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BackgroundOutdoor 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. ObjectiveThe 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. MethodsThe 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. ResultsA 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. ConclusionsThe trial demonstrates that the web-based intervention was effective in increasing mothers’ tolerance for risk in play. Trial RegistrationClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683 International Registered Report Identifier (IRRID)RR2-10.1186/s13063-018-2552-4

Training and support will be vital in developing and maintaining a skilled disability workforce in the roll-out of individualised disability funding across Australia. Technology has the potential to deliver training and support that is more accessible and cost-efficient in geographically isolated regions. The current qualitative study explored participants' experience of an autism-specific webinar and individual online support programme delivered to a range of early childhood staff in regional and remote areas. Researchers used purposive sampling to select and interview 11 participants enrolled in the training and support programme. Rigour and trustworthiness of the data were enhanced using member checking and a data analysis check on 20% of the transcripts. Several categories of responses were identified under three broad themes; impact of the training programme, interaction with technology, and barriers to access. Findings indicated that the programme had a positive impact on access to autism-specific learning and support. The interactive nature of webinars and individual online consultations (synchronous learning) was highly valued; however, barriers including extensive travel and busy caseloads resulted in participants relying on recorded webinars (asynchronous learning). Findings from the current study will inform the development of future training programme at an individual, organisational and policy level.

Purpose: The rollout of individualised disability funding in Australia resulted in an increased demand for services for people with a disability, particularly support for the high percentage of Australians with autism spectrum disorder. Continuing professional development is one way to grow and maintain a skilled workforce; however, face-to-face opportunities can be limited in remote areas of Australia. Technology may provide a low-cost and widely accessible platform for providing education and support for staff in these areas. Design/methodology/approach: The current study evaluated a novel webinar training and individual online support program for 36 allied health, education and community support staff. Data were collected via a survey on changes in perceived "knowledge and skills" and "confidence" in supporting children with autism, as well as mode of participation, and accessibility of the program. Findings: Participants reported a significant increase in their "knowledge and skills" and "confidence", in working with children with autism. This increase was positively related to the number of webinars the participants accessed. The mode of webinar access was predominantly via watching recordings of webinars (asynchronous learning). Synchronous learning via individual online sessions was accessed by a small number of participants, mostly allied health professionals. Workload and scheduling were identified as barriers to engaging in the program. The technology platform was found to be accessible and acceptable. Originality/value: A predominantly asynchronous mode of delivery was successful, thereby increasing program access and flexibility for remote staff. Technology was not a barrier to accessing the program regardless of remoteness or job role.

Caregivers of adolescents with autism spectrum disorder commonly experience stigma. However, how stigma influences social interactions of adolescents with autism spectrum disorder is unclear. We aimed to explore the impact of caregiver stigma on real-life social experiences of Taiwanese adolescents with autism spectrum disorder. In the context of everyday activities, 76 adolescents with autism spectrum disorder who were not intellectually disabled (69 males, aged 10-16 years) carried a mobile device that prompted them 7 times, randomly, each day for 7 days to record with whom they were interacting, what they perceived, and how they felt about the interactions. Caregivers completed the Affiliate Stigma Scale to measure caregiver stigma. Multilevel analyses revealed that participants whose caregivers perceived high levels of stigma were more likely than those whose caregivers experienced less stigma to interact with family members and less likely to be interested in interacting with people at school. However, those participants also experienced more anxiety while interacting with family members. The findings shed light on ways that caregiver stigma impacted the social experiences of adolescents with autism spectrum disorder and suggest that, in promoting social participation for adolescents with autism spectrum disorder, researchers and service providers must support caregivers to manage stigma.

Introduction: This study compares the experiences of high school students with visual impairments (that is, those who are blind or have low vision) in and out of school. Methods: Twelve visually impaired high school students completed the same in-the-moment survey seven times daily for seven consecutive days. The frequencies of their activities, interactions, and ratings of internal variables (fitting in, acceptance, loneliness, and enjoyment) were compared across three contexts: home, school, and other (neither home nor school) contexts. Results: Participants spent much of their time out of school alone at home. They rated leisure and structured recreation in "other" locations as their most enjoyable activities. Doing nothing at school was the least positively rated activity. Participants fitted in significantly less and felt significantly less accepted at school than elsewhere. A large proportion of school interactions involved receiving help; few involved giving help. Participants with additional disabilities reported more school social challenges than their peers who were only visually impaired. Discussion and implications for practitioners: This study highlights the subjective dimensions of choice in everyday life. The social impact of doing nothing at school provides an imperative for staff members to ensure that adolescents with visual impairments can participate in lessons. Staff may also need to facilitate opportunities for these students to reciprocate with peers. Adolescents with visual impairments highly value activities with friends out of home and, as with most adolescents, may need to lean on their families for assistance in this area until they can participate in such activities independently.

Play is often used in interventions to improve social outcomes for children with autism spectrum disorders (ASD). Play is a primary occupation of childhood and, therefore, an important outcome of intervention. The Ultimate Guide to Play, Language and Friendship (PLF) is a peer-mediated intervention for 6-11-year-old children with ASD. A total of 68 dyads were randomized to either a 10-week treatment first or waitlist control group. Results revealed a significant moderate intervention effect from pre- to post-intervention, which was maintained to the 3-month follow-up clinic session and generalized to the home environment. The findings support that the PLF intervention can be used to positively improve play in 6-11-year-old children with ASD.

Introduction: This study explores the social experiences in high school of students with visual impairments. Methods: Experience sampling methodology was used to examine (a) how socially included students with visual impairments feel, (b) the internal qualities of their activities, and (c) the factors that influence a sense of inclusion. Twelve students, including three with additional disabilities, completed the Psychological Sense of School Membership (PSSM) questionnaire as a measure of inclusion. They were subsequently asked to complete an in-the-moment survey seven times daily for one week using an iOS device. This survey asked about activities and ratings of internal variables: fitting in, acceptance, loneliness, awareness, and enjoyment. Each student was also interviewed. Z-scores were created for internal variables and correlations calculated to examine relationships between experiences, PSSM, and demographic variables. Results: This group felt included as measured by the PSSM (m = 4.24, SD = 0.67). Students' most frequent activity was classwork. Doing nothing rated most negatively and was described as time wasting. Out-of-class activities were rated most positively. In the three participants with additional disabilities, it appeared that the presence of this additional disability negatively influenced a sense of inclusion (rb = -0.67, p < 0.05), fitting in (rb = -0.86, p < 0.05), enjoyment (rb = -0.65, p < 0.05), and loneliness (rb = 0.88, p < 0.05). Interviews revealed a lack of common ground between adolescents with both visual impairments and additional disabilities and their peers. Discussion and implications for practitioners: These students worked hard to maintain parity with peers and found school more enjoyable if they fit in. It is important to provide discreet and timely access to the curriculum. Friendships require time, common interests, and reciprocity. There may be potential to further explore out-of-class clubs as a means of supporting friendship development. In addition, findings suggest that students with additional disabilities are not likely to feel included. Because this population comprises the majority of visually impaired students, this result has serious implications for practitioners and should be examined in future research.

The articles for the Special Section on Play highlight the complexity of play and the many ways occupational therapy practitioners study and promote play with children, families, and adults across individual, school, family, political, and cross-cultural settings. The authors of the articles in this issue view the importance of play across the lifespan and through multiple research lenses, including play preference, environmental supports for and barriers to play, the skills required to succeed in play, and the extent to which play is self-determined. The guest editors offer suggestions for how to enhance occupational therapy's voice in the study and promotion of play as a primary lifelong occupation. The guest editors for the Special Section on Play offer suggestions for how to enhance occupational therapy's voice in the study and promotion of play as a primary lifelong occupation. [ABSTRACT FROM AUTHOR]

Peer-mediated interventions (PMIs) are often used to support children with autism spectrum disorder (ASD) to develop social skills. However, more investigation is needed to better understand the role of peers as both intervention recipients and models. Sixty-five typically developing peers who participated in a PMI for children with ASD were investigated using a randomised control trial. Play sessions of the dyads were scored using the Test of Playfulness. Results showed a significant moderate intervention effect for the peers from pre- to post-intervention; outcomes for children with ASD were not influenced by peer characteristics; and, the children demonstrated a similar pattern of play interaction. Implications for practice are discussed.

Outdoor play is important for children's development and an area in which many children with disabilities struggle at school. The aim of this multiple-perspective case study was to understand educator play decision-making for children with disabilities within one low socioeconomic status and culturally and linguistically diverse community. Data collection included playground observations of children with disabilities and educators and interviews with teaching assistants, teachers, and a vice principal. Data were analysed inductively and thematically, with findings aligned to the capabilities approach. School staff and typically developing children appeared to not value the children with disabilities as players or learners, and had a limited understanding of the children's home and community play environments. School staff had low expectations of children with disabilities' play and learning capacities. Participants perceived children's playground presence and not breaking rules as sufficient. Despite educators stating that children with disabilities had choice on the playground, the children experienced few meaningful choices due to relative skills delays and an unsupportive environment. Applying the capabilities approach may lead to greater choice through valuing all children as learners, players, and community members; raising play and learning expectations; and creating play spaces that support the play of all children.

Play is often used in interventions to improve social outcomes for children with autism spectrum disorders (ASD). Play is a primary occupation of childhood and, therefore, an important outcome of intervention. The Ultimate Guide to Play, Language and Friendship (PLF) is a peer-mediated intervention for 6-11-year-old children with ASD. A total of 68 dyads were randomized to either a 10-week treatment first or waitlist control group. Results revealed a significant moderate intervention effect from pre- to post-intervention, which was maintained to the 3-month follow-up clinic session and generalized to the home environment. The findings support that the PLF intervention can be used to positively improve play in 6-11-year-old children with ASD. Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ (ACTRN12615000008527; Universal Trial Number: U1111-1165-2708), Author(s): Cally Kent [sup.1] , Reinie Cordier [sup.1] [sup.5] , Annette Joosten [sup.2] , Sarah Wilkes-Gillan [sup.3] , Anita Bundy [sup.4] Author Affiliations: (1) grid.1032.0, 0000 0004 0375 4078, School [...]

Individuals who cope well with challenges may engage in social situations more successfully. We examined the association between coping behaviors, self-perceived competence, and social anxiety in everyday social situations. A total of 133 participants between the ages of 10 and 16 years (82 autistic, 51 neurotypical) carried a mobile device that prompted them seven times each day for 7 days to record what they were doing and their perceived competence and social anxiety in that situation. We used the Coping Inventory to measure overall coping abilities (i.e. coping with the self and the environment). Multilevel analyses found that autistic adolescents were more likely than neurotypical peers to experience social anxiety while engaged in maintenance or productive activities with adults. While their ability to cope with the self was positively associated with perceived social competence, it was negatively associated with the ability to cope with environmental challenges. Furthermore, autistic adolescents with poor ability to cope with environmental challenges were more likely than those who coped well to be socially anxious when engaged in leisure activities with peers. Findings from this study can guide evaluation and intervention to improve the social experiences of autistic adolescents by helping them increase coping skills. 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. [ABSTRACT FROM AUTHOR]

Peer-mediated interventions (PMIs) are often used to support children with autism spectrum disorder (ASD) to develop social skills. However, more investigation is needed to better understand the role of peers as both intervention recipients and models. Sixty-five typically developing peers who participated in a PMI for children with ASD were investigated using a randomised control trial. Play sessions of the dyads were scored using the Test of Playfulness. Results showed a significant moderate intervention effect for the peers from pre- to post-intervention; outcomes for children with ASD were not influenced by peer characteristics; and, the children demonstrated a similar pattern of play interaction. Implications for practice are discussed. Clinical Trials Registry Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ https://www.anzctr.org.au/ (ACTRN12615000008527; Universal Trial Number: U1111-1165-2708)., Author(s): Cally Kent [sup.1] , Reinie Cordier [sup.1] [sup.2] , Annette Joosten [sup.3] , Sarah Wilkes-Gillan [sup.4] , Anita Bundy [sup.4] [sup.5] Author Affiliations: (1) grid.1032.0, 0000 0004 0375 4078, [...]

Our aims were to examine the efficacy of a new observational instrument "System for Observing Outdoor Play" for detecting changes in outdoor play and chart the use of recycled and repurposed materials in the school playground during the course of an intervention to increase outdoor play. Children from one Sydney primary school were observed (N = 111; 5-12 years) using an observational instrument developed as part of the Sydney Playground Project. Data on types of activities and frequencies were collected at baseline and seven times during intervention. Use of intervention materials was consistently high and associated with increases in play-related activities (40-77%), while inactive pursuits decreased (52-31%), on average. The observational instrument proved efficacious in tracking changes in play. Modification of the school playground environment by introducing loose parts changed children's play-related behaviour; the variety of activities increased, including construction and creative play. Physical inactivity decreased. Recycled materials can increase children's creative, social and physical play.

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 (ß = 9350 counts, 95% CI 3490-1522, p = 0.002), minutes of moderate/vigorous physical activity (MVPA) (ß = 1.8 min, 95% CI 0.52-3.12, p = 0.006), and reductions in sedentary time (ß = -2.1 min, 95% CI -3.77-(-0.51), p = 0.01). Although the changes in time spent in play and nonplay were not statistically different (p = 0.08) the effect size (d = 0.27) indicates clinical significance. Conclusions: This intervention was effective for increasing MVPA during recess and demonstrated capacity to improve play opportunities in school playgrounds.

Individuals with an autism spectrum disorder commonly have limited social participation. This study aimed to examine the similarities and differences of everyday participation among males and females with autism spectrum disorder in Australia and Taiwan, using an experience sampling methodology. A total of 14 Australians (4 males, aged 16-43 years) and 16 Taiwanese (12 males, aged 19-45 years) with autism spectrum disorder who are cognitively able were asked to carry a device which prompted them seven times per day for 7 days, to record everyday participation: where they were, what they were doing, and who they were with. Multilevel analyses were used to identify the relationships between everyday participation and associated factors including gender, country of residence, clinical severity of autism spectrum disorder, and social anxiety. The results showed that Taiwanese participants were more likely to stay at home than Australian participants. However, female participants were more likely to engage in social situations than males. Furthermore, participants with fewer autism spectrum disorder symptoms and those with higher levels of social anxiety were less likely to engage in social interactions. This study sheds light on ways that culture and gender affect social participation and highlights the relationship of social anxiety to social participation. The findings have implications for interventions for social participation.

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.

The purpose of this study was to survey the attitudes of parents of adolescent children (with, and without, hearing impairment), with the following objectives: (1) compare perceptions of the parent groups regarding the risk of leisure-noise-related hearing injury; and (2) investigate how comfortable parents felt endorsing their child's participation in a range of everyday leisure activities, some which may involve noise exposure. Cross-sectional cohort study. Experimental group--parents of adolescents (aged 13-18 years) with hearing impairment (HI group) n = 53. Control group--parents of age-matched youths with non-impaired/'normal hearing' (NH group) n = 70. Rasch modelling was applied to evaluate the internal validity and reliability of the leisure attitudes items. Rasch-generated interval-level data and raw ordinal-level data were used to identify systematic differences between groups. Most parents (HI and NH groups) perceived leisure-noise to be a significant health risk for young people in general, but few perceived their own child to be at high risk. Parents in the HI group were significantly less comfortable overall, and with several specific leisure activities, than parents in the NH group but, conversely, were more comfortable with two activities. Concerns related to a variety of factors. Leisure-time activities provide a major opportunity for children to socialize and they are a crucial part of healthy emotional and physical development. Parent attitudes may influence children's participation. Parents may benefit from support in identifying and managing concerns about the impact of hearing impairment on their children's leisure participation.

Children with autism spectrum disorder (ASD) tend to be less playful than their typically developing (TD) peers. Although playfulness is considered a personality characteristic, little is known about the stability of this trait in interactions with different caregivers. This study compared the playfulness of children with and without ASD in play interactions with their mothers at home and with their teachers at preschool. Twenty-nine children with ASD and 32 TD children (age 3-6), their mothers and teachers participated in the study. A significant difference was found between playfulness of children with and without ASD when playing with their mothers, but not when playing with their teachers. Additionally, while children with ASD tended to be more playful with their teachers, TD children were more playful with their mothers. The current study suggests that playfulness may be an adaptive trait, related not only to individual characteristics, but also to environmental ones.

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. This brief report adds to the growing body of evidence for validity and reliability of the Evaluation in Ayres Sensory Integration® Praxis tests. Assessment of praxis using valid and reliable measures is important for understanding factors affecting occupational participation. [ABSTRACT FROM AUTHOR]

Background: People with disability living in rural areas are vulnerable to the loss of access to allied health services due to a critical shortage of allied health professionals (AHPs). This study aimed to investigate recruitment and retention issues of importance to AHPs providing services to people with disability in rural New South Wales, Australia. Method: Focus groups and semistructured interviews were conducted with 97 purposively sampled service providers in the disability sector. Interviews and focus groups were digitally recorded and transcribed. A modified grounded theory approach using thematic analysis and constant comparison was used to analyse the data. Results: Three major themes relating to recruitment and retention were identified: (a) flexible recruitment, (b) retention strategies that work, and (c) challenges to retention. Conclusions: AHPs in the disability sector identified some of the same issues influencing recruitment and retention as AHPs in the health, education, and private sectors. Several unique issues were also identified that will assist policymakers to improve recruitment and retention of AHPs employed in the disability sector in rural areas.