A modified ICF model based on a systems perspective depicts a holistic view that acknowledges health, functioning, life quality and development are intertwined and are essential concepts to consider in the lives of all people.

Negative peer attitudes are generally recognised as being a major barrier to full social inclusion at school for children and youth with disabilities. The present study examined the attitudes of 1,872 grade nine high school students in Ontario, Canada toward their peers with disabilities. A bioecological perspective and a structural equation modeling approach were adopted to investigate how various aspects of school culture and student interpersonal factors in¯uenced attitudes. The majority of students (61%) held attitudes toward peers with disabilities that ranged from slightly above neutral to very positive. However, a substantial number (21%) held slightly below neutral to very negative attitudes. Positive student relationships at the school level and a school goal task structure that promoted learning and understanding for all students, rather than social comparison and competition among students, were two aspects of school culture that had both direct associations with positive attitudes and indirect associations through student interpersonal factors. Teacher and student relationships at the school level was an aspect of school culture that had an indirect association with positive attitudes via interpersonal support from teachers. Results support the development of ecologically based programs aimed at promoting aspects of school culture that contribute to positive attitudes of students toward their peers with disabilities.

Little is known about predictors of change over time in the intensity of the leisure and recreational activity participation of children with physical disabilities. This study reports data from 402 children/ youth with physical disabilities (216 boys and 186 girls), ages 6 to 15, collected on three occasions over a 3-year period. Latent growth curve modeling was used to determine the significant child, family, and community predictors of change in the intensity of their participation in five types of activities (recreational, active physical, social, skill-based, and self-improvement). Differences in predictors were examined for boys versus girls, and older versus younger children. Significant predictors of change were found only for recreational and active physical activities. The findings indicate that factors associated with change in participation intensity are dependent on the type of activity, and vary as a function of children's sex and age. Implications for research and service delivery are discussed, including the importance of a contextualized, holistic, and developmental approach to intervention. Keywords participation; activity; longitudinal; leisure; recreation; children; disability The intensity of children's participation in leisure and recreational activities is associated with their well-being (Brown & Gordon, 1987;Larson & Verma, 1999). A variety of positive developmental processes and related outcomes result from participation in different types of activities, including improved school outcomes (Masten & Coatsworth, 1998) and greater social adjustment (i.e., fewer emotional and behavioral problems, reduced loneliness) (Sandler et al., 2004;Simpkins et al., 2005). There is a critical gap, however, in our knowledge of the factors that promote the participation of children with disabilities (Mancini et al., 2000). Their participation in everyday activities is a goal shared by parents, service providers, and organizations involved in children's Corresponding author: Dr. Gillian King (gking27@uwo.ca). NIH Public Access Author ManuscriptChild Health Care. Author manuscript; available in PMC 2009 November 9. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript rehabilitation . Remarkably, the factors that enable, promote, and reinforce the participation of children with physical disabilities have not been comprehensively studied.In comparison with peers without disabilities, adolescents and young adults with disabilities display less diverse participation (Margalit, 1981), greater participation in passive recreational activities (such as watching television) (Brown & Gordon, 1987), and less social participation (Stevenson et al., 1997). Furthermore, boys and girls with physical disabilities participate in different activities compared to their able-bodied peers (King et al., 2008). Little is known, however, about the influence of child, family, and environmental factors on changes over time in the intensity of children's participation in various activities, and about the...

Lack of comparability across studies remains a problem due to wide variation in study focus and designs. Conceptual and methodological issues include: use of numerous HRQOL and QOL measures, lack of distinction between conceptualization and measurement of HRQL and QOL, lack of initial qualitative input from survivors about QOL, little examination of the influence of environmental factors on QOL, little attention to survivors' satisfaction with life quality, use of small heterogeneous samples, and need for population-based longitudinal studies.

Important differences were found among children in a number of areas as a function of overall physical health status. The findings emphasize the importance of measuring activity limitations distinctly from chronic conditions and impairments, and, perhaps, of measuring impairments distinctly from chronic conditions, and of comparing children with such health problems to children without health problems in order to obtain a more accurate picture of the impact of health on children's lives. The World Health Organization's distinct definitions of health condition and disability facilitate a dimensional approach for describing child health that can serve to clarify this field of study and improve comparability of data across countries.