1. Study Limitations and Future Directions See Handout for References
Environmental Impact on Young Children’s Participation in Home-Based Activities
1Erin C. Albrecht, PhD and 2Mary Khetani, ScD, OTR\L
1 Colorado State University; 2 University of Illinois at Chicago
Results
Introduction
Discussion
Young children with developmental disabilities and delays demonstrate increased difficulties with participation in activities.1-3
Prior work has modeled the effects of child, family, and environmental factors on school-aged children’s participation4-5, but less is understood about relevant correlates of young children’s participation.
A recent study found support for the hypothesis that parent perceptions about supports and barriers in their child’s environment mediate the link between child and family-level variables and children’s participation in home, school, and community contexts.6
This study was undertaken to extend prior findings to a younger target population, while accounting for child functional performance in discrete tasks as a predictor of young children’s participation.
Results may inform clinical decisions about how to focus rehabilitation services (PT, OT, SLP) involving younger populations toward improved participation at home, a primary developmental context in early childhood.
CFAs and structural equation modeling was performed using Mplus version 5.9 Model fit was evaluated using χ2, the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RMSEA).
Results demonstrate that parent perceptions of environmental support in the home mediates the link between child functional limitations and performance and children’s involvement in home-based activities.10 This model accounts for 42.5% of the variance in home involvement.
These findings partially support prior work6 that has documented perceived environmental support as a mediator between child factors and school-aged children’s participation in multiple settings.
These findings also extend prior work in that the role of perceived environmental support mediate the link between functional performance and involvement in home-based activities.
Study Limitations and Future Directions
Figure 1. Confirmatory factor analysis (CFA) of young children’s functional performance. Standardized parameter estimates are shown (all p <.01).
We could not generate a reliable model to estimate the relative effect of disability status on home involvement due to small sample size.
We could not generate a reliable model to replicate the model on frequency of participation in the home.
Participation and environment are assessed in the same YC-PEM instrument, resulting in shared method variance.
Convenience and snowball sampling resulted in homogeneity relative to income and race/ethnicity.
An NIH R03 is underway to integrate PEDI-CAT and YC-PEM in early intervention outcomes research, resulting in the potential to obtain and link large sums of functional outcomes and administrative data to strengthen model testing.
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Study Purpose
To evaluate parents’ perceptions of environmental support as a mediator of the link between child and family factors and young children’s home participation.
Method
Figure 2. CFA of young children’s home involvement. Standardized parameter estimates are shown (all p <.01).
Secondary analyses of data from a cross-sectional study involving 395 parents of young children between 0 and 5 years (M = 3 years, 1 month) in North America (June-November 2013).
Most participants were mothers (96%), living in the United States (91%), and Caucasian (89%). Nearly 25% of children sampled were receiving early intervention or special education services (N = 93).
MEASURES
VARIABLES
Demographic questionnaire
Child age, disability status, functional limitations
Parent education, family income
Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT)7
Norm scores for children’s functional performance in daily activities, social/cognitive, and mobility domains
Young Children’s Participation and Environment Measure
(YC-PEM)8 Home Section
Items from home involvement subscale were used to create a latent variable
Home environmental items were used to create a composite ‘environmental support’ score
See Handout for References
ACKNOWLEDGEMENTS
Research was supported by the National Institutes of Health under Award Number K12HD The content is solely the responsibility of the authors and do not necessarily represent the official views of the NIH. We thank Lauren Nale, MSOT, Kristen Arestad, MSOT, and Sarah Ahmed, research assistants in the Children’s Participation in Environment Research Lab (CPERL) at Colorado State University and the University of Illinois at Chicago, for their critical feedback on earlier drafts.
Fit indices showed acceptable model fit, χ2 = , p < .01; CFI = 0.91; RMSEA = 0.06, as well as a significant indirect effect for functional performance (b = .14, p = .002; 95% CI: LL=.02, UL=.28 ) and functional limitations (b = -.26, p = .001; 95% CI: LL=-.38, UL=-.14) on home involvement.