Outdoor Play Decisions by Caregivers of Children with Disabilities: a Systematic Review of Qualitative Studies

Abtsract

Outdoor play offers children vast benefits for development and well-being. However, children with developmental disabilities participate less in outdoor play than their typical peers. Typically, adults make decisions about children’s play routines, especially for children with developmental disabilities. The purpose of this systematic review was to synthesize the results from qualitative studies on decision making processes of caregivers around outdoor play in children with developmental disabilities using ecocultural theory. Studies addressing decision making of parents, teachers, and other caregivers of primary school-aged children with developmental disabilities relating to outdoor play were searched in CINHAL, Medline, Web of Science, ERIC, Scopus, PsycINFO, and SocINDEX from 1990 to May 2015. Eleven predominately qualitative studies met the inclusion criteria. The CASP quality of reporting quality checklist was used to evaluate the transparency of reporting for included studies. An ecocultural framework was used for thematic analysis and synthesis. Results showed caregivers, families, schools, and communities consider many factors when deciding about when, where, how, and if outdoor play occurs. Factors comprised: motivation for participation in outdoor play; social and built environments; familial and school considerations including time and finances; caregivers’ awareness of opportunities; and child considerations such as their skills, health, and interests. A dynamic interaction exists between and within the ecocultural environment of a child with developmental disabilities to determine decision outcomes in outdoor play. Consequently, to increase the opportunities for benefits associated with outdoor play, each ecocultural layer must be targeted.

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References

  1. Anaby, D., Hand, C., Bradley, L., DiRezze, B., Forhan, M., DiGiacomo, A., & Law, M. (2013). The effect of the environment on participation of children and youth with disabilities: a scoping review. Disability and Rehabilitation, 35, 1589–1598. doi:10.3109/09638288.2012.748840.

    Article  PubMed  Google Scholar 

  2. Anderson, K., Stowasser, D., Freeman, C., & Scott, I. (2014). Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open, 4, 1–18.

    Article  Google Scholar 

  3. Australian Institute of Health and Welfare (AIHW). (2004). Children with disabilities in Australia. AIHW cat. no. DIS 38. Canberra: AIHW.

  4. Backett-Milburn, K., & Harden, J. (2004). How children and their families construct and negotiate risk, safety and danger. Childhood, 11, 429–447. doi:10.1177/0907568204047105.

    Article  Google Scholar 

  5. Baker, K., & Donelly, M. (2001). The Social Experiences of Children with Disability and the Influence of Environment: A framework for intervention. Disability & Society, 16, 71–85. doi:10.1080/713662029.

    Article  Google Scholar 

  6. Bloemen, M., Verschuren, O., van Mechelen, C., Borst, H. E., de Leeuw, A. J., van der Hoef, M., & de Groot, J. F. (2015). Personal and environmental factors to consider when aiming to improve participation in physical activity in children with Spina Bifida: a qualitative study. BMC Neurology, 15, 11. doi:10.1186/s12883-015-0265-9.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bronfenbrenner, U. (1979). The ecology of human development: experiments in nature and design. Cambridge, MA: Harvard University Press.

    Google Scholar 

  8. Brussoni, M., Gibbons, R., Gray, C., Ishikawa, T., Sandseter, E., Bienenstock, A., et al. (2015). What is the relationship between risky outdoor play and health in children? A systematic review. International Journal of Environmental Research and Public Health, 12, 6423–6454. doi:10.3390/ijerph120606423.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bult, M. K., Verschuren, O., Jongmans, M. J., Lindeman, E., & Ketelaar, M. (2011). What influences participation in leisure activities of children and youth with physical disabilities? A systematic review. Research in Developmental Disabilities, 32, 1521–1529. doi:10.1016/j.ridd.2011.01.045.

    Article  PubMed  Google Scholar 

  10. Bundy, A. (1993). Assessment of play and leisure: delineation of the problem. The American journal of occupational therapy.: official publication of the American Occupational Therapy Association, 47, 217–222. doi:10.5014/ajot.47.3.217.

    Article  Google Scholar 

  11. Bundy, A., Luckett, T., Naughton, G., Tranter, P., Wyver, S., Ragen, J., et al. (2008). Playful interaction:occupational therapy for all children on the school playground. American Journal of Occupational Therapy, 62, 522–527.

    Article  PubMed  Google Scholar 

  12. Bundy, A., Wyver, S., Beetham, K. S., Ragen, J., Naughton, G., Tranter, P., et al. (2015). The Sydney playground project- levelling the playing field: a cluster trial of a primary school-based intervention aiming to promote manageable risk-taking in children with disability. BMC Public Health, 15, 1125. doi:10.1186/s12889-015-2452-4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Burdette, H. L., & Whitaker, R. C. (2005). Resurrecting Free Play in Young Children Looking Beyond Fitness and Fatness to Attention, Affiliation, and Affect. Archives of Pediatrics & Adolescent Medicine, 159, 46–50.

    Article  Google Scholar 

  14. Campbell, R., Pound, P., Pope, C., Britten, N., Pill, R., Morgan, M., & Donovan, J. (2003). Evaluating meta-ethnography: a synthesis of qualitative research on lay experiences of diabetes and diabetes care. Social Science and Medicine, 56(4), 671–684. doi:10.1016/S0277-9536(02)00064-3.

    Article  PubMed  Google Scholar 

  15. Case-Smith, J., & Kuhaneck, H. M. (2008). Play Preferences of Typically Developing Children and Children with Developmental Delays Between Ages 3 and 7 Years. OTJR: Occupation, Participation, Health, 28, 19–29. doi:10.3928/15394492-20080101-01.

    Google Scholar 

  16. Children’s Play Council (1998). The new charter for children’s play. Book. London: The Children’s Society.

    Google Scholar 

  17. Colver, A., Thyen, U., Arnaud, C., Beckung, E., Fauconnier, J., Marcelli, M., et al. (2012). Association between participation in life situations of children with cerebral palsy and their physical, social, and attitudinal environment: a cross-sectional multicenter European study. Archives of Physical Medicine and Rehabilitation, 93, 2154–2164. doi:10.1016/j.apmr.2012.07.011.

    Article  PubMed  Google Scholar 

  18. Coster, W., Law, M., Bedell, G., Liljenquist, K., Kao, Y. C., Khetani, M., & Teplicky, R. (2013). School participation, supports and barriers of students with and without disabilities. Child: Care, Health and Development, 39, 535–543. doi:10.1111/cch.12046.

    Google Scholar 

  19. Creswell, J. (2007). Qualitative inquiry and research design: Choosing among five approaches (2nd ed.). Thousand Oaks, California: Sage Publications Inc..

    Google Scholar 

  20. Critical Appraisal Skills Programme. (2014). CASP Checklists. http://www.casp-uk.net/

  21. Dixon-Woods, M., Sutton, A., Shaw, R., Miller, T., Smith, J., Young, B., et al. (2007). Appraising qualitative research for inclusion in systematic reviews: a quantitative and qualitative comparison of three methods. Journal of Health Services Research & Policy, 12, 42–47 %U http://jhsrp.rsmjournals.com/cgi/content/. doi:10.1258/135581907779497486

  22. Downs, S. J., Boddy, L. M., Knowles, Z. R., Fairclough, S. J., & Stratton, G. (2013). Exploring opportunities available and perceived barriers to physical activity engagement in children and young people with Down syndrome. European Journal of Special Needs Education, 28, 270–287. doi:10.1080/08856257.2013.768453.

    Article  Google Scholar 

  23. Downs, S. J., Knowles, Z. R., Fairclough, S. J., Heffernan, N., Whitehead, S., Halliwell, S., & Boddy, L. M. (2014). Exploring teachers’ perceptions on physical activity engagement for children and young people with intellectual disabilities. European Journal of Special Needs Education, 29, 402–414. doi:10.1080/08856257.2014.906979.

    Article  Google Scholar 

  24. Engel-Yeger, B., Jarus, T., Anaby, D., & Law, M. (2009). Differences in patterns of participation between youths with cerebral palsy and typically developing peers. American Journal of Occupational Therapy, 63, 96–104. doi:10.5014/ajot.63.1.96.

    Article  PubMed  Google Scholar 

  25. Friedman, H. S., Martin, L. R., Tucker, J. S., Criqui, M. H., Kern, M. L., & Reynolds, C. a. (2008). Stability of physical activity across the lifespan. Journal of Health Psychology, 13, 1092–1104. doi:10.1177/1359105308095963.

    Article  PubMed  Google Scholar 

  26. Ginsburg, K., American Academy of Pediatrics Committee on Communications, & American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health (2007). The importance of play in promoting healthy child development and maintaining strong parent-child bonds. American Academy of Pediatrics, 119, 182–191.

    Google Scholar 

  27. Hossein Memari, A., Panahi, N., Ranjbar, E., Moshayedi, P., Shafiei, M., Kordi, R., & Ziaee, V. (2015). Children with Autism Spectrum Disorder and Patterns of Participation in Daily Physical and Play Activities. Neurology Research International, 1–7. doi:10.1155/2015/531906.

  28. Imms, C. (2008). Children with cerebral palsy participate: a review of the literature. Disability and Rehabilitation, 30, 1867–1884. doi:10.1080/09638280701673542.

    Article  PubMed  Google Scholar 

  29. Imms, C., Reilly, S., Carlin, J., & Dodd, K. J. (2009). Characteristics influencing participation of Australian children with cerebral palsy. Disability and Rehabilitation, 31, 2204–2215. doi:10.3109/09638280902971406.

    Article  PubMed  Google Scholar 

  30. Isenberg, J. P., & Quisenberry, N. (2002). A Position Paper of the Association for Childhood Education International PLAY: Essential for all Children. Childhood Education, 79, 33–39. doi:10.1080/00094056.2002.10522763.

    Article  Google Scholar 

  31. King, G., Law, M., King, S., Rosenbaum, P., Kertoy, M. K., & Young, N. L. (2003). A conceptual model of the factors affecting the recreation and leisure participation of children with disabilities. Physical & Occupational Therapy in Pediatrics, 23, 63–90. doi:10.1300/J006v23n01_05.

    Article  Google Scholar 

  32. King, G., Law, M., Hanna, S., King, S., Hurley, P., Rosenbaum, P., et al. (2006). Predictors of the Leisure and Recreation Participation of Children With Physical Disabilities: A Structural Equation Modeling Analysis. Children's Health Care, 35, 209–234. doi:10.1207/s15326888chc3503_2.

    Article  Google Scholar 

  33. King, G., Law, M., Hurley, P., Petrenchik, T., & Schwellnus, H. (2010). A Developmental Comparison of the Out-of-school Recreation and Leisure Activity Participation of Boys and Girls With and Without Physical Disabilities. International Journal of Disability, Development and Education, 57, 77–107. doi:10.1080/10349120903537988.

    Article  Google Scholar 

  34. Klaczynski, P. A., Byrnes, J. P., & Jacobs, J. E. (2001). Introduction to the special issue. Journal of Applied Developmental Psychology, 22, 225–236. doi:10.1016/S0193-3973(01)00081-8.

    Article  Google Scholar 

  35. Kuo, D. Z., Houtrow, A. J., Arango, P., Kuhlthau, K. A., Simmons, J. M., & Neff, J. M. (2012). Family-centered care: Current applications and future directions in pediatric health care. Maternal and Child Health Journal, 16, 297–305. doi:10.1007/s10995-011-0751-7.

    Article  PubMed  Google Scholar 

  36. Law, M. (2002). Participation in the occupations of everyday life. American Journal of Occupational Therapy, 56, 640–649.

    Article  PubMed  Google Scholar 

  37. Law, M., Finkelman, S., Hurley, P., Rosenbaum, P., King, S., King, G., & Hanna, S. (2004). Participation of children with physical disabilities: relationships with diagnosis, physical function, and demographic variables. Scandinavian Journal of Occupational Therapy, 11, 156–162. doi:10.1080/11038120410020755.

    Article  Google Scholar 

  38. Law, M., Petrenchik, T., King, G., & Hurley, P. (2007). Perceived Environmental Barriers to Recreational, Community, and School Participation for Children and Youth With Physical Disabilities. Archives of Physical Medicine and Rehabilitation, 88, 1636–1642. doi:10.1016/j.apmr.2007.07.035.

    Article  PubMed  Google Scholar 

  39. Law, M., Darrah, J., Pollock, N., Wilson, B., Russell, D. J., Walter, S. D., et al. (2011). Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy. Developmental Medicine and Child Neurology, 53, 621–629. doi:10.1111/j.1469-8749.2011.03962.x.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Lawlor, M., & Mattingly, C. F. (1998). The complexities embedded in family centered care. The American Journal of Occupational Therapy, 52, 259–267.

    Article  PubMed  Google Scholar 

  41. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. a., et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Annals of Internal Medicine, 151, W-65. doi:10.1371/journal.pmed.1000100.

    Article  Google Scholar 

  42. Llewellyn, G. (2012). Ecocultural theory: Everyday cultures of children. In S. Lane & A. Bundy (Eds.), Kids can be kids (pp. 180–193). Philadelphia, PA: F.A. Davis Company.

    Google Scholar 

  43. Mactavish, J., & Schleien, S. (1998). Playing together growing together: Parent’s perspectives on the benefits of family recreation in families that include children with a developmental disability. Therapeutic Recreation Journal, 32, 207–230.

    Google Scholar 

  44. Mactavish, J., & Schleien, S. (2004). Re-injecting spontaneity and balance in family life: parents’ perspectives on recreation in families that include children with developmental disability. Journal of intellectual disability research: JIDR, 48, 123–141. doi:10.1111/j.1365-2788.2004.00502.x.

    Article  PubMed  Google Scholar 

  45. Martin, J., & Choi, Y. S. (2009). Parents’ physical activity-related perceptions of their children with disabilities. Disability and Health Journal, 2, 9–14. doi:10.1016/j.dhjo.2008.09.001.

    Article  PubMed  Google Scholar 

  46. Maulik, P. K., Mascarenhas, M. N., Mathers, C. D., Dua, T., & Saxena, S. (2011). Prevalence of intellectual disability: A meta-analysis of population-based studies. Research in Developmental Disabilities, 34, 419436. doi:10.1016/j.ridd.2010.12.018.

    Article  Google Scholar 

  47. Must, A., Phillips, S., Curtin, C., & Bandini, L. G. (2015). Barriers to Physical Activity in Children With Autism Spectrum Disorders: Relationship to Physical Activity and Screen Time. Journal of Physical Activity & Health, 12, 529–534. doi:10.1123/jpah.2013-0271.

    Article  Google Scholar 

  48. Nabors, L., & Badawi, M. (1997). Playground Interactions for Preschool-Age Children with Special Needs. Physical & Occupational Therapy in Pediatrics, 17, 21–31.

    Article  Google Scholar 

  49. Niehues, A. N., Bundy, A., Broom, A., Tranter, P., Ragen, J., & Engelen, L. (2013). Everyday uncertainties: reframing perceptions of risk in outdoor free play. Journal of Adventure Education & Outdoor Learning, 13, 223–237. doi:10.1080/14729679.2013.798588.

    Article  Google Scholar 

  50. Office of the United Nations High Commissioner for Human Rights. (1990). Convention on the Rights of the Child. Convention on the rights of the child: General Assembly Resolution 44/25 of 20 November 1989. doi:10.3126/jnps.v29i1.1601

  51. Ökcün, M. Ç., & Akçin, N. (2012). A description of a mother’s play guidance for her child with autism in the process of playing by the rules. Journal of Research in Special Educational Needs, 12, 96–106. doi:10.1111/j.1471-3802.2011.01218.x.

    Article  Google Scholar 

  52. Palisano, R. J., Kang, L.-J., Chiarello, L. A., Orlin, M., Oeffinger, D., & Maggs, J. (2009). Social and community participation of children and youth with cerebral palsy is associated with age and gross motor function classification. Physical Therapy, 89, 1304–1314. doi:10.2522/ptj.20090162.

    Article  PubMed  Google Scholar 

  53. Praisner, C. (2000). Attitudes of elementary school principals toward the inclusion of students with mild disabilities. Exceptional Children, 69, 135–145.

    Article  Google Scholar 

  54. Prellwitz, M., & Tamm, M. (1999). Attitudes of key persons to accessibility problems in playgrounds for children with restricted mobility: a study in a medium-sized municipality in northern Sweden. Scandinavian Journal of Occupational Therapy, 6, 166–173. doi:10.1080/110381299443645.

    Article  Google Scholar 

  55. Ripat, J., & Becker, P. (2012). Playground Usability: What Do Playground Users Say? Occupational Therapy International, 19, 144–153. doi:10.1002/oti.1331.

    Article  PubMed  Google Scholar 

  56. Rosenbaum, P., & Stewart, D. (2004). The World Health Organization International Classification of Functioning, Disability, and Health: A Model to Guide Clinical Thinking, Practice and Research in the Field of Cerebral Palsy. Seminars in Pediatric Neurology, 11, 5–10. doi:10.1016/j.spen.2004.01.002.

    Article  PubMed  Google Scholar 

  57. Saluja, G., Brenner, R., Morrongiello, B. A., Haynie, D., Rivera, M., & Cheng, T. L. (2004). The role of supervision in child injury risk: definition, conceptual and measurement issues. Injury Control and Safety Promotion, 11, 17–22. doi:10.1076/icsp.11.1.17.26310.

    Article  PubMed  Google Scholar 

  58. Scholl, K. G., McAvoy, L. H., Rynders, J. E., & Smith, J. G. (2003). The influence of an inclusive outdoor recreation experience on families that have a child with a disability. Therapeutic Recreation Journal, 37, 38–57. doi:10.1080/01490409109513147.

    Google Scholar 

  59. Shields, N., & Synnot, A. (2016). Perceived barriers and facilitators to participation in physical activity for children with disability: a qualitative study. BMC Pediatrics, 1–10. doi:10.1186/s12887-016-0544-7.

  60. Shikako-Thomas, K., Majnemer, A., Law, M., & Lach, L. (2008). Determinants of participation in leisure activities in children and youth with cerebral palsy: systematic review. Physical & Occupational Therapy in Pediatrics, 28, 155–169. doi:10.1080/01942630802031834.

    Article  Google Scholar 

  61. Skär, L. (2002). Disabled children’s perceptions of technical aids, assistance and peers in play situations. Scandinavian Journal of Caring Sciences, 16, 27–33. doi:10.1046/j.1471-6712.2002.00047.x.

    Article  PubMed  Google Scholar 

  62. Talay, L., Akpinar, N., & Belkayali, N. (2010). Barriers to playground use for children with disabilities : A case from Ankara-Turkey. African Journal of Agricultural Research, 5, 848–855. doi:10.5897/AJAR09.779.

    Google Scholar 

  63. Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8. doi:10.1186/1471-2288-8-45.

  64. Thompson, D., & Emira, M. (2011). “They say every child matters, but they don”t’: an investigation into parental and carer perceptions of access to leisure facilities and respite care for children and young people with Autistic Spectrum Disorder (ASD) or Attention Deficit, Hyperactivity D. Disability & Society, 26, 65–78. doi:10.1080/09687599.2011.529667.

    Article  Google Scholar 

  65. Veitch, J., Bagley, S., Ball, K., & Salmon, J. (2006). Where do children usually play? A qualitative study of parents’ perceptions of influences on children’s active free-play. Health & Place, 12, 383–393. doi:10.1016/j.healthplace.2005.02.009.

    Article  Google Scholar 

  66. von Benzon, N. (2010). Moving on from ramps? The utility of the social model of disability for facilitating experiences of nature for disabled children. Disability & Society, 25, 617–626. doi:10.1080/09687599.2010.489313.

    Article  Google Scholar 

  67. Weisner, T. S. (2002). Ecocultural understanding of children’s developmental pathways. Human Development, 45, 275–281. doi:10.1159/000064989.

  68. Williams, K., MacDermott, S., Ridley, G., Glasson, E., & Wray, J. (2008). The Prevalence of Autism in Australia: Can it be Establisher from Existing Data? Journal of Paediatrics and Child Health 44, 504–510. file://localhost/Volumes/Volume_2/ZoteroLib_LV/library/Papers/2006/MacDermott/Australian Advisory Board on ASD 2006 MacDermott.pdf

  69. Wilson, D. (2014). Incorporating group selection into the adaptionist program: A case study involving human decision making. In J. Simpson & D. Kenrick (Eds.), Evolutionary social psychology (pp. 345–387). Mahawah, NJ: Psychology Press.

    Google Scholar 

  70. World Health Organization (2001). International classification of functioning, disability and health. Geneva: World Health Organization.

    Google Scholar 

  71. Wyver, S., Tranter, P., Naughton, G., Little, H., Sandseter, E. B. H., & Bundy, A. (2010). Ten ways to restrict children’s freedom to play: The problem of surplus safety. Contemporary Issues in Early Childhood, 11(3), 263–277. doi:10.2304/ciec.2010.11.3.263.

    Article  Google Scholar 

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Correspondence to Julia Sterman.

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An Australian Research Council Discovery Grant (number DP140101792) obtained by AB for the Sydney Playground Project (Levelling the Playing Field: Starting with the School Playground), made possible the PhD scholarship of JS.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Sterman, J., Naughton, G., Froude, E. et al. Outdoor Play Decisions by Caregivers of Children with Disabilities: a Systematic Review of Qualitative Studies. J Dev Phys Disabil 28, 931–957 (2016). https://doi.org/10.1007/s10882-016-9517-x

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Keywords

  • Parent
  • Teacher
  • Kid
  • Thematic analysis
  • Qualitative synthesis