Khetani M, Graham J E, Alvord C
Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80523, USA.
Child Care Health Dev. 2013 Jul;39(4):490-9. doi: 10.1111/cch.12045.
We examined activity-specific patterns and child, family and environmental correlates of participation restriction in nine community-based activities among preschoolers with disabilities who have received Part C early intervention services.
Data were gathered from a subsample of 1509 caregivers whose children (mean age = 67.7 months) had enrolled in the National Early Intervention Longitudinal Study (NEILS) and completed a 40-min computerized telephone interview or 12-page mailed survey. Data were analysed on cases with complete data on the variables of interest. Bivariate relationships were examined between variables, including patterns of co-reporting participation difficulties for pairs of community activities.
Caregivers were more than twice as likely to report difficulty in one activity (20%) than difficulties in 2-3, 4-5, or 6-9 activities. Co-reporting paired difficulties was strong for activities pertaining to neighbourhood outings but less conclusive for community-sponsored activities and recreation and leisure activities. Our data show strong and positive associations between child functional limitations in mobility, toileting, feeding, speech, safety awareness, and friendships and participation difficulty in 7-9 activities. Lower household income was associated with participation difficulty in 7 out of 9 activities and difficulty managing problematic behaviour was strongly associated with participation difficulty in all 9 activities. Each of the three environmental variables (limited access to social support, transportation and respite) was associated with participation restrictions in all nine activities.
Results provide practitioners with detailed descriptive knowledge about modifiable factors related to the child, family and environment for promoting young children's community participation, as well information to support development of a comprehensive assessment tool for research and intervention planning to promote community participation for children enrolled in early intervention.
我们研究了接受C部分早期干预服务的残疾学龄前儿童在九项社区活动中特定活动模式以及参与受限的儿童、家庭和环境相关因素。
数据来自1509名照顾者的子样本，他们的孩子（平均年龄 = 67.7个月）参加了国家早期干预纵向研究（NEILS），并完成了40分钟的计算机电话访谈或12页的邮寄调查。对感兴趣变量具有完整数据的案例进行数据分析。检查了变量之间的双变量关系，包括成对社区活动共同报告参与困难的模式。
照顾者报告在一项活动中有困难的可能性（20%）是在2 - 3项、4 - 5项或6 - 9项活动中有困难可能性的两倍多。与邻里出行相关的活动共同报告成对困难的情况很强烈，但在社区赞助活动以及娱乐和休闲活动方面则不太确定。我们的数据显示，儿童在移动、如厕、进食、言语、安全意识和友谊方面的功能限制与7 - 9项活动中的参与困难之间存在强烈的正相关。较低的家庭收入与9项活动中的7项活动的参与困难相关，管理问题行为的困难与所有9项活动的参与困难密切相关。三个环境变量（获得社会支持、交通和喘息服务的机会有限）中的每一个都与所有九项活动中的参与受限相关。
研究结果为从业者提供了与促进幼儿社区参与相关的、关于儿童、家庭和环境的可改变因素的详细描述性知识，以及支持开发用于研究和干预规划的综合评估工具的信息，以促进参与早期干预的儿童的社区参与。
