Investigating the impact of developmental coordination difficulties across home, school, and community settings: Findings from the Australian Impact for DCD survey.

AIM: To evaluate the participation difficulties experienced by children with developmental coordination disorder (DCD) in home, school, and community environments. METHODS: The Impact for DCD survey was completed by primary caregivers of 4-18-year-old children with DCD (or synonymous diagnosis) (n = 429). OUTCOMES AND RESULTS: The greatest participation difficulties experienced at home included dressing, eating with utensils, self-care tasks and drawing/writing reported by over 70% of families. At school, fine motor difficulties were also frequently reported, with additional difficulties keeping up or completing tasks, and not feeling supported at school. Socialisation challenges and bullying were also commonly reported (34.9%). As a result of participation difficulties at school, 5.4% were home schooled. Many children engaged in community activity, with 72.0% currently engaged in at least one organised sports-based activity. CONCLUSIONS AND IMPLICATIONS: Increased recognition of the widespread impact of DCD in a child's life is crucial at an individual and societal level. Parents reported their children experiencing significant participation restrictions and difficulties. The findings of this large-scale study have revealed that most children with DCD are not receiving the support they need to thrive, especially at school. This largely reflects a lack of understanding and recognition of the condition and its associated challenges.

Developing novice analysts' videofluoroscopic swallowing study skills in speech-language pathology: A randomised control trial comparing blended and online training approaches.

PURPOSE: This research investigates the relative effectiveness of independent online and blended learning approaches for novice analysts' development of videofluoroscopic swallowing study (VFSS) analytical skills. The secondary aims were to explore the impact of training on decision-making and to describe learners' perspectives of training outcomes. METHOD: Undergraduate speech-language pathology students (n = 74) who had completed the dysphagia academic curriculum in an undergraduate speech-language pathology program were recruited for a randomised control trial. The ability to identify swallowing impairments in adults was compared pre- and post-training across three conditions: independent online (n = 23), peer-supported (n = 23), and expert-facilitated training (n = 28). The training comprised online VFSS training and practice with a commercially available digital video disc (DVD). RESULT: The three training approaches were equal in improving novice analysts' identification of impairments on VFSS. Participants' analysis improved pre- to post-training (p = <.001), with no statistical difference amongst training conditions (p = .280). However, the expert facilitation condition resulted in better decision-making skill for novice analysts, as well as higher levels of confidence and greater engagement in the learning. CONCLUSION: Well-designed independent online methods are appropriate to prepare novice analysts for VFSS analytical training. Expert facilitation and peer-supported environments may have benefits for more advanced skill development and engagement, and should be investigated in future studies.

Therapeutic groups run for community-dwelling people with acquired brain injury: a scoping review.

PURPOSE: Therapeutic group interventions are commonly provided in acquired brain injury (ABI) inpatient rehabilitation settings, but little is known about the extent of therapeutic groups run for community-dwellers with ABI. This paper seeks to review current literature concerning the nature of therapeutic groups run for community-dwellers with ABI and the involvement of occupational therapists. MATERIALS & METHODS: A scoping review was conducted with systematic searching of relevant databases guided by Arksey and O'Malley's framework. Studies were included if they reported on therapeutic groups for community-dwellers with ABI. Articles were collated and summarised with key findings presented in narrative form with accompanying tables. RESULTS: Seventy articles met inclusion. Groups are used as therapeutic change agents for community-dwellers with ABI and target a diverse range of participation barriers. Participants valued group programs that established safe environments, a sense of belonging, growth opportunities and social connections. Group accessibility needs to be improved, with better funding avenues available for service providers, as well as greater consumer involvement in group design and facilitation. CONCLUSIONS: Groups are a valuable therapeutic modality supporting community-dwellers with ABI. Further research is warranted into the use of groups by occupational therapists working with community-dwellers with ABI.IMPLICATIONS FOR REHABILITATIONTherapeutic groups can support the development of social connections, community participation and help community-dwellers with ABI re-establish a positive self-identity.Conducting groups in community settings and involving consumers in group design and facilitation may enhance the group experience for participants.Occupational Therapists should be involved in the design and delivery of occupation-based and participation focused group-based programs.

Effectiveness of interventions for school-aged-children and adolescents with fetal alcohol spectrum disorder: a systematic review and meta-analysis.

PURPOSE: To describe allied health and educational interventions and their effectiveness for children and adolescents with fetal alcohol spectrum disorder (FASD). To appraise the quality and strength of studies. METHODS: Electronic databases were searched between 2005 and March 2022, identifying non-pharmacological studies supporting function, activity, or participation for FASD participants aged 5-18 years using any quantitative research design. Outcomes were coded using International Classification of Functioning, Disability and Health, family of Participation Related Constructs and behaviour categories. Multi-level random-effects meta-analysis examined intervention effects. Study methodological quality was evaluated using Cochrane risk of bias tools, RoBiNT, AMSTAR 2 and NHMRC Hierarchy levels of evidence. Certainty of findings were synthesised using GRADE approach. RESULTS: The systematic review included 25 studies with 735 participants, 10 of which were analysed by meta-analysis. Body function and structure, activity, behaviour, and sense of self outcomes were pooled. A small, positive effect favouring interventions was found (g = 0.29, 95% CI = 0.15-0.43), however the GRADE certainty was rated as low. No participation outcomes were identified. CONCLUSIONS: Some interventions targeting body function and structure, activity and behaviour outcomes were effective. Evidence of interventions that support children's and adolescent's participation as an outcome is lacking.Implications for rehabilitationTo address participation outcomes for children and adolescents with fetal alcohol spectrum disorder (FASD), it is important to understand their participation needs and directly measure these.Interventions identified targeted body function and structure, activity, and behaviour outcomes.Participation outcomes of children's/adolescent's attendance, involvement and preferences were not identified.A combination of individual- and context-focused interventions is recommended to maximise rehabilitation outcomes for children and adolescents with FASD.

Factors that influence development of speech pathology skills required for videofluoroscopic swallowing studies.

BACKGROUND: Perceptual, cognitive and previous clinical experience may influence a novice Videofluoroscopic Swallowing Study (VFSS) analyst's trajectory towards competency. Understanding these factors may allow trainees to be better prepared for VFSS training and may allow training to be developed to accommodate differences between trainees. AIMS: This study explored a range of factors previously suggested in the literature as influencing the development of novice analysts' VFSS skills. We hypothesised that knowledge of swallow anatomy and physiology, visual perceptual skills, self-efficacy and interest, and prior clinical exposure would all influence VFSS novice analysts' skill development. METHODS & PROCEDURES: Participants were undergraduate speech pathology students recruited from an Australian university, who had completed the required theoretical units in dysphagia. Data assessing the factors of interest were collected-the participants identified anatomical structures on a still radiographic image, completed a physiology questionnaire, completed subsections of the Developmental Test of Visual Processing-Adults, self-reported the number of dysphagia cases they managed on placement, and self-rated their confidence and interest. Data for 64 participants relating to the factors of interest were compared with their ability to accurately identify swallowing impairments following 15 h of VFSS analytical training, using correlation and regression analysis. OUTCOMES & RESULTS: Success in VFSS analytical training was best predicted by clinical exposure to dysphagia cases and the ability to identify anatomical landmarks on still radiographic images. CONCLUSIONS & IMPLICATIONS: Novice analysts vary in the acquisition of beginner-level VFSS analytical skill. Our findings suggest that speech pathologists who are new to VFSS may benefit from clinical exposure to dysphagia cases, sound foundational knowledge of anatomy relevant to swallowing and the ability to see the anatomical landmarks on still radiographic images. Further research is required to equip VFSS trainers and trainees for training, to understand differences between learners during skill development. WHAT THIS PAPER ADDS: What is already known on the subject The existing literature suggests that no vice Video fluoroscopic Swallowing Study (VFSS) analysts training may be influenced by their personal characteristics and experience. What this study adds This study found that student clinicians, clinical exposure to dysphagia cases and their ability to identify anatomical landmarks relevant to swallowing on still radiographic images prior to training best predicted their ability to identify swallowing impairments after training. What are the clinical implications of this work? Given the expense of training health professionals, further research is required into the factors that successfully prepare clinicians for VFSS training, including clinical exposure, foundational knowledge of anatomy relevant to swallowing and the ability to identify the anatomical landmarks on still radiographic images.

Impact of adapted bicycle riding on outcomes for children and adolescents with disabilities: A systematic review.

AIM: To review the evidence for the effects of adapted bicycle riding on body structures and functions, activity, participation, and quality of life outcomes in children with disabilities, along with family-level participation outcomes. METHOD: A systematic review with searches of nine electronic databases to identify studies involving participants with a developmental disability aged 4 to 18 years who used a dynamic adapted bicycle was completed in August 2021. Risk of bias was assessed based on individual study designs. A narrative synthesis integrated the findings of the included studies. Certainty of evidence was synthesized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Ten studies were included with 234 participants. Five studies reported outcomes at the body structures and functions level, ten reported activity-level outcomes, two reported participation-related outcomes, and none assessed quality of life or family participation in social and recreational activities. INTERPRETATION: Adapted bicycle riding interventions may improve gross motor function, enhance lower-limb muscle strength, and promote physical activity; however, certainty of evidence of effects was rated very low using GRADE. Further research is required to understand the impact of adapted bicycle riding on the participation outcomes of children and adolescents with disabilities and on family-level participation in social and recreational activities. WHAT THIS PAPER ADDS: Adapted bicycle riding interventions may improve motor functions and physical activity. Evidence about participation outcomes after adapted bicycle riding is limited. Research on adapted bicycle riding interventions in natural settings is needed.

The impact of face-to-face mental health consumer-led teaching on occupational therapy student empathy levels: Two group comparison design.

INTRODUCTION: Australian and New Zealand accreditation standards for occupational therapy courses mandate consumer involvement in the design, delivery, and evaluation of courses. Consumer involvement in medical, dental, and nursing education has been evidenced as a factor for increasing student empathy. To date, there has been no known research on the impact of mental health consumer involvement on occupational therapy students' empathy. The aim of this study was to investigate if occupational therapy students who receive teaching from a mental health consumer demonstrate higher levels of empathy compared with students who receive teaching delivered by occupational therapy academics. METHODS: Pre-post, quasi experimental, two group comparison design was used to measure second-year student empathy pre and post a consumer-led teaching tutorial. Students (N = 217) were randomised into two groups across three university campuses: 'teaching as usual group' (control) or 'consumer-led' group (experimental group). The Jefferson Scale of Empathy was used to measure student empathy. RESULTS: N = 138 matched scales were returned. Little difference in empathy scales was detected between groups. The 'consumer-led' group increased for the empathy scale by 3.4(95% CI: 0.7,6.1, p = 0.014) but was not statistically significant compared to 1.3(95% CI: -1.0,3.5, p = 0.267) for the control group. Both groups scored highly on empathy. CONCLUSION: This study found that occupational therapy students had pre-existing high levels of empathy. The challenge for future research is to identify appropriate ways to measure the impact of mental health consumer involvement on occupational therapy curriculum and students.

Measure of Early Vision Use: initial validation with parents of children with cerebral palsy.

PURPOSE: To report initial psychometric evidence on the Measure of Early Vision Use. METHOD: Data on performance of the Measure of Early Vision Use scale were collected from 100 parents of children with cerebral palsy aged 0-12 years via online survey. Psychometric evaluation included assessment of scale dimensionality using Classical Test Theory and hypothesis testing for evidence of construct validity. RESULTS: Principal components analysis of the 14-item parent-rated Measure of Early Vision Use revealed one component with an eigenvalue of 9.343, explaining 66.7% of variance; internal consistency was high (Cronbach's α = 0.96). Total scores ranged from 15-56 (Mean 42.8, standard deviation = 10.6). The results support seven pre-defined hypotheses including statistically significant differences in MEVU-total scores between children with and without parent-reported cerebral visual impairment. CONCLUSIONS: Measure of Early Vision Use is the first assessment tool to describe 'how vision is used' in children with cerebral palsy. Results provide preliminary evidence that the measure comprises a unidimensional construct, sufficient construct validity, and feasibility as a parent-completed online assessment. Findings on internal structure provide foundational evidence and require further testing with Confirmatory Factor Analysis or Rasch Analysis.IMPLICATIONS FOR REHABILITATIONThe Measure of Early Vision Use is a new instrument to describe the use of basic visual abilities and is feasible to use as a parent-completed online questionnaire.The Measure of Early Vision Use is a unidimensional scale with sufficient construct validity to supports its use as a measure of 'how vision is used' without confounding visual ability with the reason why it might be impaired (e.g., cerebral vision impairment, motor limitations, or cognition).There is potential for the Measure of Early Vision Use to support early intervention planning for children with (or at high risk of) cerebral palsy.

Repetitions, duration and intensity of upper limb practice following the implementation of robot assisted therapy with sub-acute stroke survivors: an observational study.

BACKGROUND: Robot assisted upper limb (UL) therapy has been identified as an intervention with the potential to help improve the amount of practice performed by stroke survivors. OBJECTIVES: This study aimed to measure the amount of UL practice (i.e., repetitions, duration, intensity) performed by subacute stroke survivors, in particular those with severe UL impairment, pre and post implementation of robot assisted upper limb therapy (RT-UL) into an inpatient rehabilitation setting. METHODS: Two observational study phases (pre-RT-UL and post-RT-UL) were undertaken of occupational therapy and physiotherapy sessions performed by subacute stroke survivors. Upper limb tasks observed and recorded in therapy were classified as either impairment-related therapy or activity-related. RESULTS: In the pre-RT-UL observational phase, 7 subacute stroke survivors were observed across 11 days involving 25 therapy sessions. Post-RT-UL, 12 subacute stroke survivors were observed across 12 days involving 29 therapy sessions. There were no significant differences in characteristics of patients observed in each phase (p > .05). The mean difference (95% CI) between pre and post RT-UL for repetitions (reps) (569 (1 to 1136) and intensity (7 (4-11)) reps/min of practice increased for all patients, including those with severe UL impairment (337 (37-638)) reps and 8 (2-14) reps/minute, with the duration of therapy unchanged. CONCLUSIONS: This is the first study to have observed an increase in UL practice with the inclusion of RT-UL as part of routine clinical practice. This increase in practice is considered to be due to RT-UL providing highly supportive and expeditious semi-supervised practice. Notably, RT-UL was able to be implemented within the existing organisational structures with only basic training of therapy staff.IMPLICATIONS FOR REHABILITATIONRobotics presents as a viable intervention to increase the amount and intensity of upper limb practice performed by stroke survivors in routine clinical practiceRobotics were able to be implemented within the existing organisational structures with only basic training of therapy staff.

Measure of Early Vision Use: development of a new assessment tool for children with cerebral palsy.

PURPOSE: To report the development of an assessment tool to describe "how vision is used" for children with cerebral palsy. METHOD: Measurement development consisted of three steps: (i) an online survey to explore the relevance and comprehensiveness of visual behaviours identified in a previous conceptualisation study; (ii) construction of items and a rating scale for the new measure; and (iii) cognitive interviews to explore comprehensibility and refine the measure in preparation for field testing. Survey respondents were 130 parents of children with cerebral palsy, eight adults with cerebral palsy, and 108 clinicians (n = 246). Nine parents participated in the interviews. RESULTS: The new tool, the Measure of Early Vision Use, is a 14-item descriptive measure of typical performance of visual behaviours observable in everyday activities, as rated by parent/caregiver observation. Each item is rated on a 4-point ordinal scale. CONCLUSIONS: This new measure is conceptually grounded within the Activity level domain of the International Classification of Functioning, Disability and Health as a measure of a single visual ability construct. The target population is children with cerebral palsy, and using parent report the Measure of Early Vision Use describes both strengths and limitations in using vision. This study addressed the selection of items and response options for the new scale, and provides evidence to support content relevance, comprehensiveness and comprehensibility from key stakeholders. Further research will explore psychometric properties and clinical utility.Implications for rehabilitationThe ability to use vision in daily activities is relevant to the development and learning of all children, so the availability of a method for describing visual abilities has potential for diverse research and clinical purposes.The Measure of Early Vision Use is a parent-report tool that provides a criterion-referenced method for quantifying and describing how children use vision in typical daily activities to support intervention planning.Clinicians and parents wishing to measure vision use in children with cerebral palsy can be confident about the rigorous methods used to develop this tool, including consultation with key stakeholders.

The sustainability of upper limb robotic therapy for stroke survivors in an inpatient rehabilitation setting.

PURPOSE: To investigate the sustainability of Robot-assisted upper limb therapy (RT-UL) as part of routine occupational therapy and physiotherapy clinical practice. METHODS: Two separate audits, 12 months apart, of RT-UL computer data records were undertaken to determine sustainability in a subacute rehabilitation unit. Records of the two audits were compared in terms of the number of early subacute stroke survivors using RT-UL, the number of RT-UL sessions, duration of RT-UL sessions, and disciplines prescribing RT-UL. RESULTS: During Audit 1 58% (n = 18) of stroke survivors received RT-UL compared to 50% (n = 7) in Audit 2. The total number of RT-UL sessions reduced between audits (148 vs. 36 sessions) reflecting the overall reduction in admission rates for stroke survivors. There was no significant difference between audits in the average number of RT-UL sessions per patient (p = 0.203) nor the length of sessions (p = 0.762). Patients engaged in active therapy more than three-quarters of the time when on the robotic device. Physiotherapists were the primary prescribers of RT-UL when compared to occupational therapists. CONCLUSIONS: RT-UL was in continued and regular use with stroke survivors 2 years after initial implementation within an inpatient rehabilitation setting. RT-UL practice was intensive and used routinely with patients.IMPLICATIONS FOR REHABILITATIONRT-UL is a sustainable and intensive intervention for stroke survivors within an inpatient rehabilitative setting.The cost-benefits of RT-UL should be evaluated from the perspective of the whole rehabilitation service not just at an individual patient level.RT-UL may be considered a "bridging" form of UL practice for those with more limited active UL movement until there is sufficient UL movement and power for more complex real-world task-specific practice.

Employment profiles of autistic adults in Australia.

Autistic adults experience a high number of job changes, reduced working hours, minimal workplace supports, and overrepresentation in entry-level and low paid positions. This study adds to the existing evidence base to guide clinical decisions and interventions for this population. This study utilized baseline data collected between 2015 and 2017 from the Autism CRC's Australian Longitudinal Study of Autism in Adulthood. The aim was to describe the employment profiles and explore factors related to employment for Australian autistic adults aged 25 and older (N = 149). Comparisons between participants and the Australian workforce were made using Australian Bureau of Statistics (ABS) data. Two logistic regression models were conducted to explore the association between underemployment and underutilisation with personal and environmental factors. In comparison to the Australian workforce, autistic adults were more likely to work part-time, work reduced hours and be employed at skill levels lower than their qualifications warranted. Logistic regressions reported that more autistic traits, more social supports and having workplace adjustments implemented were significantly associated with a higher odds of autistic adults being appropriately employed and/or utilized in the workforce. Results suggest that interventions implementing appropriate workplace adjustments, a supportive workplace environment, and adequate social supports may improve employment outcomes for autistic adults. All employees may benefit from workplace resources targeted toward fostering an inclusive workplace environment. LAY SUMMARY: This study aimed to describe the employment profiles and explore factors related to employment for Australian autistic adults. We compared this with the Australian workforce using data from the Australian Bureau of Statistics. Autistic adults with more autistic traits and more social and workplace supports were more likely to be employed and have jobs that were better suited to them. Autistic adults might have better employment outcomes if they have the appropriate workplace adjustments, a supportive workplace and adequate social supports.

Training for videofluoroscopic swallowing analysis: A systematic review.

PURPOSE: To synthesise the available evidence relating to best practice in training videofluoroscopy and barium swallow analysts. METHOD: The review was conducted according to the PRISMA statement and registered in PROSPERO (CRD42017053744). Data were extracted from nine databases. Studies were included if they described training approaches for clinicians or students of any profession learning to interpret videofluoroscopic (VFSS) or barium swallow studies and were written in English. The methods were heterogeneous and a metanalysis was not possible; a narrative review is presented. RESULT: Sixteen studies were eligible, including those designed to evaluate the influence of training as well as those that described training as part of validating an assessment tool or method. The quality of the studies was assessed with the Hawker scale and assigned an NHMRC rating. While the evidence was low quality (NHMRC level IV), training consistently improved the accuracy and reliability of clinicians and students conducting VFSS. No studies reported the outcome of training for barium swallow analysis. There was significant variability in the dose, method, and setting of training. CONCLUSION: To elucidate best practice in VFSS analysis to ensure training is cost effective and results in accurate diagnosticians requires further research.

Mothers supporting play as a choice for children with disabilities within a culturally and linguistically diverse community.

Background: Play is a right for children; an essential childhood occupation influenced by their family environment. Despite increasing recognition of unstructured outdoor play benefits, children with disabilities experience limited play opportunities.Aim: To apply a capabilities approach lens to understand outdoor play decision-making by mothers of children with disabilities within a culturally and linguistically diverse community.Materials and methods: Data collection for this case study involved semi-structured interviews with five mothers of primary school-aged children with disabilities and a week-long survey that profiled their children's outdoor play. Analysis was thematic and involved identifying barriers and opportunities at each ecocultural layer, aggregating strategies families used to address the barriers, and understanding their overall play decision-making.Findings: Mothers considered the child's interests and abilities, valued play as both a means and ends, planned for play, and facilitated in the moment as required. Multiple factors influenced mothers' outdoor play decisions. Mothers' values were child-centred, positively influencing the child's play opportunities.Conclusion and significance: This study's capabilities lens could inform professions such as occupational therapy to support families of children with disabilities from culturally diverse communities to advocate for play opportunities across settings.

Introducing robotic upper limb training into routine clinical practice for stroke survivors: Perceptions of occupational therapists and physiotherapists.

INTRODUCTION: Robot-assisted therapy for the upper limb (RT-UL) is an emerging form of intervention for stroke survivors with upper limb deficits. However, there is limited knowledge regarding therapists' perceptions of RT-UL and the factors influencing the implementation of RT-UL into the clinical setting. This is important when considering that therapists in Australia are primarily responsible for the prescription of RT-UL in daily practice. This study aimed to explore occupational therapists' and physiotherapists' perceptions of RT-UL and the perceived barriers and enablers influencing implementation. METHODS: Two discipline-specific focus groups were conducted involving occupational therapists (n = 6) and physiotherapists (n = 6). Participants were members of the same multidisciplinary team working in an Australian public health rehabilitation facility where RT-UL (i.e. InMotion2) was being introduced for the first time. Focus groups explored therapist perceptions of the new RT-UL as well as perceived barriers and enablers to implementation. Focus groups were recorded, transcribed and deductively analysed using the Theoretical Domains Framework (TDF). RESULTS: Out of the 14 domains of the TDF, 7 were raised by participants during the focus groups: environmental context and resources, beliefs about consequences, optimism, knowledge, skills, social influences, and social and professional role and identity. Therapists' expressed their optimism towards the introduction of RT-UL but believed successful implementation would be primarily dependent on the availability of clinical leadership, training and a suitable client mix. CONCLUSION: Therapists perceived that RT-UL would provide opportunity for increased upper limb practice particularly for patients with severe upper limb impairment. To facilitate implementation, support of RT-UL should come from both management and clinical leaders and training include RT-UL efficacy, device functionality and patient suitability. The availability of a single RT-UL device in a workplace may create unique interdisciplinary and logistical challenges.

Economic evaluation of simulated and traditional clinical placements in occupational therapy education.

INTRODUCTION: This economic evaluation complements results of the randomised controlled trial that established non-inferiority of the learning outcomes of a one-week simulated clinical placement (SCP) in occupational therapy qualifying degrees in comparison to an equivalent traditional clinical placement (TCP). This companion study presents detailed cost analyses of two placement alternatives and a cost-benefit study to assess the value for money of SCP. An economic evaluation of simulated versus traditional placements has not previously been conducted in Australia. METHODS: Nine SCP/TCP rounds were conducted by six Australian universities. Costs were collected using study-specific instruments. Public health sector costs were sourced from available literature. Willingness-to-pay for SCP/TCP was estimated using both a Discrete Choice Experiment and a Contingent Valuation method. These methods were employed to assess a comparative 'value' of SCP/TCP from the perspective of heads of occupational therapy departments (N = 28), who were asked to put a monetary value on the broader range of benefits associated with SCP/TCP. RESULTS: From the universities' perspective the average cost per student ranged from AUD$460 to AUD$1511 for simulated and AUD$144 to AUD$1112 for traditional placement. From the health care sector perspective, the difference in costs favoured simulated placements for four implementations and traditional placements for five. In the Discrete Choice Experiment respondents preferred traditional rather than simulated placement and would pay additional AUD$533. The estimated monetary value of simulated placements from a contingent valuation ranged from AUD$200 to AUD$1600. CONCLUSIONS: For universities that procure TCPs predominately at public health care facilities and sustain high administrative overheads, the SCP program could be a cost-saving alternative. From a broader value-for-money perspective, respondents favoured TCP over SCP, yet placed importance on placement availability and opportunity to demonstrate competence for students during the placement. Results should be interpreted with caution and further research with larger sample sizes is required.

Planning for outdoor play: Government and family decision-making.

BACKGROUND: Despite indisputable developmental benefits of outdoor play, children with disabilities can experience play inequity. Play decisions are multifactorial; influenced by children's skills and their familial and community environments. Government agencies have responsibilities for equity and inclusion of people with disabilities; including in play. AIM: This multiple-perspective case study aimed to understand outdoor play decision-making for children with disabilities from the perspectives and interactions of: local government and families of primary school-aged children with disabilities. MATERIAL AND METHOD: Five mothers, four local government employees, and two not-for-profit organization representatives participated in semi-structured interviews. Inductive and iterative analyzes involved first understanding perspectives of individuals, then stakeholders (local government and families), and finally similarities and differences through cross-case analysis. FINDINGS: Local government focused more on physical access, than social inclusion. Local government met only minimal requirements and had little engagement with families. This resulted in poor understanding and action around family needs and preferences when designing public outdoor play spaces. CONCLUSION AND SIGNIFICANCE: To increase meaningful choice and participation in outdoor play, government understanding of family values and agency around engagement with local government needs to improve. Supporting familial collective capabilities requires understanding interactions between individuals, play, disability, and outdoor play environments.

Leisure participation and satisfaction in autistic adults and neurotypical adults.

Leisure participation is important for well-being and has been attributed to improved quality of life for autistic individuals. Rigorous studies exploring the leisure participation of autistic adults are sparse. This study aimed to compare the type of leisure activity and frequency of participation between autistic adults and neurotypical adults as well as compare and identify factors associated with their leisure satisfaction. Data for 145 autistic and 104 neurotypical adults were obtained from time point one of the Australian Longitudinal Study of Adults with Autism. The primary outcome measure used was the Leisure Satisfaction Scale. Autistic adults were less satisfied with their leisure overall (mean = 3.29, standard deviation = 0.75) compared with neurotypical adults (mean = 3.69, standard deviation = 0.55). Multiple linear regression revealed being younger and reporting less depressive symptoms were significantly associated with higher leisure satisfaction in autistic but not neurotypical adults. Engagement in solitary leisure activities was comparable across participants, but socialising in person was predominated by neurotypical adults. Leisure activity preferences of autistic adults' and the frequency of their leisure participation are important factors for clinicians to understand when working with this population and tailoring well-being interventions.

The play skills of children with high-functioning autism spectrum disorder in peer-to-peer interactions with their classmates: A multiple case study design.

BACKGROUND/AIM: Children with ASD are known to have lower play skills than their typically developing peers. However, the play skills of children with ASD are rarely investigated using observational measures in the context of their everyday peer-to-peer play interactions. To explore the play skills of children with ASD and their aged matched classmates during a peer-to-peer play interaction. METHODS: Using convenience sampling, four children with ASD (5-11 years) attending mainstream schools were recruited for this multiple case design study. Each child with ASD was paired with one of their aged matched typically developing classmates. Children's play skills were measured using the Test of Playfulness (ToP). Additional case data were collected through teacher-reported social skills and behaviours. Rasch analysis was utilised to convert raw ToP scores into an interval level overall score for each child. Children's individual ToP item scores, social skills and behaviours are presented by case. RESULTS: The two children with ASD who had the highest ToP scores, also had the highest teacher-reported social skills. All children with ASD had greatest difficulty on ToP items reflecting suspension of reality and framing. Two children with ASD had higher ToP scores than their classmate. In these two cases, the classmates had similar play skills of children with ASD. CONCLUSION: The play skills of children with ASD varied by case. Across the cases, teacher-reported social skills, classmate age and existence of friendship between children were all factors observed to influence play. These findings require replication and investigation in larger scale studies.