The Occupation of Play.

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

Development of the Scale of Parental Playful Attitude During the Co-Occupation of Play.

IMPORTANCE: There is a need for tools to measure adults' playfulness in reference to parent-child joint play. OBJECTIVE: To (1) develop items for the Scale of Parental Playful Attitude (PaPA), (2) evaluate evidence for validity based on content, and (3) evaluate evidence for validity based on the response process. DESIGN: A mixed-methods design with three phases: (1) development of the first draft of the PaPA (based on the literature, focus groups, and semistructured interviews), (2) review by experts and revision of the first draft, and (3) cognitive interviews with parents. SETTING: Various (e.g., schools, a university). PARTICIPANTS: Phase 1 had 32 participants: 13 parents of children ages 2.5-6 yr without major diagnosed conditions; 8 parents of autistic children age 4-7 yr; and 11 preschoolers age 3-5 yr. Phase 2 involved 10 experts. Phase 3 had 5 participants: 3 mothers and 2 fathers of children ages 2.5-6 yr; 1 child was autistic. OUTCOMES AND MEASURES: Interview protocols and experts' review form. RESULTS: Phase 1 involved the initial item development. Extrinsic motivation and barriers to play emerged as important areas to include. Experts' review enhanced representation of the construct of playfulness. Content validity index values ranged from .78 to 1.00. Cognitive interviews provided insights into parents' comprehension of PaPA items. CONCLUSIONS AND RELEVANCE: Validity related to test content and the response process was supported. Additional sources of validity testing are necessary. Plain-Language Summary: Adult playfulness is critical for both the child and the parent, especially for developing a deeper connection. The Scale of Parental Playful Attitude (PaPA) assesses parents' self-perceptions of their playfulness when playing with their child. The study authors developed the PaPA (in both English and Spanish) to address a lack of tools for assessing how parents perceive their own playfulness relative to their child's playfulness. Understanding how parents perceive their own playful attitudes can create opportunities for occupational therapists to guide parents to approach play with an attitude that is as attuned as possible to their child's playfulness. Future validity studies are needed to support the clinical use of the PaPA.

Validation of an Instrument That Measures Factors Affecting Saudi Parents' Tolerance of Risky Play: A Rasch Analysis.

IMPORTANCE: Benefits of children's participation in risky play are broadly recognized. However, most related research originates in Western countries; none focuses on outdoor play in Eastern countries, including Saudi Arabia. Furthermore, although the literature identifies varying perspectives on risky play among parents, there is no objective measure to assess personal, situational, and cultural factors shaping their risk tolerance. OBJECTIVE: To establish the construct validity and internal reliability of data gathered with the newly developed Factors Affecting Tolerance for Risk in Play Scale (FAC-TRiPS). DESIGN: Instrument development. SETTING: Online survey. PARTICIPANTS: Ninety Saudi parents with children ages 7 to 10 yr. OUTCOMES AND MEASURES: The FAC-TRiPS, a 17-item, self-report measure. We used Rasch analysis (Winsteps 4.4.4) to establish evidence for construct validity (item fit, match of item difficulty and parent tolerance, principal-components results) and internal reliability (person reliability index). RESULTS: Item fit analysis revealed that data from 15 of 17 items (88%) conformed to Rasch model expectations. Item difficulty closely matched parents' risk tolerance level. The principal-components analysis of residuals demonstrated that observed variance (49.6%) closely matched expected variance (49.7%). The first contrast's unexplained variance had an eigenvalue slightly greater than 2.5, suggesting possible multidimensionality. The person reliability index was .90. CONCLUSIONS AND RELEVANCE: Preliminary analysis suggests that the FAC-TRiPS yields valid, reliable data measuring factors that influence parents' risk tolerance. Further research is needed. Plain-Language Summary: This study contributes to the knowledge of how parents in Eastern countries perceive risky play. The Factors Affecting Tolerance for Risk in Play Scale (FAC-TRiPS) is a newly developed tool that occupational therapy practitioners can use to understand parents' beliefs about and tolerance for their children's participation in risky play. The findings facilitate an understanding of the complex nature of parenting when determining whether to allow children to participate in risky play activities.

Play as Occupation: The State of Our Science and a Research Agenda for the Profession.

Occupational therapists view play through a unique lens. Considering play as a human occupation, and one to which all people have a right, places occupational therapists among a special group of professionals championing play. This State of the Science article seeks to increase awareness regarding the occupational therapy profession's contributions and to situate those contributions within the larger body of literature on play while also promoting further study of play as an occupation.

Ideational Praxis, Play, and Playfulness: A Cross-Sectional Study of Autistic Children.

IMPORTANCE: Assessment of praxis skills is an essential aspect of understanding autistic children's development of play and playfulness. OBJECTIVE: To assess the relationship and influence of ideational praxis skills on play skills and playfulness among autistic children. DESIGN: A cross-sectional study. SETTINGS: Homes, schools, and early care centers across Spain. PARTICIPANTS: Children ages 4 yr 6 mo to 6 yr 11 mo (45 typically developing [TP] and 45 with autism spectrum disorder [ASD]). OUTCOMES AND MEASURES: Student's t tests were used to compare means between the two groups. Pearson's correlation and multiple linear regression were used to determine possible effects of ideational skills on play and playfulness. RESULTS: Scores for the TP group were significantly higher than those of the ASD group on all play dimensions-space management, t(88) = 4.58; material management, t(88) = 5.86; pretense-symbolism, t(88) = 8.12; and participation, t(88) = 7.31-and on the Test of Playfulness (ToP), t(88) = 10.18, and Test of Ideational Praxis (TIP), t(88) = 4.38 (all ps < .001). Multiple linear regression revealed a statistically significant effect of TIP dimensions-space management, F(3, 41) = 4.83, p < .042; material management, F(3.41) = 8.49. p < .001; pretense-symbolism, F(3, 41) = 5.66. p < .002; and participation, F(3.41) = 7.81. p < .001-and on the ToP, F(3, 41) = 5.96. p < .002. CONCLUSIONS AND RELEVANCE: Ideational praxis skills combined with diagnostic information significantly predicted play skills and playfulness, highlighting the influence of ideation on play. Plain-Language Summary: This article provides data supporting the influence of ideational praxis skills on the play skills and playfulness of autistic children. Understanding how ideational praxis skills affect the ability to recognize and act on object affordances might promote greater possibilities for play interactions among autistic children.

Predicting Fitness to Drive for Medically At-Risk Drivers Using Touchscreen DriveSafe DriveAware.

IMPORTANCE: Occupational therapists require valid cognitive fitness-to-drive tools to advise drivers in this high-stakes area. OBJECTIVE: To examine the psychometric properties and predictive validity of data gathered with the touchscreen DriveSafe DriveAware (DSDA). DESIGN: Prospective study that compared a screening tool with a criterion standard. SETTING: Ten community- and hospital-based driver assessment clinics in Australia and New Zealand. PARTICIPANTS: Older and cognitively impaired drivers (N = 134) ages 18 to 91 years (Mage= 68) who were referred for an assessment to determine the impact of a medical condition on driving. The inclusion criteria were a valid driver's license, vision within license authority guidelines, completion of at least 1 year of high school, and English as a first language. OUTCOMES AND MEASURES: The results of the touchscreen DSDA, a standardized assessment of awareness of the driving environment and one's own driving abilities, were compared with those of a standardized occupational therapist-administered on-road assessment. RESULTS: Rasch analysis provided evidence for the construct validity and internal reliability of data gathered with the touchscreen DSDA. Optimal upper and lower cutoff scores were set to trichotomize drivers into three categories: likely to pass an on-road assessment, likely to fail an on-road assessment, and further testing required. Specificity of the touchscreen DSDA was 86%, and sensitivity was 91%; positive predictive value was 83%, negative predictive value was 92%, and overall accuracy of classification was 88%. CONCLUSIONS AND RELEVANCE: Evidence supports the utility of the touchscreen DSDA for accurately predicting which participants require on-road assessment. What This Article Adds: The touchscreen DSDA is a promising screen for occupational therapists and other health professionals to use in conjunction with other clinical indicators to determine whether drivers require further assessment.

Scale of Parental Playfulness Attitude (PaPA): Psychometric Properties With Latino Caregivers in the United States.

IMPORTANCE: Parent-child play is a beneficial and meaningful co-occupation. Therapists who want to optimize parent-child play for Latino- and Latina-American dyads need valid, reliable measures to assess caregiver playfulness in addition to preexisting measures of child playfulness. OBJECTIVE: To evaluate data collected from Latino-American caregivers with the Scale of Parental Playfulness Attitude (PaPA), a 28-item parent self-report to determine its construct validity, internal reliability, and cross-cultural validity. DESIGN: Quantitative exploratory design applying a latent-trait psychometric model. SETTING: Online survey. PARTICIPANTS: Convenience sample of 50 Spanish-speaking parents from the mainland United States recruited via snowballing (88% mothers, ages 24-47 yr; M = 34.8 yr; 82% first-generation Americans). The inclusion criteria were age ≥18 yr; literate in Spanish; primary caregiver to a child age 2.5-7 yr. Data from an existing sample of 50 parents dwelling in Puerto Rico were used to examine cross-cultural validity. OUTCOMES AND MEASURES: Rasch analysis demonstrated evidence for adequate construct validity: positive point-measure correlations, 93% fit of items, logical item hierarchy, and good progression of the rating scale. Range and mean for parent playfulness exceeded those of the items; principal-components analysis revealed one contrast of 4.46 eigenvalues, bringing unidimensionality into question. Evidence suggested excellent internal reliability (person-reliability index = 0.85, strata = 3.55) and good cross-cultural validity (25 of 28 items formed a similar hierarchy for parents dwelling in the mainland United States and Puerto Rico). CONCLUSIONS AND RELEVANCE: Although the PaPA can be used to assess caregiver playfulness with culturally diverse Latino-American dyads, further research is required. What This Article Adds: This study provides evidence for the construct validity and internal reliability of a tool that measures parent playfulness in the context of parent-child play. The PaPA is an important tool for occupational therapists working with Latino-American families.

Evaluation in Ayres Sensory Integration® (EASI) Tactile Perception Tests: Construct Validity and Internal Reliability.

IMPORTANCE: Assessment of tactile perception is foundational for addressing aspects of occupational performance. OBJECTIVE: To evaluate the construct validity and internal reliability of four new tactile perception tests. DESIGN: Causal comparative groups design. SETTINGS: Homes, schools, and therapy practices across the United States. PARTICIPANTS: Children ages 3 to 12 yr: typically developing (n = 174) and those with sensory integration concerns (n = 153). OUTCOMES AND MEASURES: Rasch analyses to evaluate construct validity; analysis of covariance to evaluate group differences. RESULTS: The Rasch model confirmed evidence of construct validity for each of the four tests. The typically developing group scored significantly higher than the clinical group on all tests (η2p = .040-.105, p < .001). Person reliability indices and strata indicated moderate to strong internal reliability (Rasch person reliability indices = .69-.87; strata = 2.33-3.82). CONCLUSIONS AND RELEVANCE: The Evaluation in Ayres Sensory Integration® (EASI) Tactile Perception Tests are reliable and valid measures for assessing tactile perception in children ages 3 to 12 yr. Findings suggest that these tests are likely to be clinically useful and appropriate for children in this age range and may provide critical information regarding underlying sensory functions necessary for optimal occupational performance. What This Article Adds: This article provides data supporting the reliability and validity of the EASI Tactile Perception Tests in a U.S. SAMPLE: These assessments can be used by therapists trained in their administration to assess tactile functions that may affect participation in activities, tasks, and occupations.

Evaluation in Ayres Sensory Integration® Praxis Tests: Construct Validity and Internal Reliability.

IMPORTANCE: Assessment of praxis using valid and reliable measures is important for understanding factors affecting occupational participation. OBJECTIVE: To evaluate evidence of construct validity and internal reliability of data gathered with four newly developed praxis tests. DESIGN: Comparative descriptive design. SETTING: Homes, schools, and therapy practices across the United States. PARTICIPANTS: A control group consisting of 163 children without any concerns or diagnoses and a case group of 145 children with sensory integration difficulties, ages 3 to 12 yr. OUTCOMES AND MEASURES: Rasch analyses to evaluate construct validity, and Student's t tests to evaluate group differences. RESULTS: Total test scores and most item scores conformed to Rasch model expectations. Group differences were significant; the control group scored higher. Internal reliability was strong. CONCLUSIONS AND RELEVANCE: Findings support the validity and internal reliability of the four praxis tests. What This Article Adds: This study adds to the growing body of evidence for validity and reliability of the Evaluation in Ayres Sensory Integration® tests.

Usability, acceptability, and implementation strategies for the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm: a Delphi study.

INTRODUCTION: Oncology guidelines recommend participation in cancer rehabilitation or exercise services (CR/ES) to optimize survivorship. Yet, connecting the right survivor, with the right CR/ES, at the right time remains a challenge. The Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm was developed to enhance CR/ES clinical decision-making and facilitate access to CR/ES. We used Delphi methodology to evaluate usability, acceptability, and determine pragmatic implementation priorities. METHODS: Participants completed three online questionnaires including (1) simulated case vignettes, (2) 4-item acceptability questionnaire (0-5 pts), and (3) series of items to rank algorithm implementation priorities (potential users, platforms, strategies). To evaluate usability, we used Chi-squared test to compare frequency of accurate pre-exercise medical clearance and CR/ES triage recommendations for case vignettes when using EXCEEDS vs. without. We calculated mean acceptability and inter-rater agreement overall and in 4 domains. We used the Eisenhower Prioritization Method to evaluate implementation priorities. RESULTS: Participants (N = 133) mostly represented the fields of rehabilitation (69%), oncology (25%), or exercise science (17%). When using EXCEEDS (vs. without), their recommendations were more likely to be guideline concordant for medical clearance (83.4% vs. 66.5%, X2 = 26.61, p < .0001) and CR/ES triage (60.9% vs. 51.1%, X2 = 73.79, p < .0001). Mean acceptability was M = 3.90 ± 0.47; inter-rater agreement was high for 3 of 4 domains. Implementation priorities include 1 potential user group, 2 platform types, and 9 implementation strategies. CONCLUSION: This study demonstrates the EXCEEDS algorithm can be a pragmatic and acceptable clinical decision support tool for CR/ES recommendations. Future research is needed to evaluate algorithm usability and acceptability in real-world clinical pathways.

Cognition Mediates Playfulness Development in Early Childhood: A Longitudinal Study of Typically Developing Children.

IMPORTANCE: Play, children's central occupation, and playfulness, its behavioral manifestation, are the foci of occupational therapy intervention. However, information about the development of playfulness behavior and the role of cognitive function is limited. OBJECTIVE: To explore the development of playfulness and its relation to cognitive functioning from infancy to toddlerhood. DESIGN: Longitudinal study with data collected at ages 6 mo, 18 mo, and 24 mo. SETTING: Laboratory (age 6 mo) and home (ages 12 and 18 mo). PARTICIPANTS: Eighty-six typically developing children drawn from a convenience sample of 109 low-risk families of middle to upper socioeconomic status. MEASURES: The Mullen Scales of Early Learning (MSEL) to assess cognitive functioning and the Test of Playfulness (ToP) to assess children's playfulness. RESULTS: ToP scores were significantly higher at age 24 mo than at age 6 mo, t(88) = -60.30, p < .001, 95% confidence interval (CI) [-1.47, -1.38]. Correlation analysis revealed that the more playful the infant was at age 6 mo, the higher their cognitive functioning was at age 18 mo and the more playful they were at age 24 mo. Toddlers with higher cognitive performance at age 18 mo demonstrated more playful behavior at age 24 mo (ß = 0.120, SE = 0.05, 95% CI [0.0377, -0.2276]). CONCLUSIONS AND RELEVANCE: Children's playfulness is evident as early as age 6 mo and continues to develop through toddlerhood, depending on their cognitive growth. Occupational therapists play a key role in working with families with young children, promoting cognitive development to further the development of playfulness behaviors. What This Article Adds: Understanding the development of playfulness and exploring its relationship with cognitive functioning in typically developing children fills important gaps in occupational therapy knowledge and contributes to delivery of early intervention, especially when cognition or playfulness are at risk. Our findings confirmed that cognitive functioning contributes to the development of playfulness.

Entering Kindergarten After Years of Play: A Cross-Case Analysis of School Readiness Following Play-Based Education.

Cross-case study research was used to explore the school readiness of four 5-year-old children entering kindergarten during the 2020-2021 school year after three or more years of play-based early childhood education at a Reggio Emilia-inspired early childhood education center. Data included a series of three 1-h individual interviews with four mothers and three kindergarten teachers, field visits during remote learning, and artifact collection over the course of the school year. Themes describing the children's school readiness were developed through cross-case analysis. Participants described the children as learners, explorers, communicators, and empathizers. The learner theme centers on the children's responsiveness to instruction; the explorer theme describes how the children approached learning; the communicator theme illustrates the children's prowess with social connection and self-advocacy, and the empathizer theme shows the thoughtfulness and emotional sensitivity these children displayed. Findings suggest that play-based learning prepared these children for successful kindergarten experiences and was a viable early childhood education pedagogy fostering school readiness.

A Web-Based and In-Person Risk Reframing Intervention to Influence Mothers' Tolerance for, and Parenting Practices Associated With, Children's Outdoor Risky Play: Randomized Controlled Trial.

BACKGROUND: Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers', are a major deterrent to children's opportunities for outdoor risky play. OBJECTIVE: The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers' perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition. METHODS: The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized. RESULTS: A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes. CONCLUSIONS: The trial demonstrates that the web-based intervention was effective in increasing mothers' tolerance for risk in play. TRIAL REGISTRATION: ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-018-2552-4.

Evaluation in Ayres Sensory Integration® (EASI) Vestibular and Proprioceptive Tests: Construct Validity and Internal Reliability.

IMPORTANCE: Vestibular and proprioceptive functions play a critical role in occupational performance and participation. Assessment of these functions in a reliable and valid manner is part of a comprehensive assessment in the Ayres Sensory Integration® frame of reference, commonly applied in pediatric occupational therapy. OBJECTIVE: To report on reliability and validity of six tests of vestibular and proprioceptive functions of the Evaluation in Ayres Sensory Integration (EASI). DESIGN: We used Rasch analyses to examine and modify the number of items and scoring categories on the six tests and known-groups analysis to examine group differences. We evaluated internal consistency using Cronbach's α and Rasch person reliability. PARTICIPANTS: The sample contained typically developing children (n = 150) and children with sensory integration concerns (n = 84); all participated voluntarily. Outcomes and Measures: The EASI is used to measure sensory and motor functions in children ages 3 to 12 yr. The six tests of vestibular and proprioceptive functions were analyzed in this study. RESULTS: Data from >96% of items conformed to the expectations of the model. We found statistically significant group differences (ps < .001-.128; ds = 0.20-1.31), with the typically developing children group scoring significantly higher on all but one test, and moderate to strong evidence of internal consistency (Rasch person-reliability indices ≥ 0.80; strata > 3) for five of six tests. CONCLUSIONS AND RELEVANCE: The EASI vestibular and proprioceptive tests have strong construct validity and internal reliability, indicating that they are psychometrically sound clinical measures. What This Article Adds: The development of occupational therapy assessments with strong psychometric properties, such as the EASI tests of vestibular and proprioceptive functions, enhances clinical practice and research by elucidating the factors affecting participation in accurate and dependable ways so that occupational therapy interventions can be focused and effective.

Spanish Cultural Adaptation and Inter-Rater Reliability of the Test of Playfulness.

AIM: To adapt the Test of Playfulness (ToP) to the Spanish context (culturally and linguistically) and analyze the inter-rater reliability of the translated version. METHODS: Following a specific methodology for cultural adaptation, direct and back translations were carried out, together with cognitive interviews with pediatric occupational therapists, to analyze the comprehensibility of the translated version. The resulting version was analyzed by a linguistic expert to determine its grammatical and linguistic adequacy. Finally, inter-rater reliability was analyzed in a sample of typically developing children aged between 4 years old and 6 years and 11 months (n = 12). RESULTS: Direct and back translation phases showed a good conceptual equivalence with the original version. The cognitive interviews enabled the identification of difficulties surrounding the understanding and the terminology used in several items. The linguistic expert and the research team revision ensured that final grammatical and conceptual improvements were made. Inter-rater reliability analysis showed an almost perfect degree of agreement (0.82 ≤ κ ≤ 1.00; p < 0.001), as well as stability and a strong positive linear correlation (0.81; p < 0.001). CONCLUSIONS: The translated version of the ToP fits the Spanish context and can be used in the clinical setting of pediatric occupational therapy in Spain.

Can I join in? Multiple case study investigation of play performance generalisation for children with autism spectrum disorder from dyad to triad.

INTRODUCTION: Children with autism spectrum disorder (ASD) have difficulties with play, social interaction with peers and generalisation of intervention outcomes. The Ultimate Guide to Play, Language and Friendship (PLF) has demonstrated effectiveness in improving play performance of children with ASD and their typically developing (TD) peers. The aim of this investigation was to examine the changes in play performance when an additional TD child is added to an existing dyad of a child with ASD and a TD playmate to inform future delivery and adaptations of the intervention. METHODS: Participants in this multiple case study design were five children with ASD and their TD peer who completed a dyad intervention as part of a randomised control trial investigation of the PLF and an additional TD peer who joined the play dyad. A trained occupational therapist delivered an adapted version of the PLF to the triad over four clinic sessions. An independent rater scored each child (N = 15) on The Test of Playfulness at pre- and post-triad intervention. Line graphs were used to examine case data and compare to dyad play performance and patterns of interaction. RESULTS: Four of the five children with ASD generalised their play performance from the dyad to the triad social environment. However, the triad intervention did not demonstrate improvements in play performance. The play performance scores for the children with ASD and their TD peers were variable and demonstrated changes in their play pattern from the dyad to the triad. CONCLUSION: This investigation delivered preliminary evidence of play performance generalisation from a dyad to a triad with TD peers for children with ASD. Careful consideration of characteristics of all playmates is recommended for delivering the intervention to support play performance of children with ASD.

Creating play opportunities on the school playground: Educator experiences of the Sydney playground project.

INTRODUCTION: Children with disabilities often experience unsupportive environments that restrict their play opportunities and inclusion on the school playground. This exclusion can perpetuate inequities for children with disabilities, with lifelong implications. The Sydney Playground Project uses a simple, innovative intervention consisting of placing recycled materials on the playground and engaging parents and educators in risk reframing sessions to create increased playground choice, control, independence and inclusion for all children. METHODS: The purpose of this study was to learn from participants about the utility of the intervention for promoting choice and control among children with disability on the school playground. Data included evaluative interviews with 27 school staff (teaching assistants, teachers, therapists, school leadership) across five participating schools after completing of the intervention. Analysis was thematic and explored prominent ideas first within schools, and then between schools. RESULTS: Prior to the intervention, participating school staff focused on active supervision to support play and student needs. During the intervention, school staff experienced role shift and confusion as they allowed the children increased independence while using the recycled materials and learned to navigate how much independence to give the children. Children engaged in increased imaginative and social play, and school staff adopted higher expectations of children's capabilities. CONCLUSION: Interventions such as the Sydney Playground Project that collaboratively shift adult perceptions to focus on the capabilities of children with disabilities and increase the supportiveness of the physical environment have great promise in increasing play choice and inclusion on the school playground.

Construct Validity and Test-Retest Reliability of the Coping Inventory (CI) for Children With Developmental Disabilities.

OBJECTIVE: A reliable, valid, and readily usable method of measuring coping is essential for occupational therapy practitioners and researchers working with children with developmental disabilities. The aim of this study was to examine evidence for the construct validity and internal and test-retest reliability of the Coping Inventory (CI), a 48-item survey designed for use with children. METHOD: School staff (N = 39) completed CIs for 79 students with developmental disabilities age 5-13 yr (mean = 8.0, standard deviation = 2.0) who were primarily boys (n = 52; 68%) with autism spectrum disorder (n = 40 of 47 diagnoses provided). We used Rasch analysis to examine construct validity, internal reliability, and possible redundancy of items and intraclass correlations, Pearson correlations, Bland-Altman plots, and t tests were used to examine test-retest reliability. RESULTS: Rasch analysis provided evidence of construct validity: All items correlated positively with the overall measure; data from 94% of items conformed with Rasch expectations, and the items form a logical hierarchy. Intraclass correlations revealed an average coefficient of .96, providing evidence of test-retest reliability. CONCLUSION: The CI demonstrated good evidence for construct validity and internal and test-retest reliability. Redundancy of items suggests that some items could be eliminated after further research.

Converting the DriveSafe subtest of DriveSafe DriveAware for touchscreen administration.

BACKGROUND: DriveSafe measures awareness of the driving environment. It is one subtest of DriveSafe DriveAware, a cognitive fitness-to-drive screening instrument. We converted DriveSafe to a touchscreen format for ease of administration; this necessitated the development of an automatic data collection and scoring system to reflect the decision that would otherwise have been made by an expert rater. We applied a structured process to determine what constituted 'correct' scores. We then examined the resulting scoring parameters to determine if these discriminated at-risk drivers from a comparison sample. METHODS: Thirty at-risk older drivers and 30 younger drivers took touchscreen DriveSafe. Following presentation of images containing between one and four objects/hazards for 4 seconds, participants indicated their recall of object/hazard characteristics (type, location and direction of movement) by touching the screen. We analysed responses via descriptive statistics to compare spread, accuracy and consistency; and via a Fisher's exact test to determine whether the set scoring parameters could discriminate between at-risk and comparison drivers. RESULTS: Fisher's exact test results indicated 24 of 28 location zones and 18 of 28 direction ranges discriminated at-risk drivers from the comparison group (P < 0.05). Frequency of missed or incorrectly identified hazards was much higher for the at-risk group for all variables. At-risk drivers missed or misidentified significantly (P < 0.00) more object types (34%), directions (47%), and locations (36%) than the comparison group (≤4% for each variable). At-risk drivers entered 31 additional responses for objects/hazards not displayed; the comparison group entered no additional responses. CONCLUSION: The automatic variable data collection and scoring system reflected decisions that would have been made by an expert rater. This systematic process provided automated scoring decisions that enabled us to discriminate at-risk drivers from a comparison group. Psychometric evaluation of data gathered with touchscreen DriveSafe is required prior to use in clinical practice.

Peer-mediated intervention to improve play skills in children with autism spectrum disorder: A feasibility study.

BACKGROUND/AIM: Children with autism spectrum disorder (ASD) frequently demonstrate impaired play skills and poor quality social interactions compared to typically developing peers. Complex interventions to improve play skills should be investigated with randomised control trials (RCT) where possible to support evidence-based practice for occupational therapists. Prior to a RCT, multiple feasibility studies are recommended to identify barriers to the trial. The aim of this study is to adapt a complex intervention to improve play skills in children with ASD and investigate the feasibility of conducting a RCT. METHODS: Participants were 10 children with ASD paired with typically developing playmates chosen by their families. Pairs attended 10 intervention sessions involving video modelling, therapist- and peer-mediation and free play. Participant numbers needed for future investigation of effectiveness were calculated and time and cost considerations were reviewed. The Test of Playfulness (ToP) was the primary outcome measure; both parent- and child-report outcome measures were evaluated for appropriateness. RESULTS: To determine effectiveness of the intervention 34 pairs in both control and intervention groups will be needed to conduct a RCT over an 18-month timeframe. ToP scores showed a positive, but not statistically significant trend from pre- to post-intervention. These improvements were maintained at follow-up in both clinic and home environments. The Piers-Harris 2 and the Parent Relationship Questionnaire were identified as appropriate secondary outcome measures; additional parent- and teacher-report outcome measures are recommended for the RCT. CONCLUSION: A RCT to investigate effectiveness of this intervention for improving play skills of children with ASD and their playmates are feasible.