Research in Developmental Disabilities 35 (2014) 223–233

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Research in Developmental Disabilities

Participation in leisure activities: Differences between children with and without physical disabilities N. Schreuer *, D. Sachs, S. Rosenblum Department of Occupational Therapy, University of Haifa, Haifa 31905, Israel

A R T I C L E I N F O

A B S T R A C T

Article history: Received 15 August 2013 Received in revised form 29 September 2013 Accepted 1 October 2013 Available online 28 October 2013

The aim of the current study was to compare varied dimensions of participation in leisure activities among school-aged children ages 10–16 with and without disabilities. The Children Leisure Activity Scale (CLASS) was administrated to 294 children, 81 with and 213 without physical disability. Two-way MANCOVA revealed significant differences between the frequency of participation in leisure activities of the study groups: an effect of disability F(4,265 = 239.57; p < 0.001, h2 = 0.78); an effect of gender F(4,265 = 3.35; p < 0.01, h2 = 0.05); and an interaction effect between gender and disability F(4,265 = 5.23; p < 0.001, h2 = 0.64). Children with disabilities, and mostly girls, were found at risk to participate in a narrower variety of activities that involved fewer social interactions. Using linear regressions for each group two different models were identified. Using the CLASS the study contributes evidence-based data regarding children at risk for leisure participation. In addition, the research further established the discriminate validity of the CLASS. ß 2013 Elsevier Ltd. All rights reserved.

Keywords: Play Games and sports Indoor and outdoor activities Self-enrichment

1. Introduction Participation is a complex concept that relates to involvement in major life areas, such as mobility, domestic life, learning and applying knowledge, productivity, and engaging in social and leisure activities. As such, it constitutes a core concept related to health and disease, ability and disability within the framework of the World Health Organization’s International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY; WHO, 2007). Participation in leisure activities may serve psychologists and other clinicians, educators, researches and policy makers, as an indicator of function and health correlated with quality of life, as well as physical and emotional well-being (ShikakoThomas et al., 2012). It is a recommended high level outcome measure since by its nature it is driven by internal motivation and involves freedom of choice and control, in contrast to other duties and roles individual are engaged in their daily life (Coleman & Iso-Ahola, 1993; Neistadt & Crepeau, 1998). Leisure or play activities provide school-age children with opportunities for enjoyment, relaxation, recreation, self-enrichment, and goal achievement. Moreover, leisure is of central importance for building children’s competence, self-determination, and identity as well as for social and personality development (Coastsworth et al., 2005; Passmore & French, 2003; Shikako-Thomas et al., 2012; Wilkes, Cordier, Bundy, Docking, & Munro, 2011). Furthermore, participation in meaningful leisure activities correlates with children’s well-being (Adolfsson, 2011), and quality of life, if it fits the child’s skills and preferences, especially in case they live with disability (Shikako-Thomas et al., 2012).

* Corresponding author at: Department of Occupational Therapy, Faculty of Social Welfare & Health Sciences, University of Haifa, Mount Carmel, Haifa 31905, Israel. Tel.: +972 4 828 8738; fax: +972 4 8249753. E-mail addresses: [email protected], [email protected] (N. Schreuer). 0891-4222/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ridd.2013.10.001

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In line with the WHO’s classification mentioned above, disability was defined as ‘a difficulty in functioning at the body, person or social levels, in one or more life domains, as experienced by an individual with a health condition in interactions with contextual factors’ (Leonardi, Bickenbach, Ustun, Kostanjsek, & Chatterji, 2006; p. 1220). The current study focuses participation in leisure and social activities, as essential life domain of children with and without disability. Society has a duty to facilitate the participation of children with disabilities in leisure activities (ICF-CY, 2004; McConachie, Colver, Forsyth, Jarvis, & Parkinson, 2006). Indeed, meaningful leisure participation is necessary to enable children with disabilities to learn skills, and develop self-efficacy and self-identity, while involved in meaningful occupations (Heah, Case, McGuire, & Law, 2007; Shikako-Thomas et al., 2012; Shimoni, Engel-Yeger, & Tirosh, 2010). Participation et large, and mostly in leisure activities is a complex concept characterized along multiple dimensions, including: objective and subjective report, quantitative and qualitative measures, and the context where the participation takes place (Coster & Khetani, 2008; Palisano et al., 2011). However, previous studies comparing the participation of children and youths with and without disabilities have struggled to discover multi-dimensional phenomena. On the one hand, it is evident that children and youth with disabilities are more restricted than children without disabilities in their leisure and play participation. This manifests in less variation in activities, fewer social engagements, more time spent in quiet recreational activities at home, and less in formal organized activities (Law, Petrenchik, King, & Hurley, 2007; Palisano et al., 2011; Shimoni et al., 2010). On the other hand, Majnemer and her colleagues (Majnemer et al., 2008) found that children with disabilities are actively involved in a wide range of informal leisure activities and experience a high level of enjoyment. In a longitudinal study among 427 children ages 6–14 with physical disabilities (50.8% with Cerebral Palsy), Law and her colleagues (2006) found that children participate in a wide range of activities. As a whole, they exhibit proportionally greater participation and greater intensity in informal activities rather than in organized/structured formal activities, in which only 60% participate once or more a week. The authors consider their findings to be of concern, given that participation in organized activities is important for the development of skills and competences, and long-term mental and physical health (Bult, Verschuren, Jongmans, Lindeman, & Ketelaar, 2011; Simeonsson, Carlson, Huntington, McMillen, & Brent, 2001). Researchers investigating the factors that explain participation rates by children with disabilities found that mastery, motivation, and involvement in rehabilitation services enhance participation in leisure activities. However, cognitive and behavioral difficulties, motor limitations, and parental stress are obstacles to participation (Bult et al., 2011; Imms, Reilly, Carlin, & Dodd, 2008). The personal factors of age and gender also strongly influence participation by children with disabilities. These factors are the most significant factors explaining choice of and participation in leisure activities in children with cerebral palsy (Bult et al., 2011; Shikako-Thomas, Majnemer, Law, & Lach, 2008), which is consistent with findings for children without disability (Allison et al., 2005; Johnson, Christie, & Yawkey, 1999; King et al., 2007; Mota, Silva, Santos, Ribeiro, & Duarte, 2005). With respect to age, children with disabilities aged over 12 years participate less frequently and in a smaller variety of activities than younger children (Bult et al., 2011). Regarding gender, Law and her colleagues (2006) found that, among children with disabilities, girls participate in significantly more social and skill-based activities than boys, which is again consistent with findings for typically developing children (Rosenblum, Sachs, & Schreuer, 2010). Some of the variance in the studies about play and leisure participation described above may stem from the assessment tool used in each study. Recently, the literature has increased its focus on play/leisure participation among school-aged children while implementing standardized new tools. However, comprehensive, culturally sensitive evaluations of the multi-dimensional construct of leisure participation among children with disabilities remain scarce. Indeed, only a few studies (Hackett, 2003; King et al., 2007) have been undertaken outside of North America and Europe. Such evaluations may contribute to unveiling the factors that explain the participation of children with disabilities in leisure activities in order to recommend intervention programs for improving their inclusion and enhancing their quality of life. The Children’s Leisure Activity Scale (CLASS – Rosenblum et al., 2010) was developed in response to the call to evaluate leisure participation among school-aged children in a comprehensive manner (McConachie et al., 2006) with a tool that is practical and culturally sensitive to multicultural groups in Israel. The CLASS enables us to examine participation in 40 leisure activities from a wide perspective, via six dimensions of participation: variety (which activities), frequency (how often), sociability (with whom), preference (how much he or she likes the activity), time consumption (how much time is invested), and desired activities (which activities are desired but not currently undertaken). Following factor analysis, the 40 activities in the CLASS were also divided into four main factors: instrumental indoor, outdoor, self-enrichment, and games and sports (Rosenblum et al., 2010) The aim of the current study is to explore the multidimensional characteristics of participation in leisure activities among school-aged children with various disabilities, in comparison with typically developing children, while controlling other demographic child’s characteristics (age, mean years of education of parents, socio-cultural identity and place of residence). A secondary goal is to further establish the discriminate validity of the CLASS. These aims were divided into three specific hypotheses regarding significant differences between children with and without disabilities in terms of their leisure activities, as reflected through the CLASS: H1. Differences in CLASS dimensions. School-aged children with disabilities participate in a smaller variety of activities, less frequently, and with fewer social interactions than their peers without disabilities. These differences are significant and not attributable to the controlled demographic characteristics.

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H2. Differences in CLASS factors. Significant differences exist between school-aged children with and without disabilities in the four activity categories (instrumental indoor, outdoor, self-enrichment, and games and sports). These differences are significant and not attributable to the controlled demographic characteristics. H3. Differences by gender. Significant differences exist between school-aged boys and girls with and without disabilities in the variety of activities they participate in. These differences are significant beyond the controlled demographic characteristics.

2. Methods 2.1. Research population A stratified snowball sample of 213 children without disabilities was recruited from various communities in northern Israel, and was compared with 81 children with disabilities, who had developmental and either motor or sensory disability (Table 1). The children with disabilities in the study were recruited by the educational department in six municipalities for a national project called ‘‘a computer for every child’’ (Computer for Every Child, 2013), which was established to close the digital gap in Israel. The project provided children with disabilities who had no computer four elements: adapted computers, Internet connectivity, assistive technology f needed and tutors in their homes. Recruiting was conducting according to the Ministry of Education’s criteria. Among 200 candidates, 81 participated in the study, addressing all criteria of inclusion: age (10–21); having registered developmental and motor or sensory disability; accepting all services provided by the program; providing signed consent form; and able to understand the questionnaire and answer themselves or with technical assistance of the interviewer. The majority of the children with disabilities were integrated into the regular educational system, while a quarter of them studied in special education schools. According to their self-report most of the group reported having a single disability (n = 58), while about fifth of the group reported having multiple disabilities (n = 13), mostly a combination of motor and sensory disabilities. Both groups (Table 1) consisted of equal numbers of males and females aged 13  3 from diverse cultural backgrounds around the country. The group of children with disabilities included more children who belong to minority groups and lower socio-economic levels as a result of the criteria of the ‘‘computer for every child’’ project. In the absence of any financial data, we used socio-cultural identity (defined by the child’s mother tongue) and parental education (the mean years of education of both parents) as covariates throughout all the analyses.

Table 1 Descriptive statistics for demographic variables. Variables

Age of child Parental education (years)

Gender Male Country of birth Israel Mother’s tongue Hebrew Arabic Other Residence Urban Rural Socio-cultural identity Arab Jewish School Regular Special Disability Single Multiple *** p < 0.001

Mean  SD

t

With disabilities (n = 81)

Without disabilities (n = 218)

13.22  3.04 11.27  2.63

13.90  2.17 13.45  3.11

1.68 5.59***

Percent (N)

Percent (N)

x2

53.5 (38)

45.5 (97)

1.36

88.7 (63)

92.5 (197)

0.97

25.4 (18) 66.2 (47) 8.5 (6)

79.8 (170) 18.3 (4) 1.9 (4)

64.94***

48.2 (39) 51.8 (42)

57.8 (126) 42.2 (92)

0.18

66.2 (47) 33.8 (24)

18.3 (39) 81.7 (174)

54.67***

75.7 (3) 24.3 (17) 87.9 (58) 58.3 (35)

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2.2. Research tool The Children’s Leisure Assessment Scale (CLASS) (Rosenblum et al., 2010) was developed to examine engagement in leisure activities by school-aged Israeli children from a wide age range of backgrounds and environments. The CLASS is a multi-dimensional scale that aims to document the perceptions of children about their time investment in leisure activities. The CLASS was developed in Hebrew, but has since undergone a standardized translation process into English. The CLASS contains 40 leisure activities, and an open item ‘‘Other activities’’, which are evaluated according to six dimensions of leisure participation: 1. Variety (which activities)—the sum of leisure activities in which the child engages. 2. Frequency (how often)—rated on a four-point Likert scale: 1, once every few months; 2, once a month; 3, twice a week; and 4, every day. 3. Sociability (with whom)—rated on a three-point Likert scale: 1, alone; 2, with a relative (e.g., parent, sibling); 3, with one or more friends. 4. Preference (how much he/she likes the activity)—rated on a scale ranging from 1 (do not like at all) to 10 (like very much). 5. Desired activities (which activities are desired, but not currently undertaken). The CLASS underwent a thorough expert evaluation of its 40 items, followed by internal consistency checking. The alpha coefficient (a = 0.71) was determined for the CLASS frequency dimension from a sample of 249 typically developing children (Rosenblum et al., 2010). Factor analysis of the frequency domain of the CLASS revealed four activity type factors that explained 32.73% of the total variance: (a) instrumental indoor activities; (b) outdoor activities usually performed with others; (c) self-enrichment activities; (d) games and sports activities. In addition, the construct validity of the CLASS was determined by its ability to distinguish between the participation of girls and boys (Rosenblum et al., 2010). The current study used the six dimensions of the CLASS, as well as its four factors, to examine whether there are differences in participation in leisure activities between children with and without disabilities. 2.3. Procedure The research was approved by the ethical committees of the Ministry of Education and the University of Haifa, Israel. Once a consent form was signed by participants with and without disabilities and by their parents or guardians, the children were asked to report about their engagement in leisure activities using the CLASS and to fill a demographic questionnaire. Administration of the CLASS and the questionnaire took about half an hour, mostly conducted in the children’s homes. 2.4. Data analysis Statistical analyses were conducted using SPSS version 17. The descriptive data demonstrate demographic characteristics as well as the patterns of participation in leisure activities of children with and without disabilities, as measured by the CLASS. Consistently with the literature and in light of the significant differences found between the groups with and without disability, the child’s socio-cultural identity and age, and parental education were controlled as covariates. In order to compare participation in leisure activities among school-aged children with and without disabilities, two-way Multivariate Analyses (MANCOVA) were used twice to examine differences between the two groups and across gender. The first MANCOVA examined the four dimensions of participation in leisure activities (variety, frequency, sociability, and preference), while the second probed the four factors (instrumental indoor; outdoor; games and sports; and selfenrichment). The comparisons relating to CLASS dimensions and factors were then further analyzed across gender differences. In addition, an integrative linear regression model was used to examine demographic variables that explain the variety of activities children and youth participate in, namely, age, gender, and parental years of education, socio-cultural identity, and residence. The significance level was set at p < 0.05. 3. Results In order to have an overall descriptive picture regarding the activities children and youth participate in, mean scores of the four dimensions of activities found among children with disability followed by the group without disability, reveal the following: both groups of children presented similar preferences of activities they like to do [7.46 (SD 1.45) vs. 7.3 (SD 1.65)]. However, children with disabilities participate in a smaller variety of activities [21 (SD 7) vs. 23.5 (SD 5.62)], more frequently [2.77 (SD 0.38) vs. 1.46 (SD 0.39)], and with less social interactions with their peers without disabilities [1.99 (SD 0.29) vs. 2.15 (SD 0.26)]. In addition, a t-test for independent groups was used for each one of the activities listed in the CLASS. Fourteen out of 40 activities revealed no significant mean difference between participation rate of children and youth in both groups were: watching TV; typing on computers; sleeping during day time; taking care of pets; creating arts and crafts; singing; playing

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music; playing cards and quiet structured games; playing in a playground; eating in restaurants; discussing issues with parents; wondering around (mostly in malls and neighborhoods); volunteering or supporting others; and gardening. Few analyses were used to examine the hypotheses (H) and described hereby regarding the differences in participation of children and the effect of disability, as well as other demographic variables that may explain the phenomena. 3.1. H1 – group differences in leisure participation across the four dimensions of the CLASS, by disability and gender The first analysis (Table 2) sought to investigate H1 by examining differences between children with and without disabilities in the four dimensions of participation in leisure activities (variety, frequency, sociability, and preference); The differences were examined while controlling the child’s age, socio-cultural identity, place of residence and parental years of education as covariates. Frequency: Two-way MANCOVA analysis revealed three significant differences between the frequency of participation in leisure activities of the study groups: an effect of disability F(4,265 = 239.57; p < 0.001, h2 = 0.78); an effect of gender F(4,265 = 3.35; p < 0.01, h2 = 0.05); and an interaction effect between disability and gender F(4,265 = 5.23; p < 0.001, h2 = 0.64). Preference: No significant difference was found between the two study groups in terms of preference of their leisure activities. This confirmation of the claim that both groups like to do the same activities leaves open the question of whether they actually participate in the activities that they equally like. Variety and sociability: MANCOVA analyses (Table 2) on each of the variables revealed significant differences between the groups in terms of the Variety of activities they undertook, their Frequency, and their Sociability. We found that children with disabilities participate in a narrower variety of activities that involved fewer social interactions with their peers than children with without disabilities, so confirming these aspects of H1. However, children with disabilities were found to engage more frequently than their children without disabilities, in those leisure activities that they can do, so contradicting this component of H1. The examination with respect to gender differences shown in Table 2 reveals differences between the participation patterns of boys compared with girls. Girls from both groups preferred the activities they participate in significantly more than boys. Boys with disabilities preferred the activities they participate in significantly more than boys without disability. The interaction effect between group and gender was driven mainly by Preference and Variety, meaning that the main differences between boys and girls were the variety of activities they prefer to do. Hence, the results show that girls without disabilities are involved in the largest variety of activities, while girls with disabilities are involved in a smaller variety of leisure activities. Fig. 1 demonstrates descriptive differences between male and female by disability (those without disability are represented by solid line; as those with disability are represented by broken line). The one on the left represents the variety of activities (average number) male and female are engaged in (Min. 18, Max. 24, out of 40). The right one represents the mean score for their preference of activities (range 1–10). 3.2. H2 – group differences in leisure participation across the CLASS four factors, by disability and gender The second two-way MANCOVA (Table 3) examined differences in participation across the four factors that represent different types of activities (instrumental indoor, outdoor, self-enrichment, and games and sports). The differences were examined while controlling the child’s age, socio-cultural identity and place of residence, and the parents’ years of education as covariates. The two-way MANCOVA revealed three significant differences in participation between the groups in most of the CLASS activity factors, namely, an effect of disability (F(4,265) = 7.63; p < 0.001, h2 = 0.10); an effect of gender

With disability

Without disability 8

Variety

Preference

26

18

6 Male

Female

Male

Female

Fig. 1. Variety in and preference for leisure activities among boys and girls with and without disability.

228

With disabilities Male

Female

N Variety

38 22.08  7.64

32 19.50  6.14

Frequency

2. 78  0.38

2.77  0.39

Preference

7.31  1.55

7.64  1.31

Sociability

2.04  0.29

1.93  0.27

* p < 0.05. ** p < 0.01. *** p < 0.001.

Without disabilities F group (h2) 10.21*** (0.06) 490.38*** (0.64) 0.89 NS 9.35** (0.03)

Entire research population

Male

Female

F gender

With disabilities

Without disabilities

Male

Female

95 22.12  5.04

114 24.66  5.85

0.09

70 20.90  7.07

209 23.51  5.63

133 22.11 5.87

146 23.53 6.27

1.41  0.32

1.51  0.44

0.88

2.77  0.38

1.47  0.39

1.80  0.71

1.79  0.68

6.79  1.82

7.64  1.31

7.46  1.45

7.30  1.65

6.94  1.75

7.70  1.35

2.16  0.28

2.15  0.25

8.77** (0.03) 2.13

1.99  0.29

2.16  0.26

2.13  0.29

2.10  0.27

Group  gender (h2) 13.66*** (0.05) 0.62 NS 5.46* (0.02) 1.91 NS

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Table 2 Two-way MANCOVA analyzing four dimensions of participation in leisure activities by children with and without disability, across gender.

Instrumental indoor activities Outdoor activities Self- enrichment activities Games and sports activities * p < 0.05. ** p < 0.01. *** p < 0.001.

With disabilities

Without disabilities

Entire research population

F

F

F

Male M  SD n = 38

Female M  SD n = 32

Male M  SD n = 95

Female M  SD n = 114

With disabilities M  SD n = 70

Without disabilities M  SD n = 209

Male M  SD n = 133

Female M  SD n = 146

Group (h2)

Gender

Group  gender

0.18  0.71

0.20  0.64

0.75  0.16

0.79  0.18

0.68  0.19

0.77  0.18

0.74  0.17

0.76  0.20

0.22

0.56  0.22

0.49  0.21

0.63  0.21

0.66  0.19

0.53  0.22

0.65  0.20

0.61  0.21

0.62  0.21

0.49  0.26

0.48  0.26

0.25  0.21

0.49  0.26

0.48  0.26

0.38  0.26

0.32  0.25

0.49  0.26

4.46* (0.03) 13.21*** (0.05) 0.08

0.54  0.31

0.39  0.28

0.67  0.25

0.56  0.30

0.47  0.30

0.61  0.28

0.63  0.28

0.53  0.30

5.20* (0.02) 5.83* (0.02) 19.23*** (0.07) 0.58

22.33*** (0.08)

0.45 10.07** (0.04) 11.81** (0.04)

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Table 3 Two-way MANCOVA analyzing four dimensions of participation in leisure activities by children with and without disability, across gender.

229

230

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Table 4 Regression analysis of demographic variables that explain the variety of leisure activities engaged in by each of the research groups separately. Variable

Socio-cultural identitya Parental education Gender Age Residence R2 (Adj. R2) F

With disability

Without disability

B

SE B

b

B

SE B

b

3.11 0.64 5.30 1.07 0.50 0.19 (0.14) 3.45**

2.37 0.41 2.11 0.34 2.35

0.16 0.17 0.27* 0.34** 0.03

7.26 0.04 3.51 0.40 3.19 0.26 (0.24) 13.99***

1.06 0.11 0.72 0.21 0.86

0.50*** 0.02 0.31*** 0.15 0.28***

a

Socio-cultural identity: 1 = Jewish, 0 = Arab Residence: 1 = urban, 0 = rural; Gender: 1 = female, 0 = male. * p < 0.05. ** p < 0.01. *** p < 0.001.

(F(4,265) = 10.08; p < 0.001, h2 = 0.13); and an interaction effect between disability and gender (F(4,265) = 5.04; p < 0.001, h2 = 0.07). The results revealed significant differences between the groups in terms of all factors representing types of activities except one, namely, self-enrichment. They partially confirm the hypothesized differences between the groups (H2), since children with disabilities reported that they are involved in fewer activities in all factors of the CLASS, except selfenrichment. 3.3. H3 – group differences in participation in types of activities, by disability interacted with gender Differences were found between mean of participation rate of four groups divided by disability interacted with gender, which may assist identifying children at risk; Boys without disability reported they do significantly less self-enrichment activities than other groups. The gender effect revealed that girls are engaged in self enrichment activities more than boys, while boys are engaged in games and sports more than girls. An interaction between disability and gender was found in three activity type factors: Instrumental Indoor; Outdoor, and Self-enrichment. Girls with disabilities are least engaged in games and sports and in instrumental home activities. Activities from the latter factor are performed the most by girls without disabilities. 3.4. Explanation of variety of participation in leisure activities Following the findings revealed the significant differences in participation in leisure activities by children with and without disability we undertook linear regression modeling on the variety of activities data (Table 4). We used two distinctive models to examine which personal characteristics explain participation in leisure activities (child’s gender, age, sociocultural identity, residence, and parental education). In line with our previous study (Rosenblum et al., 2010), Variety of activities was defined in terms of the number of types of activities that children reported participating in. It was chosen for the regression because it was the most frequently reported variable in literature, with the least missing data in our study. Model 1: among children with disabilities, participation in a variety of leisure activities can be explained significantly by the model [R2 = 0.27, F = 3.45; p < 0.05], although the model could explain only 19% of the variance. Gender (b = 0.27, p < 0.05) and age (b = 0.34, p < 0.01) significantly explained leisure participation. In this model, socio-cultural identity and place of residence were not significant and were therefore dropped from the model. Model 2: among children without disabilities, participation in a variety of leisure activities can be explained by a stronger model [R2 = 0.26; F = 13.99; p < 0.001]. The following personal characteristics explained 26% of the variance: gender (b = 0.31, p < 0.001), socio-cultural identity (b = 0.50, p < 0.001), and residence, urban versus rural (b = 0.28, p < 0.001). 4. Discussion Involvement in discretionary play and leisure activities is very important for the development of essential skills, self identity and well-being and of children and youth (Wilkes et al., 2011). Hence it is an important outcome measure for the social inclusion of children with disabilities in particular (Lee, 2011). The current study aimed to compare participation in leisure activities between groups of typical school-aged children and a matched group with heterogeneous disabilities. The comparison using the CLASS tool, contributes a theoretical multidimensional concept of participation in leisure activities. It also enables researchers and practitioners to identify groups at risk, plan interventions and calls for future studies regarding correlations between participation in leisure activities and other psychological parameters of self-esteem and well-being. Children in the entire current research population (N = 279) reported on participating in a large variety of leisure activities at least once a month. Moreover, as others have found (Henry, 1998; Shimoni et al., 2010), children and youth with disabilities expressed a desire to participate actively in the same types of activities as their counterparts without disabilities. However, the leisure activities in which they actually engage were least preferred by boys without disabilities.

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Analysing the results revealed differences in the actual participation patterns of the group of children with disabilities in comparison with the group of children without disabilities. The former group participated in a smaller variety of activities, but more frequently than children without disabilities. Girls without disabilities reported involvement in the largest range of activities, while girls with disabilities reported involvement in a smaller variety of leisure activities. The latter finding may indicate that girls with disabilities may be at risk for reduced participation in leisure activities and calls for further attention. These differences were found while controlling for other demographic differences between the research groups across gender. Such control strengthened the effect of the interaction between disability and gender far beyond age and other demographic characteristics related to the low socio-economic status of the group recruited from the ‘‘computer for every child’’ project. This control for demographic characteristics may also contribute to the generalization of the presented findings. The two integrative regression models contribute to the debate regarding which demographic variables explain participation by children in leisure activities. Such variables are: gender (Bult et al., 2011; Eccles, Barber, Stone, & Hunt, 2003; Van Naarden Braun, Yeargin-Allsopp, & Lollar, 2006); age (Adolfsson, 2011; Bult et al., 2011); parental education (Dimitrios, Georgia, Eleni, & Asterios, 2008; Guryan, Hurst, & Kearney, 2008); residence—rural vs. urban (Bult et al., 2011; Van Naarden Braun et al., 2006); and socio-cultural identity, which somewhat overlaps with the concept of cultural and linguistic diversity examined by Adolfsson (2011). These variables are better at explaining variance among children without disabilities than among children with disabilities. The similarity in the latter group may indicate that the effect of disability is so strong that it obscures other differences among children with disabilities. The effect of disability on participation heightens the risk of children and youth with disabilities participating in a narrower variety of leisure activities and being uninvolved or less involved than children without disabilities (Heah et al., 2007). Their lack of participation in a variety of leisure activities may be the result, on one hand, of the disability, but it may result, on the other hand, with experiencing fewer opportunities to develop motor skills, self control, and social, intellectual, physical, emotional, and problem solving skills than their counterparts without disabilities (Hofferth & Sandberg, 2001; Hines, 2004; Sagnitti & Unsworth, 2000). Participation in preferred activities performed with others, having fun, and experiencing a sense of control are elements that promote a sense of confidence and well-being (Adolfsson, 2011). These elements are meaningful to children with disabilities, beyond acquiring skills and experiences. This emerges from interviews, in which children with disabilities expressed their perception of successful participation as: ‘‘having fun’’, ‘‘feeling successful’’, ‘‘doing and being with others’’, and ‘‘doing things myself’’ (Heah et al., 2007). Reduced participation can create a vicious circle whereby children with disabilities are prevented from developing the skills and gaining the social interactions, experiences, and opportunities necessary to enable their participation, which is thereby further reduced (Van Naarden Braun et al., 2006). Differences between the genders in terms of the leisure activities in which they participate are well documented among children and youth with disabilities and are confirmed by the current study. Our findings indicate a greater risk of low participation, because of the interaction between gender and disability. Specifically, our findings revealed that such girls participate least in games and sports and, surprisingly, even in home activities, which girls without disabilities perform the most. Looking into personal and family factors that could explain this finding, girls may be more likely than boys to internalize their frustrations when their needs are not met and adopt passive behaviors, whereas boys may be more likely to respond with disruptive behavior that attracts their teachers’ and parents’ attention (Wehmeyer & Schwartz, 2001). In the first social circle, namely, in a family context, parents respond to the desire of girls to participate with limits, constraints, and precautions out of a concern for their safety significantly more than to boys. Parents express a desire to protect their daughters with a disability and lack specific goals for them (Powers, Hogansen, Geenen, Powers, & Gil-Kashiwabara, 2008). The social model of disability posits that disability is constructed by society and occurs when society fails to provide people with access and interventions that address their specific needs. In an analysis of transition programs Powers et al. (2005) found that girls with disabilities were more likely to receive training centered on home economics, office work, and health care, whereas their male counterparts tended to be steered into agriculture and industry. During transition programs, although girls expressed a wide variety of goals and expectations for their future, they reported a lack of opportunities, receiving less attention from their service providers, and facing greater barriers than boys (Hogansen, Powers, Geenen, GilKashiwabara, & Powers, 2008). Our findings shed further light on the risk of ‘‘triple jeopardy’’ faced by women and girls who are members of minority groups and have disabilities. The UN Convention for human rights for people with disabilities claims (UN Enable, 2012), in line with the literature, that such girls and women encounter negative attitudes and inequality because of the stereotyped expectations of their families and service providers, especially if they come from a cultural background that traditionally emphasizes gender roles (Lewis & Armstrong, 2011; Powers et al., 2008). In the long term, women with disabilities experience inequality in education, employment, health care, and rehabilitation programs, as well as more poverty and abuse, and less social inclusion. 4.1. Conclusions and limitations The current study calls for special preventive interventions to address the needs of children and youth with disabilities and specifically to empower girls. Pediatric psychologists, occupational therapists and related professionals can empower

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and advocate for this at-risk population with the aim of assisting them to overcome the gap between their goals and their actual participation, to recognize and respond to bias, and to ask for accommodations related to disability, gender, culture, or other life circumstances. The current research also sought to improve the validation of the CLASS research tool. Indeed, we found it to be suitable for use with people from diverse cultural backgrounds, reliable, and generally sensitive to differences between groups. It provided rich information and enabled a theoretical understanding regarding the phenomenon examined. At the practical level, the CLASS may be useful for identifying children at risk of restricted participation and for planning interventions suitable for their needs (based on the information of varied dimensions and factors), as well as for promoting their increased social participation in activities in which they already engage (Adolfsson, 2011). This information obtainable using the CLASS may also facilitate other recommendations to promote accessibility and remove barriers for participation (Welsh, Jarvis, Hammal & Colver, 2006), including applying the Internet and new technologies to open up new opportunities for the participation in leisure activities of people with disabilities (Kaye, 2000; Kaveri Subrahmanyam & Greenfield, 2008). A follow-up study of such an intervention—an examination of the outcomes of the ‘computer for every child’ project, forms part of the current research project and will be published later. In examining a multicultural Middle-Eastern population, the current research obtained significant results (while controlling for demographic variables as co-variants) that are consistent with the largely North American and Europeanbased literature. 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