مشارکت کودکان مبتلا به معلولیت ذهنی در مقایسه با کودکان در حال رشد به طور معمول

We compared participation in out-of-school activities between children with intellectual disability and children with typical development using the Children's Assessment of Participation and Enjoyment and Preferences for Activities of Children questionnaires. Thirty-eight pairs of children were matched for age (mean age 12.3 ± 2.7 years), sex (17 female, 21 male), location (32 metropolitan, 6 regional) and socioeconomic background (mean SEIFA score 1021 ± 70 and 1024 ± 66). When compared to their typically developing peers, children with intellectual disability participated in fewer Active-Physical and Skill-Based activities and in more Recreational activities. Children with intellectual disability participated less frequently in Skilled-Based activities, had a higher preference for Recreational and Self-Improvement activities, enjoyed Self-Improvement activities more, and participated in a higher proportion of Social activities at home and in a lower proportion of Recreational, Active-Physical, Skill-Based, and Self-Improvement activities alone. These differences may be due to reduced physical, cognitive and social skills in children with intellectual disability, or a lack of supportive environments.

Children with intellectual disability may participate in fewer activities outside school than their typically developing peers (Abells, Burbidge, & Minnes, 2008). Participation in outside school activities is important for all children as it optimises physical growth, increases cultural awareness and psychological wellbeing and establishes community relationships (Murphy & Carbone, 2008). Children with intellectual disability may have reduced motor, communication and social skills and have lower cognitive functioning than their typically developing peers (Pratt and Greydanus, 2007 and Westendrop et al., 2011), and this may lead to fewer opportunities to participate in recreation, leisure and sporting activities (Ehrmann et al., 1995, Matthews, 1979, Matthews, 1982 and Solish et al., 2010). Lower levels of participation in activities outside of school among children with intellectual disability may encourage the sedentary behaviour (Frey & Chow, 2006) and social isolation (Rimmer, Rowland, & Yamaki, 2007) that are commonly reported in this group. Five studies have compared the participation of children with intellectual disability to their typically developing peers (Ehrmann et al., 1995, Margalit, 1984, Matthews, 1979, Matthews, 1982 and Solish et al., 2010). These studies included between 20 and 82 children with intellectual disability and an average age of 3 to 10 years. Data were collected in these studies by questionnaire sent by post (Ehrmann et al., 1995, Margalit, 1984 and Solish et al., 2010), email (Solish et al., 2010) or interview (Matthews, 1979 and Matthews, 1982). These studies found no differences in participation in informal activities such as playing with toys (Margalit, 1984 and Matthews, 1982) and in leisure activities such as doing puzzles (Ehrmann et al., 1995, Matthews, 1979 and Solish et al., 2010). However, children with intellectual disability were reported to participate in fewer physical activities (Ehrmann et al., 1995, Matthews, 1979 and Matthews, 1982) and in fewer social activities in the community (Ehrmann et al., 1995, Matthews, 1979 and Solish et al., 2010), and to spend less time doing academic activities such as homework (Margalit, 1984) or attending a public library (Ehrmann et al., 1995 and Matthews, 1979) than children with typical development. In 2001, the World Health Organisation introduced the International Classification of Functioning, Disability and Health (ICF) (World Health Organisation, 2001), which considers body structure and function, activity limitations and participation restrictions when evaluating health outcomes and recognises disability as a universal human experience (World Health Organisation, 2001). The ICF incorporates participation as one aspect of describing, measuring and treating disability and led to a paradigm shift in the way health care professionals view disability (World Health Organisation, 2001). This shift in perspective may have facilitated how children with intellectual disability participate in outside school activities. However, since the introduction of the ICF, only one published study (Solish et al., 2010) has compared the participation patterns of children with intellectual disability with children with typical development. Several factors may influence a child's participation in outside school activities, including their age, sex, residential location (for example, metropolitan or regional area) and socioeconomic status. Of the five previous studies that have compared the participation of children with intellectual disability and children with typical development, no study adequately accounted for all of these potential confounders (either via selection criteria or statistical adjustment). All five studies attempted to account for the potential for socioeconomic status to influence children's participation but only one study could be identified that matched groups for age, sex and socioeconomic status (obtained as a surrogate of parent age and education level) (Margalit, 1984), and this study was completed before the introduction of the ICF and prior to a number of policy changes related to educational inclusion. Different dimensions of participation can be described including diversity (number of activities participated in), frequency (how often activities are participated in), location (where activities are participated in), companionship (with whom activities are completed), enjoyment, and preference for activities. Previous work investigating participation in children with intellectual disability has focused on evaluating participation diversity and frequency. Two studies have evaluated companionship (Matthews, 1979 and Solish et al., 2010), and one study has evaluated location (Matthews, 1979). To our knowledge, no previous studies have investigated the enjoyment and preference aspects of participation in relation to children with intellectual disability. Understanding all these aspects of children's participation is important to explain potential differences in participation patterns and to guide interventions aimed at enhancing participation. Participation preference is particularly salient because children typically exhibit greater motivation to participate in activities they prefer (Watkinson, Dwyer, & Nielson, 2005). As the available evidence base was largely obtained prior to the introduction of the ICF, has not always controlled for potential confounding variables, did not investigated certain aspects of participation and included mostly younger children with intellectual disability, we undertook to complete a study that would address these limitations. Such a study has the potential to contribute to the knowledge base and to guide families and practitioners in supporting activity choice and participation by children with intellectual disability. The aim of this study was to compare the participation in outside school activities of children with intellectual disability with children with typical development. Our research questions were: 1. Is the level of participation (diversity and frequency) of children with intellectual disability the same as their peers with typical development? 2. Are their differences between these groups in terms of their enjoyment, preference for, companionship during and location of participation? Based on previous literature we hypothesised that, when compared to their typically developing peers, children with intellectual disability would participate in fewer Active-Physical, Skill-Based, Self-Improvement and Social activities, less frequently. We also hypothesised that there would be no differences between the groups in the domains of preference and enjoyment, that children with intellectual disability would participate in a higher proportion of Self-Improvement activities with others, and in a higher proportion of Active-Physical, Skill-Based, Self-Improvement and Social activities at home.

Subtle differences in participation in out-of-school activities exist between children with intellectual disability and children with typical development. Children with intellectual disability participated in fewer Active-Physical and Skill-Based activities. They reported a higher preference for sedentary Recreational activities when compared to their typically developing peers, although it is not clear why this is. These differences may be due to reduced physical, cognitive and social skills in children with intellectual disability. This study builds on previous work on participation among children with disability by focusing on children with intellectual disability, controlling for factors that might influence participation, measuring participation using an outcome measure specifically designed for children with disability and by investigating aspects of participation (preference and enjoyment) not previously explored in the literature. Future research should further explore the participation of children with intellectual disability to help guide our understanding of the activities these children typically participate in, and determine whether their patterns of participation are sufficient to provide health, well being and developmental benefits.