U.S. Physical Activity Para Report Card for Children and Adolescents With Disabilities.

The U.S. Report Card on Physical Activity for Children and Youth has tracked 10 physical activity (PA) indicators common to the Active Healthy Kids Global Matrix since 2014. This article expands on the U.S. report cards by presenting PA indicator assessments among children and adolescents with disabilities. Grades for indicators were assigned based on a search of peer-reviewed articles presenting nationally representative data. The Global Matrix 3.0 benchmarks and grading framework guided the process. Grades for overall PA, sedentary behaviors, organized sports, and school were F, D+, D+, and D, respectively. Insufficient evidence existed to assign grades to the remaining six indicators. There is a need in the United States for targeted PA promotion strategies that are specific to children and adolescents with disabilities. Without a commitment to this effort across sectors and settings, the low grades identified in this para report card are expected to remain.

Results From Spain's 2022 Para Report Cards on Physical Activity of Children and Adolescents With Disabilities.

This report aims to provide a better understanding of physical activity (PA) and related factors among Spanish children and adolescents living with disabilities. The 10 indicators used for the Global Matrix on Para Report Cards of children and adolescents living with disabilities were evaluated based on the best available data in Spain. An analysis of strengths, weaknesses, opportunities, and threats based on data provision was drafted by three experts and critically reviewed by the authorship team to provide a national perspective for each evaluated indicator. Government was the indicator with the highest grade (C+), followed by Sedentary Behaviors (C-), School (D), Overall PA (D-), and Community & Environment (F). The remaining indicators received an incomplete grade. There were low levels of PA in Spanish children and adolescents living with disabilities. Yet, opportunities to improve the current surveillance of PA among this population exist.

2022 Para Report Card on Physical Activity of Israeli Children and Adolescents With Disabilities.

Children and adolescents with disabilities (CAWD) represent 11% of Israeli children and adolescents. The 10 core indicators of the Global Matrix on Para Report Cards of physical activity (PA) of CAWD were used to create the 2022 Israeli Para Report Card. A panel of four experts reviewed resources and synthesized evidence of PA behaviors and policies for CAWD in Israel, converted the data to grades, and charted subcategories of language, sex, and disability across population. Data sources were surveys, reports, and memberships in sport federations and clubs. Among CAWD, levels of participation in daily PA were poor (<20%; Grade F), and participation of CAWD in sports was even lower (<10%; Grade F). A lack of environmental infrastructure may explain the low levels of participation. Females, Arabic speakers, and physiological CAWD need particular attention. Establishing governmental policies and interventions is required to increase overall PA and participation in sports among CAWD.

Global Matrix of Para Report Cards on Physical Activity of Children and Adolescents With Disabilities.

This is an overview of the results from 14 countries or jurisdictions in a Global Matrix of Para Report Cards on physical activity (PA) of children and adolescents with disabilities. The methodology was based on the Active Healthy Kids Global Alliance's Global Matrix 4.0. Data were aligned with 10 indicators (Overall PA, Organized Sport, Active Play, Active Transport, Physical Fitness, Sedentary Behavior, Family & Peers, Schools, Community & Environment, and Government) to produce Para Report Cards. Subsequently, there were 139 grades; 45% were incomplete, particularly for Active Play, Physical Fitness, and Family & Peers. Collectively, Overall PA was graded the lowest (F), with Schools and Government the highest (C). Disability-specific surveillance and research gaps in PA were apparent in 14 countries or jurisdictions around the world. More coverage of PA data in Para Report Cards is needed to serve as an advocacy tool to promote PA among children and adolescents with disabilities.

Infant exuberant object play at home: Immense amounts of time-distributed, variable practice.

Object play yields enormous benefits for infant development. However, little is known about natural play at home where most object interactions occur. We conducted frame-by-frame video analyses of spontaneous activity in two 2-h home visits with 13-month-old crawling infants and 13-, 18-, and 23-month-old walking infants (N = 40; 21 boys; 75% White). Regardless of age, for every infant and time scale, across 10,015 object bouts, object interactions were short (median = 9.8 s) and varied (transitions among dozens of toys and non-toys) but consumed most of infants' time. We suggest that infant exuberant object play-immense amounts of brief, time-distributed, variable interactions with objects-may be conducive to learning object properties and functions, motor skill acquisition, and growth in cognitive, social, and language domains.

Systematic review of the correlates of outdoor play and time among children aged 3-12 years.

BACKGROUND: Due to the myriad of benefits of children's outdoor play and time, there is increasing concern over its decline. This systematic review synthesized evidence on the correlates of outdoor play and outdoor time among children aged 3-12 years. METHODS: A total of 12 electronic databases in five different languages (Chinese, English, Korean, Spanish, Portuguese) were searched between October 28, 2019 and July 27, 2020. Covidence software was used for screening and Microsoft Excel with a predesigned coding form was used for data extraction. Evidence was synthesized and correlates were categorized using the socioecological model framework. RESULTS: Based on 107 studies representing 188,498 participants and 422 childcare centers from 29 countries, 85 studies examined potential correlates of outdoor play while 23 studies examined that of outdoor time (one examined both). The duration of outdoor play and outdoor time ranged between 60 and 165 min/d and 42-240 min/d, respectively. Out of 287 (outdoor play) and 61 (outdoor time) potential correlates examined, 111 correlates for outdoor play and 33 correlates for outdoor time were identified as significant correlates. Thirty-three variables were identified as key/common correlates of outdoor play/time, including eight correlates at the individual level (e.g., sex/gender, race/ethnicity, physical activity), 10 correlates at the parental level (e.g., parental attitude/support/behavior, parenting practice), nine at the microsystem level (e.g., proximal home/social environment such as residence type, peer influence), three at the macrosystem/community level (e.g., availability of space children can play), and three at the physical ecology/pressure for macrosystem change level (e.g., seasonality, rurality). No key correlates were found at the institutional level. CONCLUSIONS: Individual, parental, and proximal physical (home) and social environments appear to play a role in children's outdoor play and time. Ecological factors (i.e., seasonality, rurality) also appear to be related to outdoor play/time. Evidence was either inconsistent or lacking at institutional and macrosystem/community levels. Standardizing terminology and measures of outdoor play/time is warranted. Future work should investigate the interactions and processes of multiple variables across different levels of socioecological modelling to better understand the mechanisms through which outdoor play/time opportunities can be optimized for children while paying special attention to varying conditions in which children are born, live, and play.

MANTRA: development and localization of a mobile educational health game targeting low literacy players in low and middle income countries.

BACKGROUND: Mobile technology is increasingly important for delivering public health interventions to remote populations. This research study developed, piloted, and assessed a serious game for mobile devices that teaches geohazard, maternal, and neonatal health messages. This unique mHealth intervention aimed at low-literacy audiences in low resource settings is part of the Maternal and Neonatal Technologies in Rural Areas (MANTRA) project: Increasing maternal and child health resilience before, during, and after disasters using mobile technology in Nepal. METHODS: The serious game was developed through a co-creation process between London and Kathmandu based researchers by email and video-calling, and face-to-face with local stakeholders in Nepal. The process identified core needs, developed appropriate pictograms and mechanics, and tailored the pilot serious game to the local cultural context. Evaluations and feedback from end users took place in rural villages and suburban Kathmandu in Province Three. Field evaluation sessions used mixed methods. Researchers observed game play and held focus group discussions to elicit qualitative feedback and understand engagement, motivation, and usability, and conducted a paired pre- and post-game knowledge assessment. RESULTS: The MANTRA serious game is contextualized to rural Nepal. The game teaches 28 learning objectives in three modules: maternal health, neonatal health, and geohazards, through picture matching with immediate audio and visual feedback. User feedback from focus groups demonstrated high engagement, motivation, and usability of the game. CONCLUSIONS: This MANTRA study is a unique mHealth intervention of a serious game to teach core health and geohazards messages to low-literacy audiences in rural Nepal. Although the mobile game is tailored for this specific context, the developmental process and insights could be transferable to the development of other games-based interventions and contextualized for any part of the world. Successfully targeting this low-literacy and illiterate audience makes the MANTRA development process the first of its kind and a novel research endeavor with potential for widespread impact and adoption following further game development. TRIAL REGISTRATION: This project was approved by the University College London Ethics Committee in London, United Kingdom [10547/001], and the Nepal Health Research Council in Kathmandu, Nepal [Reg. No. 105/2017]. All participants provided informed written consent.

Desert on the menu? What children are served in German full-service restaurants.

OBJECTIVES: Prevalence of obesity and overweight among children is rising worldwide. Thus, the importance of restaurants as food environments is also growing. Considering these developments, the present study describes and evaluates menus and meals offered to children in German full-service restaurants. METHODS: Using quota sampling procedure, a representative sample of German full-service restaurants was identified. The individual meals were then assessed, using the Children's Menu Assessment tool (CMA). A total of 500 restaurants and 1,877 individual meals were analyzed. RESULTS: On average, every menu included 3.76 ± 1.31 meals for children. The arithmetic mean of the CMA score was 0.73 ± 0.85. Around 80% of all offered meals were limited to eight typical dishes and over 50% included French fries or another form of fried potatoes. Not one of the meals included any nutritional information. Healthy entrees were never marked (e.g. by an optional qualitative information such as healthy food symbol or a healthier choice tag). Eighty-one percent of all the main components in the meals were rated as unhealthy and none of the meals used wholegrain products. The automatic inclusion of a drink and free refill options are both rather unusual in Germany, as well as the use of cartoon characters and product logos or giving away promotional toys. A positive correlation was found between the price of the food and its quality. The majority of dishes feature a high energy density while simultaneously having a low nutrient density. CONCLUSIONS: Overall, the range of food on offer for children in German restaurants is unhealthy and lacking in variety. There is an urgent need for improvement of both the menus themselves as well as the offered meals. Our study is not only by far the most comprehensive study, but also the study with the worst CMA score values worldwide.

Child's Play or Sexual Abuse? Reviewing the Efficacy of the Justice Framework in Dealing with Child on Child Sexual Abuse in the United Kingdom.

This literature review appraises how the justice system of the United Kingdom deals with child on child sexual abuse allegations. It is crucial to consider the impact of minor sexual abuse within the community. Sensationalized reporting of sex crimes demonizes offenders and unintentionally hides some perpetrators by not representing children can cause harm. Cases where children demonstrate sexual agency are confusing and uncomfortable to appropriate blame. A freedom of information request to the Metropolitan Police uncovered 5,500 minor sex abuse allegations in England and Wales between 2011 and 2014, including, 4,000 physical assaults and 600 rape allegations. Officials caution these figures only represent a small proportion of known sexual abuse cases but the full extent of the problem is yet to be seen. Children are being exposed to explicit imagery far beyond their developmental age causing a blurring of the lines between normal sexual curiosity, harmful behavior, sexual deviance, and abuse. Evidence suggests societal failings and technological advances have created vulnerabilities from which new and dangerous sexual norms have evolved. Therefore, this paper reviews the justice, welfare, and restorative justice frameworks to explore the efficacy of the justice system in dealing with child on child sexual abuse in the UK.

Impact of a playful booklet about diabetes and obesity on high school students in Campinas, Brazil.

Obesity and diabetes are two of the biggest public health problems in the modern world. One possible way to combat the rising prevalence of these diseases is through the spread of awareness about its consequences and how to prevent them. Therefore, educational interventions focused on teaching the physiological basis of these conditions might be valuable tools. However, most scholar curriculums lack high-quality material devoted to this topic. Thus we developed an educational booklet, composed of playful elements, targeted toward high school students and destined for application in classrooms. The efficacy of the developed material was validated through a pretest-posttest design, in which the students had to answer a 10-question test. After booklet completion, students had better outcomes, with an increase in the percentage of correct answers in 7 out of 10 questions contained in the test (P < 0.05). Thus we developed an effective material for usage in the high school classroom to spread the awareness of the risks of metabolic diseases and how to prevent them.

An exploratory experimental study examining the short-term effects of a public service announcement on parents' perceptions of the descriptive norm for children's outdoor play: A cautionary tale.

ISSUE ADDRESSED: Public service announcements (PSA) targeting physical activity are not always effective at enacting behaviour change. One factor that may impact message effectiveness is whether the message matches its intent (ie, what norm is being portrayed and received). The current study explored the effects of two PSAs on parents' perceptions of outdoor play. METHODS: Parents (N = 333) completed a pre/postexperimental online survey to examine the acute impact of a PSA on their perception of how often children play outdoors (ie, descriptive norms). Participants provided their descriptive norm perceptions and then were randomised to view one of two PSAs: (a) the Mr. Lonely PSA, which portrayed outdoor activity as not normative, and (b) a control message, which portrayed outdoor activity as the norm (VERB PSA). After viewing their PSA, descriptive norm perceptions were reported again. RESULTS: A two-way mixed ANOVA indicated that participants who viewed the Mr. Lonely PSA (where outdoor play was not normative) perceived that children and youth played outdoors less frequently immediately after watching the PSA compared to before viewing it (P < 0.05). No significant change occurred in the control condition. CONCLUSIONS: PSAs can alter individuals' perceptions of whether they perceive outdoor play as normative among children and youth. SO WHAT?: As individuals align their behaviour with what is typical, PSA developers should be wary of what message is being conveyed. In terms of activity, portraying that outdoor play is not normative may not have the intended outcome.

Effectiveness of leisure and play activities for socialization skills of a child with intellectual disability - A case study.

OBJECTIVE: To investigate effectiveness of leisure and play social group activities for enhancing socialisation skills in a child with intellectual disability.. METHODS: The experimental study was done at a special education school for disadvantaged children Lahore from 28th November, 2016 to 3rd February, 2017. The subject was a boy aged 17 years who was part of a leisure and play group comprising peers. Pre-rating of socialisation domain of the subject was carried out through Portage Guide to Early Education (PGEE). Atotal of 20 groups were conducted in which two sessions per week were carried out. One session of group activity lasted 25-30 minutes. Postrating was carried out after the completion of group activities.. RESULTS: There were 6 children in the play group, but the focus remained on 1(17%) subject. From pre and post rating it was evident that significant reduction in symptoms occurred in the subject, indicating effectiveness of leisure and play social groups approach.. CONCLUSIONS: Leisure and play social group activities were found to be effective in enhancing overall social skills of a child having intellectual disability.

Regulating Child Sex Robots: Restriction or Experimentation?

In July 2014, the roboticist Ronald Arkin suggested that child sex robots could be used to treat those with paedophilic predilections in the same way that methadone is used to treat heroin addicts. Taking this onboard, it would seem that there is reason to experiment with the regulation of this technology. But most people seem to disagree with this idea, with legal authorities in both the UK and US taking steps to outlaw such devices. In this article, I subject these different regulatory attitudes to critical scrutiny. In doing so, I make three main contributions to the debate. First, I present a framework for thinking about the regulatory options that we confront when dealing with child sex robots. Secondly, I argue that there is a prima facie case for restrictive regulation, but that this is contingent on whether Arkin's hypothesis has a reasonable prospect of being successfully tested. Thirdly, I argue that Arkin's hypothesis probably does not have a reasonable prospect of being successfully tested. Consequently, we should proceed with utmost caution when it comes to this technology.

Child soil ingestion in rural Ghana - frequency, caregiver perceptions, relationship with household floor material and associations with child diarrhoea.

OBJECTIVES: The objectives of this work were to evaluate (i) the prevalence and frequency of caregiver-reported soil ingestion by children, (ii) whether household flooring material in the bedroom (earth vs. concrete) affected caregiver-reported soil ingestion, (iii) whether caregiver-reported soil ingestion was associated with caregiver-reported diarrhoea and (iv) caregivers' perceptions of their children ingesting soil. METHODS: We conducted 309 household surveys in northern Ghana, including 529 children under five (249 children aged 6-36 months), and measured faecal contamination in soil from 31 households. RESULTS: Among all children, 15% were reported to have directly ingested soil in the past week, including 28% of children aged 6-36 months. Among children reported to have ingested soil, the median frequency was 14 times in the past week, and the median amount of soil ingested each time was half a handful. There was no association between household floor material and whether the caregiver observed a child directly ingesting soil. After adjusting for household floor material and other potential confounding variables, caregiver-reported soil ingestion was associated with caregiver-reported diarrhoea for children under five [adjusted odds ratio (adj. OR) = 3.13, 95% confidence interval (CI) 2.76-3.55] and children aged 6-36 months (adj. OR = 2.61, 95% CI 2.01-3.39). Approximately 83% of caregivers whose children ingested soil reported they thought it was unsafe and were more likely to report stopping their child from ingesting soil, but these responses did not affect the quantity of soil ingested. CONCLUSIONS: Our results suggest direct soil ingestion is associated with diarrhoea independent of household floor material, and separate interventions may be necessary to prevent exploratory soil ingestion.

A randomized controlled trial of a group intervention for siblings of children with cancer: Changes in symptoms of anxiety in siblings and caregivers.

OBJECTIVE: This study assessed the effects of a group intervention-Siblings Coping Together (SibCT)-on siblings' and caregivers' anxiety symptoms compared to controls, and potential moderators. METHODS: Seventy healthy siblings of children on or off treatment (7-16 y old, 41 males) participated in a randomized controlled trial (RCT) with 2 arms/groups: SibCT (n = 41) and an attention control (CG) (n = 34). Both groups had eight 2-hour weekly sessions. EG followed SibCT's educational, social, and problem-solving activities. CG had planned games and crafts. Siblings and caregivers self-reported on anxiety symptoms at baseline, intervention end, and 3 months later. Multivariable mixed model analyses examined the intervention effect over time, and potential moderators (gender, on/off ill child's treatment). RESULTS: No main effects of group or time were found in sibling scores. A group × gender interaction (P < .05) indicated that in the intervention group female siblings reported less total anxiety symptoms than male siblings, with no significant gender differences in the control group. Caregivers' total anxiety symptoms declined over time (P < .02). A group × on/off treatment interaction in physiological/panic subscale (P < .03) indicated that when ill child was on treatment, caregivers of siblings in SibCT reported less anxiety compared with caregivers of CG. CONCLUSIONS: There was no clear SibCT intervention effect. SibCT may benefit female siblings, and caregivers whose ill child is on active treatment. Contextual factors (gender) seem to influence psychosocial intervention in this population.

INSIGHT responsive parenting intervention reduces infant's screen time and television exposure.

BACKGROUND: Sedentary behaviors, including screen time, in childhood have been associated with an increased risk for overweight. Beginning in infancy, we sought to reduce screen time and television exposure and increase time spent in interactive play as one component of a responsive parenting (RP) intervention designed for obesity prevention. METHODS: The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is a randomized trial comparing a RP intervention with a safety control intervention. Primiparous mother-newborn dyads (N = 279) were randomized after childbirth. Research nurses delivered intervention content at infant ages 3, 16, 28, and 40 weeks and research center visits at 1 and 2 years. As one component of INSIGHT, developmentally appropriate messages on minimizing screen time, reducing television exposure in the home, and promoting parent-child engagement through interactive play were delivered. Mothers self-reported their infant's screen time at ages 44 weeks, 1, 1.5, 2 and 2.5 years; interactive play was reported at 8 and 20 weeks and 2 years. RESULTS: More RP than control parents reported their infants met the American Academy of Pediatrics' no screen time recommendation at 44 weeks (53.0% vs. 30.2%) and at 1 year on weekdays (42.5% vs. 27.6%) and weekends (45.5% vs. 26.8%), but not after age 1 year. RP mothers and RP children had less daily screen time than controls at each time point (p ≤ 0.01). Fewer RP than control group mothers reported the television was ever on during infant meals (p < 0.05). The frequency of tummy time and floor play did not differ by study group; approximately 95% of infants spent time in restrictive devices (i.e. swing) at 8 and 20 weeks. At 2 years of age, there were no study group differences for time children spent in interactive play. CONCLUSION: From infancy to early childhood, the INSIGHT RP intervention reduced screen time and television exposure, but did not increase the frequency or amount of interactive play. TRIAL REGISTRATION: clinicaltrials.gov NCT01167270 . Registered on 21 July 2010.

Button battery and magnet ingestions in the pediatric patient.

PURPOSE OF REVIEW: Pediatric foreign body ingestion is a common occurrence that presents a challenge both to pediatric gastroenterologists and primary care providers. Increasing prevalence of smaller, more technologically advanced toys in the household has resulted in an increased exposure to higher voltage batteries and powerful magnets that carry a high incidence of morbidity and mortality. This review highlights the latest findings regarding the patients at risk for button battery and magnet ingestions, the symptoms of presentation, and complications of these objects in contributing to long-standing gastrointestinal injury. RECENT FINDINGS: Button batteries may lead to esophageal injury within a few hours. Batteries retained in the esophagus are larger in diameter on average and size is associated with esophageal impaction as well as higher grade esophageal injury. Magnet ingestions, when multiple or with another metallic object, are often initially asymptomatic but may have acute worsening, and therefore warrant close monitoring. SUMMARY: Button battery and magnet ingestions have increased in incidence over the past two decades. Recent literature demonstrates that higher voltage, larger lithium button batteries, and prevalence of high-powered magnets can lead to significant morbidity. High suspicion, early referral, and removal may lead to improved outcomes.

Playground activities and gender variation in objectively measured physical activity intensity in Australian primary school children: a repeated measures study.

BACKGROUND: Recent studies have sought to address the limited time for physical activity by focusing on increasing physical activity intensity among students during non-curricula periods and specifically school break times. We objectively measured the intensity of student physical activity (PA) during recess and lunch breaks at primary schools in the Western Sydney region of New South Wales (NSW), Australia using a 12-month repeated measures observation design study. METHODS: Systematic direct observation of recess and lunch breaks over a ten-week period in 2014 and 2015. 120 recess and lunch breaks across twenty schools (2014) with 839 periodic observations and across 15 schools with 587 periodic observations in 2015. Both observation periods were conducted over 10-weeks in Term 4 (September - December). RESULTS: The mean proportion of vigorous physical activity reported as a percentage (%VPA) across both time points was 16.6% (SD = 23.4). 36.8% (SD = 26.0) of time was spent walking and the remaining time (46.6%; SD = 30.4) was spent in sedentary activities. There was a significant decline in %VPA and increase in sedentary activity (p < 0.01) between the two time periods of measurement. In 2014, boys spent twice as much time in %VPA than girls during breaks in the school day and in 2015 this increased to nearly three times as much time in %VPA. %VPA also varied on the type of surface PA took place and the types of activities the children were allowed to undertake during breaks. CONCLUSIONS: Recess and lunch breaks potentially offer an opportunity for children to participate in unstructured PA during the school day. Substantial variations in the %VPA during these periods exist. Addressing playground gender participation disparities and space usability/accessibility may be a necessary first step in promoting higher PA intensities during breaks.

Gamification of nutrition: A preliminary study on the impact of gamification on nutrition knowledge, attitude, and behaviour of adolescents in Nigeria.

BACKGROUND:: In Nigeria and many parts of sub-Saharan Africa, the availability of foods that are high in salt, sugar, and saturated fat is steadily increasing. This has led to an increase in the consumption of such foods among Nigerians, particularly among adolescents. AIM:: This pilot study was undertaken to understand whether, and how, gamification of nutrition can have an impact on addressing the problem of unhealthy eating among Nigerian adolescents. METHODS:: Gamification of nutrition through board games, clubs and vouchers was introduced in three secondary schools in Abuja, Nigeria over a span of three to four months. Semi-structured focus groups were conducted with grade 11 and 12 students in the three secondary schools. Participants were asked about their perceptions of the intervention and how it influenced their eating behaviour, attitudes and knowledge about nutrition. RESULTS:: A total of 31 students participated in four focus groups. Participants reported that the intervention shifted their perceptions and preferences, leading them to alter their behaviour by incorporating more nutritious foods (such as fruits and vegetables) into their diet and engaging in more physical activity. Five themes emerged from the analyses: improved eating behaviour; increased physical activity; improved overall well-being; increased nutrition knowledge; and influencing others. CONCLUSIONS:: The results from the focus groups suggest that gamification of nutrition can lead to improvements in dietary behaviour among adolescents over the short-term. More studies are needed to evaluate the long-term effects of nutrition interventions that use gamification techniques.

Occupation-Based Coaching by Means of Telehealth for Families of Young Children With Autism Spectrum Disorder.

OBJECTIVE: We investigated the efficacy of Occupation-Based Coaching delivered via telehealth for families of young children with autism spectrum disorder (ASD). METHOD: Participants were 18 families of children with ASD ages 2-6 yr. We used descriptive statistics to understand intervention characteristics and paired-sample t tests to examine changes in parent efficacy and child participation. RESULTS: Parents identified many areas of child adaptive behavior as intervention goals. Results showed that parent efficacy and various domains of child participation significantly increased postintervention (both ps < .05). Additionally, children showed significant gains in parent-identified goals. CONCLUSION: Occupation-Based Coaching delivered via telehealth appears to be an effective method of intervention to increase parent efficacy and child participation among families of children with ASD. Occupational therapists may consider how telehealth may be used to provide intervention to an increased number of families, in particular those in underserved areas.