Patterns and Predictors of Recreational and Leisure Participation for Children with Physical Disabilities

Keeping Current. ©Law, M., King, G., King, S., Kertoy, M., Hurley, P., Rosenbaum, P., Young, N., Hanna, S., & Petrenchik, T., 2006

What is Participation?

The World Health Organization's (WHO) new International Classification of Functioning, Disability and Health, defines 'participation' as "involvement in a life situation" (2001). For children and youth, involvement in life situations includes participation in recreational and leisure activities as well as school and work activities. Recreational and leisure activities include artistic, creative, cultural, active physical, sports, play, social, and skill-based activities (Kalscheur, 1992; King et al., 2003; Sloper, Turner, Knussen, & Cunningham, 1990). In this report, formal activities are defined as structured activities that have rules, and a leader, coach or instructor (e.g., lessons and sports) whereas informal activities are initiated by the child and are more spontaneous in nature (e.g., playing and reading).

The Importance of Participation in People's Lives

Participation is vital to child health, development and quality of life

• Participation in activities is the context in which people form friendships, develop skills and competencies, express creativity, achieve mental and physical health, and determine meaning and purpose in life (Kinney & Coyle, 1992; Lyons, 1993; Brown, Brown, & Bayer, 1994).
• Participation enables children to understand societal expectations and acquire the physical and social competencies needed to function and flourish in their homes and communities (Brown & Gordon, 1987; Larson & Verma, 1999).
• Satisfaction with activities is an important predictor of life satisfaction among adults with physical disabilities (Kinney & Coyle, 1992) and is associated with children's behavioral and emotional well-being (Brown & Gordon, 1987; Rae-Grant, Thomas, Offord, & Boyle, 1989; Sandler, Ayers, Suter, Schultz, & Twohey-Jacobs, 2004).

Participation is a key goal of rehabilitation services

• In the World Health Organization's ICF (2001), participation is regarded as a chief indicator of child health, irrespective of diagnosis or functional ability.
• Increasingly, the goal of rehabilitation interventions is to enable children to participate fully in the life of their family and community (King et al, 2002).

What Do We Know About the Participation of Children with Physical Disabilities?

• Children with disabilities tend to be more restricted in their participation in daily activities (e.g., formal and informal leisure and recreation activities outside of school, household tasks, and social engagements) than their peers, and that the scope of their activities is limited (Brown & Gordon, 1987; Canadian Institute of Child Health, 1994; Stevenson, Pharoah & Stevenson, 1997; McDougall et al., 2004).
• Compared to children without disabilities, children with disabilities tend to engage in fewer recreational and social activities (Brown & Gordon, 1987; Sillanpää, 1987).
• The participation of children and youth with disabilities decreases as children grow up so that, by adulthood, their participation is restricted; typically, they take part in passive, often home-based, activities (Brown & Gordon, 1987; Crapps et al., 1985; Dempsey, 1991; Pollock & Stewart, 1990; Stevenson, Pharoah, & Stevenson, 1997).
• Children with disabilities often feel socially isolated (Anderson & Clarke, 1982; Blum et al., 1991; Cadman et al., 1987; LaGreca, 1990; Law & Dunn, 1993).

It is therefore vital that parents, service providers, and policy makers concerned with children with disabilities understand the factors that promote or inhibit children's participation (King et al., 2003).

What Factors Influence Children's Participation?

Until now, little was known about the patterns and predictors of leisure and recreational participation for children and youth with physical disabilities. CanChild recently conducted a longitudinal study of 427 children, ages 6-14 years, with physical disabilities. The purpose of the study was to examine children's patterns of participation and to determine the child, family and environmental factors that influenced children's participation in formal and informal activities (Law et al., in press; Law et al., 2004; King et al., in press). This study showed that some factors have a more direct impact on the intensity with which children participate while others have an indirect impact (an indirect factor is a factor that works in conjunction with another factor to influence participation)

Direct predictors of participation

• the child's functional ability (i.e., cognitive, communicative, and physical functioning)
• family participation in social and recreational activities
• family values related to intellectual and cultural activities
• child preferences for activities

Indirect predictors of participation

• parents' perceptions of environmental barriers
• family cohesion
• supportive relationships for the child
• family income

We found that supportive environments (i.e., environments that are accessible, accommodating, socially supportive, non-discriminatory, and resource ready) influenced participation through their effects on children's functional ability. Greater social support from friends, parents, and teachers also enhanced participation by affecting children's activity preferences.

With respect to the family, we found that family cohesion had a strong effect on family members participating together in social and recreational activities, which in turn affected children's participation. Family income indirectly influenced children's participation through its effects on family orientation to activities. Thus, families play an important role in providing opportunities, support, and encouragement for children to take part in various activities.

Patterns of Participation

• The gender-related differences in participation in our study are consistent with those in studies of the recreational and leisure activities of children and youth without disabilities.
• Girls participated in significantly more social and skill-based activities, while boys participated in significantly more physical activities. Also, girls enjoyed formal, skill-based and self-improvement activities significantly more than boys.
• In terms of age, children 12 years or older scored significantly lower on overall participation intensity and in particular, on intensity of participation in informal activities.
• This pattern is in keeping with trends in the general population which show marked decreases in participation in physical recreation and extracurricular activities (Mahoney, Larson, & Eccles, 2005) with increasing emphasis on social activities (Henry 1998; Garton & Pratt 1991) as children transition into adolescence.

What Do these Findings Mean?

Implications for Families

• Families play a vital role in enabling their children's participation.
• Children participate more intensely when their families value intellectual and cultural activities, and also when families are more engaged in social and recreational activities.
• Families also provide and encourage supportive relationships, and a feeling of togetherness, that are linked to children's preferences for activities.

Implications for Service Providers

• Service providers should formally assess children's functional abilities and activity preferences, family engagement in social and recreational activities, and family activity preferences and discuss these aspects of children's participation with families.

Implications for Policy Makers

• Policy interventions are likely to be most effective when they address both direct and indirect determinants of children's participation.
• Indirect pathways show that children participate more intensely when environmental barriers are lower, when social supports to children are higher, and when family members help and support one another (family cohesiveness).
• The findings suggest the importance of utilizing multi-pronged strategies to encouraging participation that are aimed not only at the child, but at the family and environmental levels as well.

It is important to keep in mind that participation in more activities is not necessarily better (Forsyth & Jarvis, 2002; Henry, 1998). For example, a child might choose to participate in fewer activities but may have intense involvement in these activities. Another child might be involved in several activities, but participate in them very infrequently. The important consideration is whether children are able to participate in the recreational and leisure activities in which they would like to be involved.

What's Next?

We will continue to analyze our data to determine:

• Longitudinal patterns of participation and how these patterns change over time.
• How and in what ways the activities of children with physical disabilities differ from those of children without disabilities.
• The ways in which children's participation patterns are linked to the places in which they live.

Acknowledgements

We would like to thank the 427 families across Ontario who were involved in the Participate Study. The many hours they spent filling out questionnaires and completing interviews made this study a success.

We are also grateful to the United States National Institutes of Health for funding this research project (GRANT HD38108-02). Thanks to Jessica Telford for her assistance in preparing this document.

Want additional information about the Participate Study?

For more information about the Participate Study, please visit the CanChild website. Please check this website regularly for updates.