that affected their participation. Physical/social engagement and independence were motivators for standing in PWSDs. Enablers included positive attitudinal/social environments. Barriers included pain during supported standing and lack of physical environment accessibility. The characteristics of successful users were identified. Supported standing via PWSDs has potential to improve participation for boys with DMD. The disease stage, individual personal factors and environmental supports impact on use. Therapists should carefully consider and manage factors that impact on uptake and sustainability of use.

A Web-Based and In-Person Risk Reframing Intervention to Influence Mothers' Tolerance for, and Parenting Practices Associated With, Children's Outdoor Risky Play: Randomized Controlled Trial

BACKGROUND

Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers', are a major deterrent to children's opportunities for outdoor risky play.

OBJECTIVE

The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers' perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition.

METHODS

The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized.

RESULTS

A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes.

CONCLUSIONS

The trial demonstrates that the web-based intervention was effective in increasing mothers' tolerance for risk in play.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-018-2552-4.

Expectations and Assumptions: Examining the Influence of Staff Culture on a Novel School-Based Intervention to Enable Risky Play for Children with Disabilities

Risky play is challenging, exciting play with the possibility of physical, social, or emotional harm. Through risky play, children learn, develop, and experience wellbeing. Children with disabilities have fewer opportunities than their typically developing peers to engage in this beneficial type of play. Our team designed a novel, school-based intervention to address this disparity; however, our intervention yielded unexpected quantitative results. In the present study, we qualitatively examined divergent results at two of the five schools that participated in the intervention. Specifically, we aimed to explore how staff culture (i.e., shared beliefs, values, and practices) influenced the intervention. To explore this relationship, we employed a retrospective, qualitative, multiple case study. We used thematic analysis of evaluative interviews with staff members to elucidate the cultures at each school. Then, we used cross-case analysis to understand the relationships between aspects of staff culture and the intervention's implementation and results. We found that staff cultures around play, risk, disability influenced the way, and the extent to which, staff were willing to let go and allowed children to engage in risky play. Adults' beliefs about the purpose of play and recess, as well as their expectations for children with disabilities, particularly influenced the intervention. Furthermore, when the assumptions of the intervention and the staff culture did not align, the intervention could not succeed. The results of this study highlight the importance of (1) evaluating each schools' unique staff culture before implementing play-focused interventions and (2) tailoring interventions to meet the needs of individual schools.

Spanish Cultural Adaptation and Inter-Rater Reliability of the Test of Playfulness

AIM

To adapt the Test of Playfulness (ToP) to the Spanish context (culturally and linguistically) and analyze the inter-rater reliability of the translated version.

METHODS

Following a specific methodology for cultural adaptation, direct and back translations were carried out, together with cognitive interviews with pediatric occupational therapists, to analyze the comprehensibility of the translated version. The resulting version was analyzed by a linguistic expert to determine its grammatical and linguistic adequacy. Finally, inter-rater reliability was analyzed in a sample of typically developing children aged between 4 years old and 6 years and 11 months (n = 12).

RESULTS

Direct and back translation phases showed a good conceptual equivalence with the original version. The cognitive interviews enabled the identification of difficulties surrounding the understanding and the terminology used in several items. The linguistic expert and the research team revision ensured that final grammatical and conceptual improvements were made. Inter-rater reliability analysis showed an almost perfect degree of agreement (0.82 ≤ κ ≤ 1.00; p < 0.001), as well as stability and a strong positive linear correlation (0.81; p < 0.001).

CONCLUSIONS

The translated version of the ToP fits the Spanish context and can be used in the clinical setting of pediatric occupational therapy in Spain.

An Estimation of the Whole-of-Life Noise Exposure of Adolescent and Young Adult Australians with Hearing Impairment

Background: Since amplified music gained widespread popularity, there has been community concern that leisure-noise exposure may cause hearing loss in adolescents and young adults who would otherwise be free from hearing impairment. Repeated exposure to personal stereo players and music events (e.g., nightclubbing, rock concerts, and music festivals) are of particular concern. The same attention has not been paid to leisure-noise exposure risks for young people with hearing impairment (either present from birth or acquired before adulthood). This article reports on the analysis of a subset of data (leisure participation measures) collected during a large, two-phase study of the hearing health, attitudes, and behaviors of 11- to 35-yr-old Australians conducted by the National Acoustic Laboratories (n = 1,667 hearing threshold level datasets analyzed). The overall aim of the two-phase study was to determine whether a relationship between leisure-noise exposure and hearing loss exists.

Purpose: In the current study, the leisure activity profiles and accumulated (“whole-of-life”) noise exposures of young people with (1) hearing impairment and (2) with normal hearing were compared.

Research Design: Cross-sectional cohort study.

Study Sample: Hearing impaired (HI) group, n = 125; normal (nonimpaired) hearing (NH) group, n = 296, analyzed in two age-based subsets: adolescents (13- to 17-yr-olds) and young adults (18- to 24-yr-olds).

Data Collection and Analysis: Participant survey. The χ2 test was used to identify systematic differences between the leisure profiles and exposure estimates of the HI and NH groups. Whole-of-life noise exposure was estimated by adapting techniques described in ISO 1999.

Results: For adolescents, leisure profiles were similar for the two groups and few individuals exceeded the stated risk criterion. For young adults, participation was significantly lower for the HI group for 7 out of 18 leisure activities surveyed. Activity diversity and whole-of-life exposure were also significantly lower for the HI group young adults. A substantial number of individuals in both groups reported participation in leisure activities known to involve high noise levels (HI < NH). The individual whole-of-life exposures for the HI and NH participants were estimated and group median exposures were calculated. The median exposure for HI group young adults was significantly lower than that for the NH group (710 versus 1,615 Pa2 h [Pascal squared hours]).

Conclusions: The number of young adults with estimated exposure above the chosen noise-risk criterion in the NH group is concerning. With respect to the goals of hearing loss prevention initiatives, the more conservative social behavior (e.g., less nightclubbing) observed among HI group young adults may be regarded as a positive finding, but it could also signify relative social disadvantage for some young adults with hearing impairment.

Wrapped in Cotton Wool: Using Implementation Science to Examine Unexpected Results in a Recess-Based Intervention Study for Children With Autism Spectrum Disorder (ASD)

Date Presented 03/27/20

This study merges implementation science with a qualitative, comparative case-study design to examine implementation of a recess-based intervention designed to promote free play for children with disabilities. We found that factors such as school culture and climate impacted implementation more than financing, resources, or expertise did. School-based implementation research of this nature is fundamental for examining the translational potential of OT interventions.

Primary Author and Speaker: Patricia Grady

Additional Authors and Speakers: Julie Silver Seidle

Contributing Authors: Anita Bundy

School Playground Intervention for Children With Disabilities Creates Play Capabilities and Shifts Adult Perspectives

Date Presented 03/28/20

Five schools participated in the Sydney Playground Project to increase choice, control, and inclusion of students with disabilities on the school playground. The intervention served as a catalyst to challenge teacher perceptions of children’s disabilities and increase children’s capabilities.

Primary Author and Speaker: Julia Sterman

Additional Authors and Speakers: Michelle Villeneuve

Contributing Authors: Anita Bundy, Shirley Wyver

The Play Differences of Children With Autism Spectrum Disorder (ASD) Within Sibling and Nonsibling Peer Dyads

Date Presented 03/26/20

Peer-mediated interventions are effective for children with ASD. We investigated the difference in play performance of 68 children with ASD playing with a sibling versus a nonsibling peer. Test of Playfulness scores were significantly higher with a nonsibling play partner. Two social items explained much of the difference: "support of playmate" and "response to play cues," indicating these need to be a focus of intervention for sibling dyads.

Primary Author and Speaker: Cally Kent

Contributing Authors: Reinie Cordier, Annette Joosten, Sarah Wilkes-Gillan, Anita Bundy

Pilot Study: Occupational Therapy in an Equine Environment for Youth With Autism

Despite growing prevalence, research investigating occupational therapy incorporating horses for youth with autism is limited. This study aimed to (a) pilot a screening, evaluation, and intervention protocol of occupational therapy in an equine environment and (b) assess preliminary effects on occupational performance goals, behavior, and social functioning of youth with autism. A multiple baseline single-case experimental design was used. Six youth with autism participated in a no-treatment baseline phase and 10 weeks of intervention. Therapists implemented the intervention with 95% fidelity. Per parent report, participants improved in occupational performance goals, social motivation, and communication; four demonstrated decreased irritability and hyperactivity. This research operationalizes a screening, evaluation, and intervention protocol for occupational therapy in an equine environment, and demonstrates it may improve occupational, behavioral, and social outcomes for youth with autism. Next steps include manualizing the intervention, refining feasibility measures, and implementing a randomized controlled efficacy study.

Can I join in? Multiple case study investigation of play performance generalisation for children with autism spectrum disorder from dyad to triad

INTRODUCTION

Children with autism spectrum disorder (ASD) have difficulties with play, social interaction with peers and generalisation of intervention outcomes. The Ultimate Guide to Play, Language and Friendship (PLF) has demonstrated effectiveness in improving play performance of children with ASD and their typically developing (TD) peers. The aim of this investigation was to examine the changes in play performance when an additional TD child is added to an existing dyad of a child with ASD and a TD playmate to inform future delivery and adaptations of the intervention.

METHODS

Participants in this multiple case study design were five children with ASD and their TD peer who completed a dyad intervention as part of a randomised control trial investigation of the PLF and an additional TD peer who joined the play dyad. A trained occupational therapist delivered an adapted version of the PLF to the triad over four clinic sessions. An independent rater scored each child (N = 15) on The Test of Playfulness at pre- and post-triad intervention. Line graphs were used to examine case data and compare to dyad play performance and patterns of interaction.

RESULTS

Four of the five children with ASD generalised their play performance from the dyad to the triad social environment. However, the triad intervention did not demonstrate improvements in play performance. The play performance scores for the children with ASD and their TD peers were variable and demonstrated changes in their play pattern from the dyad to the triad.

CONCLUSION

This investigation delivered preliminary evidence of play performance generalisation from a dyad to a triad with TD peers for children with ASD. Careful consideration of characteristics of all playmates is recommended for delivering the intervention to support play performance of children with ASD.

Parents' Perceptions of Risk and the Influence on Children's Everyday Occupations

Date Presented 04/05/19

This presentation describes parents' risk perceptions regarding children's engagement in everyday occupations and how these influence the decisions they make to offer children age-appropriate opportunities for risk taking. It offers a qualitative analysis of stories parents shared that illustrate specific instances when children's engagement in age-appropriate risk taking resulted in children developing specific abilities, experiencing positive emotions, and gaining life skills.

Primary Author and Speaker: Anita Niehues

Contributing Authors: Anita Bundy

What Do Children Do on the Playground? A Rasch Analysis Approach to Measurement

Date Presented 04/06/19

Psychometric properties of a novel, mobile application-based measure of group playground play sophistication were evaluated using the Rasch partial credit model. The results demonstrate strong evidence for validity and emerging evidence for reliability of this measurement strategy. This type of measurement can advance the role of OTs in universal playground interventions and playground design.

Primary Author and Speaker: Patricia Grady

Additional Authors and Speakers: Anita Bundy

Development of the Scale of Parental Playfulness Attitude (PaPA) During the Co-occupation of Play

Date Presented 04/06/19

Initial development of the Scale of Parental Playfulness Attitude during the co-occupation of play (PaPA, or Escala AJugar in Spanish) will be detailed. The PaPA is the first self-report measure, developed with the purpose of evaluating whether the approach of parents playing with their children between 2.5 and 6 years 11 months, reflects a playful attitude. It is expected to serve as a useful tool for professionals working on play with families of children with developmental challenges.

Primary Author and Speaker: Rosa Roman-Oyola

Additional Authors and Speakers: Chastiti Vazquez-Gual

Contributing Authors: Itzamar Dasta-Valentin, Graciela Diaz-Lazzarini, Glorian Collazo-Aguilar, Coraly Yambo-Martinez, Anita Bundy, Shelly Lane, Victor Bonilla-Rodriguez

The Toileting Habit Profile Questionnaire (THPQ): Examining Construct Validity Using the Rasch Model

Date Presented 04/06/19

Reports support the hypothesis that sensory issues may be related to atypical defecation habits in children. Practice in this area is limited by the lack of validated measures. We used Rasch analysis, directed content analysis, and expert review to validate the Toileting Habit Profile Questionnaire (THPQ). After adjusting items, we examined the construct validity of the revised version (THPQ-R). The THPQ-R appears to capture challenging defecation behaviors related to sensory over-reactivity.

Primary Author and Speaker: Isabelle Beaudry-Bellefeuille

Contributing Authors: Shelly Lane, Anita Bundy, Alison Lane, Eduardo Ramos-Polo

A Cross-Sectional Description of Parental Perceptions and Practices Related to Risky Play and Independent Mobility in Children: The New Zealand State of Play Survey

The potential for risky play and independent mobility to increase children’s physical activity, and enhance cognitive development and emotional wellbeing has been recognised for some time. The aim of this study was to describe the attitudes of New Zealand parents towards such risky play practices and independent mobility, the barriers preventing them from allowing their children to participate, and how often their children engaged in risky play activities. An online survey comprised mostly of validated scales and standardised questions was completed by a nationally representative sample of 2003 parents. We found that parents had neutral feelings about the risk of injury to their child through play, rather they were concerned about road safety and “stranger danger”. There was strong agreement that there are multiple benefits to be gained from exposure to risk and challenge, and that health and safety rules are too strict. However, 73% of respondents stated that their 5–12 year old child seldom or never engaged in four or more risky activities, and only 14.3% engaged in four or more often or always. While parents agree that their child is likely to benefit from risky play, they do not have the confidence to allow their children to engage in such activities. Future research should address barriers and fears when implementing strategies to facilitate risky play.

The toileting habit profile questionnaire: Examining construct validity using the Rasch model

Introduction

Preliminary reports support the hypothesis that sensory issues may be related to atypical defecation habits in children. Clinical practice in this area is limited by the lack of validated measures. The toileting habit profile questionnaire was designed to address this gap.

Methods

This study included two phases of validity testing. In phase 1, we used Rasch analysis of existing data to assess item structural validity, directed content analysis of recent literature to determine the extent to which items capture clinical concerns, and expert review to validate the toileting habit profile questionnaire. Based on phase 1 outcomes, we made adjustments to toileting habit profile questionnaire items. In phase 2, we examined the item structural validity of the revised toileting habit profile questionnaire.

Results

Phase 1 resulted in a 17-item questionnaire: 15 items designed to identify habits linked to sensory over-reactivity and two designed to identify sensory under-reactivity and/or poor perception items. The analysis carried out in phase 2 supported the use of the sensory over-reactivity items. Remaining items can be used as clinical observations.

Conclusion

Caregiver report of behaviour using the revised toileting habit profile questionnaire appears to adequately capture challenging defecation behaviours related to sensory over-reactivity. Identifying challenging behaviours related to sensory under-reactivity and/or perception issues using exclusively the revised toileting habit profile questionnaire is not recommended.

Carers' preferences for the delivery of therapy services for people with disability in rural Australia: evidence from a discrete choice experiment

BACKGROUND

The implementation of the Australian National Disability Insurance Scheme is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However, little attention has been paid to examine how users of the National Disability Insurance Scheme will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics.

METHODS

A stated preference discrete choice experiment was incorporated into a survey of carers of people with disability living in rural Australia. Carers chose between therapy delivery services differing in attributes such as travel time to receive therapy, sector providing the service (i.e. Government, not-for-profit and private), out-of-pocket costs, person who delivers the therapy (therapist or other staff) and waiting time.

RESULTS

A total of 133 carers completed the discrete choice experiment. The majority of respondents cared for a child with a disability (84%); the average age of the person they cared for was 17 years (SD 14.25). Participants expressed strong preferences for a short waiting time (0-3 months) to receive therapy services; services delivered by a therapist, no out-of-pocket cost and travelling up to 4 h to receive a therapy session (P < 0.05). Sector providing the service was not statistically significant.

CONCLUSION

Carers of people with a disability in rural Australia exhibited strongest preferences for short waiting times (0-3 months). Therapy services that are delivered by therapy assistants or support workers will require careful introduction to achieve uptake and acceptability.

Parents' perceptions of the long-term appropriateness of a psychosocial intervention for children with attention deficit hyperactivity disorder

BACKGROUND/AIM

Designing psychosocial interventions that parents perceive as appropriate is essential to enhancing their engagement with the intervention and their long-term use of the intervention strategies. The aim of this study was to explore the long-term appropriateness of a play-based psychosocial intervention for children with Attention Deficit Hyperactivity Disorder (ADHD) from the perspectives of parents.

METHODS

Semi-structured phone interviews were conducted with 14 parents of children with ADHD who participated in a randomised controlled trial of the play-based intervention 1 year earlier.

RESULTS

Thematic analysis led to the development of three core-themes: (i) Everybody needs a parenting handbook, (ii) No one thing you are dealing with, and (iii) A different approach: Reframing.

DISCUSSION

The core-themes related back to a definition of intervention appropriateness that acknowledges the intervention as important/relevant, beneficial, socially and ecologically valid and promotes sustainable change, indicating parents perceived the intervention as appropriate. The core-themes also resembled aspects of the process of family adaptation. Findings highlight the importance of designing interventions that are appropriate from parents' perspectives to enhance their long-term engagement and use of the intervention strategies as well as outcomes for their child in the long term.

Peer-mediated intervention to improve play skills in children with autism spectrum disorder: A feasibility study

BACKGROUND/AIM

Children with autism spectrum disorder (ASD) frequently demonstrate impaired play skills and poor quality social interactions compared to typically developing peers. Complex interventions to improve play skills should be investigated with randomised control trials (RCT) where possible to support evidence-based practice for occupational therapists. Prior to a RCT, multiple feasibility studies are recommended to identify barriers to the trial. The aim of this study is to adapt a complex intervention to improve play skills in children with ASD and investigate the feasibility of conducting a RCT.

METHODS

Participants were 10 children with ASD paired with typically developing playmates chosen by their families. Pairs attended 10 intervention sessions involving video modelling, therapist- and peer-mediation and free play. Participant numbers needed for future investigation of effectiveness were calculated and time and cost considerations were reviewed. The Test of Playfulness (ToP) was the primary outcome measure; both parent- and child-report outcome measures were evaluated for appropriateness.

RESULTS

To determine effectiveness of the intervention 34 pairs in both control and intervention groups will be needed to conduct a RCT over an 18-month timeframe. ToP scores showed a positive, but not statistically significant trend from pre- to post-intervention. These improvements were maintained at follow-up in both clinic and home environments. The Piers-Harris 2 and the Parent Relationship Questionnaire were identified as appropriate secondary outcome measures; additional parent- and teacher-report outcome measures are recommended for the RCT.

CONCLUSION

A RCT to investigate effectiveness of this intervention for improving play skills of children with ASD and their playmates are feasible.

Go Play Outside! Effects of a risk-reframing tool on mothers' tolerance for, and parenting practices associated with, children's risky play: study protocol for a randomized controlled trial

Background

Children’s risky play is associated with a variety of positive developmental, physical and mental health outcomes, including greater physical activity, self-confidence and risk-management skills. Children’s opportunities for risky play have eroded over time, limited by parents’ fears and beliefs about risk, particularly among mothers. We developed a digital tool and in-person Risk-reframing (RR) workshop to reframe parents’ perceptions of risk and change parenting behaviours. The purpose of this paper is to describe our RR intervention, rationale and protocol for a randomised controlled trial to examine whether it leads to increases in mothers’ tolerance of risk in play and goal attainment relating to promoting their child’s opportunities for risky play.

Methods

We use a randomised controlled trial design and will recruit a total of 501 mothers of children aged 6–12 years. The RR digital tool is designed for a one-time visit and includes three chapters of self-reflection and experiential learning tasks. The RR in-person tool is a 2-h facilitated workshop in which participants are guided through discussion of the same tasks contained within the digital tool. The control condition consists of reading the Position Statement on Active Outdoor Play.

Primary outcome is increased tolerance of risk in play, as measured by the Tolerance of Risk in Play Scale. Secondary outcome is self-reported attainment of a behaviour-change goal that participants set for themselves.

We will test the hypothesis that there will be differences between the experimental and control conditions with respect to tolerance of risk in play using mixed-effects models. We will test the hypothesis that there will be differences between the experimental and control conditions with respect to goal attainment using logistic regression.

Discussion

The results of this trial will have important implications for facilitating the widespread change in parents’ risk perception that is necessary for promoting broad societal understanding of the importance of children’s risky play. In addition, the findings may provide relevant information for the design of behaviour-change tools to increase parental tolerance of risk.

Trial registration

ClinicalTrials.gov, ID: NCT03374683. Retrospectively registered on 15 December 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2552-4) contains supplementary material, which is available to authorized users.

The ICF has made a difference to functioning and disability measurement and statistics

AIMS

Fifteen years after the publication of the International Classification of Functioning, Disability and Health (ICF), we investigated: How ICF applications align with ICF aims, contents and principles, and how the ICF has been used to improve measurement of functioning and related statistics.

METHODS

In a scoping review, we investigated research published 2001-2015 relating to measurement and statistics for evidence of: a change in thinking; alignment of applications with ICF specifications and philosophy; and the emergence of new knowledge.

RESULTS

The ICF is used in diverse applications, settings and countries, with processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys, information systems and ICF-based instruments; and international efforts to improve disability data. Knowledge is growing about the components and interactions of the ICF model, the diverse effects of the environment on functioning, and the meaning and measurement of participation.

CONCLUSION

The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating new thinking, new applications in measurement and statistics, and the assembling of new knowledge. Nevertheless, the field needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin policies, services and outcomes. Implications for Rehabilitation The ICF offers a conceptualization of functioning and disability that can underpin assessment and documentation in rehabilitation, with a growing body of experience to draw on for guidance. Experience with the ICF reminds practitioners to consider all the domains of participation, the effect of the environment on participation and the importance of involving clients/patients in assessment and service planning. Understanding the variability of functioning within everyday environments and designing interventions for removing barriers in various environments is a vital part of rehabilitation planning.

Sydney Playground Project: A Cluster-Randomized Trial to Increase Physical Activity, Play, and Social Skills

BACKGROUND

We assessed the effectiveness of a simple intervention for increasing children's physical activity, play, perceived competence/social acceptance, and social skills.

METHODS

A cluster-randomized controlled trial was conducted, in which schools were the clusters. Twelve Sydney (Australia) primary schools were randomly allocated to intervention or control conditions, with 226 children (5-7 years old) selected randomly to participate. Data were collected at baseline and after 13 weeks. The intervention consisted of introducing recycled materials without an obvious play purpose into school playgrounds and a risk-reframing workshop for parents and teachers.

RESULTS

Children from the intervention schools increased physical activity and reduced sedentary time while control schools decreased physical activity and increased sedentary time. The intervention yielded increases in total accelerometer counts (β = 9350 counts, 95% CI 3490-1522, p = .002), minutes of moderate/vigorous physical activity (MVPA) (β = 1.8 min, 95% CI 0.52-3.12, p = .006), and reductions in sedentary time (β = -2.1 min, 95% CI -3.77-(-0.51), p = .01). Although the changes in time spent in play and nonplay were not statistically different (p = .08) the effect size (d = .27) indicates clinical significance.

CONCLUSIONS

This intervention was effective for increasing MVPA during recess and demonstrated capacity to improve play opportunities in school playgrounds.

Adult Decision Making on Outdoor Play for Children With Disabilities: A Systematic Review of Qualitative Studies

Date Presented 3/31/2017

This systematic review used an ecocultural framework to synthesize qualitative data across 11 studies involving decision making of parents, teachers, and other adults around outdoor play for children with disabilities. Results highlight the complexity of the decision-making process.

Primary Author and Speaker: Julia Sterman

Contributing Authors: Geraldine Naughton, Michelle Villeneuve, Elspeth Froude, Shirley Wyver, Kassia Beetham, Anita Bundy

Underrepresentation of the Needs of Children With Disabilities and Their Families in Community Outdoor Play Spaces: A Local Government Perspective

Date Presented 3/30/2017

A local government in a culturally and linguistically diverse city was used as a case to better understand considerations around providing outdoor play opportunities for children with developmental disabilities within the community. Triangulation occurred between parent and government perspectives.

Primary Author and Speaker: Julia Sterman

Contributing Authors: Geraldine Naughton, Michelle Villeneuve, Elspeth Froude, Shirley Wyver, Anita Bundy

Deliberative Dialogues Between Policy Makers and Researchers in Canada and Australia

Knowledge translation (KT) and implementation science are growing fields in Canada, Australia, and worldwide. Many audiences are targeted as KT knowledge users—policy makers represent one key knowledge user in the health care field. The need for policy makers to understand research and for researchers to understand policy processes is commonly recognized. There is also increasing interest in health policy that focuses on KT as a framework for understanding the use of evidence and, in particular, describing the influence of research on policy along with concepts of coproduction and user involvement. With relationship building central to successful evidence-informed policy, this article explores deliberative dialogue as a potential approach to enhancing KT. It describes two examples of researcher efforts to cultivate relationships and contacts with policy and decision makers via such dialogues and illustrates the inherent opportunities and challenges of doing so.

Access to therapy services for people with disability in rural Australia: a carers' perspective

In Australia and around the world, people with disability and their carers living in rural areas face additional challenges compared to their urban-dwelling counterparts. This cross-sectional study explored current access to therapy services for people with disability living in western New South Wales as reported by their primary carers. Data were collected using an online and paper survey distributed to carers, from December 2012 until June 2013. Information was sought about the carers, the person they care for, access to physiotherapy, speech pathology, occupational therapy and psychology services. A total of 166 carers participated. Respondents were mostly the carers of a son or daughter (83.6%) , the person they care for had an average age of 17.6 years (range 1-69 years) and more than half were males (56%). The majority of people with disability (73.5%) had received therapy services in the last 2 years. Waiting time and distance travelled to access physiotherapy, speech and occupational therapy services varied. People with disability had to wait an average of 6.6 months to receive speech pathology and had to travel an average of 2.6 hours to receive physiotherapy. The main provider of all services was the specialist disability government department, except for psychology, which is mainly provided in the private sector. From the carers' perspective, availability and accessibility to services are limited. Carers noted that availability of services was more restricted once people with disability reached adulthood. Lack of choice and frustration with the lack of availability of specialist disability services was reported frequently. Carers believed that timely allied health intervention prevented the development of more severe or complicated conditions that had a greater impact on carers, families, communities and the person with disabilities.

Comparison of the Properties of the Handwriting Speed Test (HST) and Detailed Assessment of Speed of Handwriting (DASH): An Exploratory Study

BACKGROUND

Handwriting speed is an important component of students' ability to adequately express their ideas, knowledge and creativity in a timely and effective manner.

AIMS

Psychometric properties of the Handwriting Speed Test (HST) and Detailed Assessment of Speed of Handwriting (DASH) and accuracy of the norms for identifying current Australian students with handwriting speed difficulties were examined.

METHODS

An exploratory, cross-sectional study was conducted involving students, with and without handwriting difficulties, in Years 3-12 (mean age: 12.0 yrs, SD = 3.0 yrs; range = 7 to 18 yrs) in New South Wales (NSW; Australia). Participants were recruited through occupational therapists and schools. Students completed the HST and all DASH subtests.

RESULTS

Thirty-two students with, and 139 students without, handwriting difficulties participated. Intra-rater and inter-rater reliability were found to be excellent; sensitivity was low and specificity high for the HST and DASH. No significant differences were found between test scores and normative data for students without handwriting difficulties (year/age groups with n > 10).

CONCLUSIONS

The HST and DASH are reliable assessments of handwriting speed. Further research is required into discriminant validity of the HST and DASH and need for updated norms.

The use of video-modelling as a method for improving the social play skills of children with attention deficit hyperactivity disorder (ADHD) and their playmates

Introduction

We investigated child outcomes and mothers' perspectives following technology-based intervention sessions aimed at improving children's social play skills.

Method

Participants in this multiple case study included five children with attention deficit hyperactivity disorder, their mothers and five typically developing playmates, who had completed a parent-delivered play-based intervention 18 months previously. The initial intervention included the use of a technology-based interactive DVD at home and clinic-based sessions involving video-modelling. In this study, children received two additional technology-based clinic sessions involving video-modelling. Children's social play skills were measured pre- to post-intervention using the Test of Playfulness. Trends in scores were descriptively analysed by case. Mothers' perspectives were explored through semi-structured interviews; data were descriptively analysed by group and case.

Results

Two children with attention deficit hyperactivity disorder showed an increase in their social play skills, and three a decrease in skills. Of the playmates, three showed consistent social play skills, one an increase and one a decrease. Qualitative findings suggest parents felt better able to support their child. Parents also suggested next steps for the intervention were necessary as their child continued to develop.

Conclusion

Additional intervention support using technology after initial intervention may need to be adapted to different developmental stages and for use across different contexts.

Playfulness in Children with Autistic Disorder and their Typically Developing Peers

This study investigated the playfulness of 24 children with autistic disorder (AD) and 34 typically developing children aged 3–7 years, in free (unstructured) and adult-facilitated (structured) play conditions within a clinical play environment. Video recordings of play were rated using the Test of Playfulness (Bundy 2003). The data were analysed using repeated measures ANOVA and ANCOVA and qualitative observations.

The children with AD were less playful compared with the typically developing children (F = 49.64, p<0.001), even when developmental age was accounted for (F = 28.20, p<0.001). Both groups of children were slightly more playful in a structured environment with adult facilitation (F = 7.72, p = 0.007). Despite statistically significant differences in playfulness between play conditions, considerable overlap in observations for both groups suggests that this may not be as clinically meaningful. When developmental age was accounted for, the play conditions no longer had a significant effect on playfulness (F = 1.54, p = 0.220). The implications of the findings and the limitations of the study are discussed.

The Experience of Social Participation in Everyday Contexts Among Individuals with Autism Spectrum Disorders: An Experience Sampling Study

This study explored the everyday life experiences of individuals with an autism spectrum disorder (ASD). Fourteen Australians and 16 Taiwanese (aged 16-45 years) with Asperger syndrome/high functioning autism recorded what they were doing, level of interest/involvement, emotional reactions and preference for being alone 7 times/day for 7 days. Multilevel analyses showed that 'solitary/parallel leisure' and 'social activities' were positively associated with interest and involvement. Engaging in these two activities and interacting with friends were positively associated with enjoyment. However, engaging in 'social activities' and having less severe ASD symptoms were associated with in-the-moment anxiety. Severity of ASD and social anxiety moderated experience in social situations. The findings highlight the importance of considering the in-the-moment experience of people with ASD.