title: Participation of Children with Disabilities in Taiwan: The Gap between Independence and Frequency.
abstract: BACKGROUND
  Independence and frequency are two distinct dimensions of participation in daily life. The gap between independence and frequency may reflect the role of the environment on participation, but this distinction has not been fully explored.
  
  
  METHODS
  A total of 18,119 parents or primary caregivers of children with disabilities aged 6.0-17.9 years were interviewed in a cross-sectional nationwide survey with the Functioning Scale of the Disability Evaluation System - Child version (FUNDES-Child). A section consisting of 20 items measured the children's daily participation in 4 environmental settings: home, neighborhood/community, school, and home/community. Higher independence and frequency restriction scores indicated greater limitation of participation in daily activities. Scores for independence, frequency and independence-frequency gaps were examined across ages along with trend analysis. ANOVA was used to compare the gaps across settings and diagnoses for children with mild levels of severity of impairment.
  
  
  RESULTS
  A negative independence-frequency gap (restriction of frequency was greater than that of independence) was found for children with mild to severe levels of impairment. A positive gap (restriction of independence was greater than that of frequency) was found for children with profound levels of severity. The gaps became wider with age in most settings of children with mild impairment and different diagnoses. Widest negative gaps were found for the neighborhood/community settings than for the other three settings for children with mild to severe impairment.
  
  
  CONCLUSIONS
  Children's participation and independence-frequency gaps depend not only on the severity of their impairments or diagnoses, but also on their age, the setting and the support provided by their environment. In Taiwan, more frequency restrictions than ability restrictions were found for children with mild to moderate severity, especially in the neighborhood/community setting, and increased with age. Further identification of environmental opportunities that positively impact frequency of participation is needed.
authors.affiliation: Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Ai-Wen
authors.initials: AW
authors.lastname: Hwang
authors.affiliation: Department of Public Health, Tzu Chi University, Hualien, Taiwan.
authors.forename: Chia-Feng
authors.initials: CF
authors.lastname: Yen
authors.affiliation: Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Tsan-Hon
authors.initials: TH
authors.lastname: Liou
authors.affiliation: School Psychology Program, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; School of Education and Communication, Jönköping University, Jönköping, Sweden.
authors.forename: Rune J
authors.initials: RJ
authors.lastname: Simeonsson
authors.affiliation: School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Wen-Chou
authors.initials: WC
authors.lastname: Chi
authors.affiliation: Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon, United States of America.
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Lollar
authors.affiliation: The School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Hua-Fang
authors.initials: HF
authors.lastname: Liao
authors.affiliation: Graduate Institute of Early Intervention, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
authors.forename: Lin-Ju
authors.initials: LJ
authors.lastname: Kang
authors.affiliation: Graduate Institute of Rehabilitation Counseling, National Taiwan Normal University, Taipei, Taiwan.
authors.forename: Ting-Fang
authors.initials: TF
authors.lastname: Wu
authors.affiliation: Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Sue-Wen
authors.initials: SW
authors.lastname: Teng
authors.affiliation: Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
authors.forename: Wen-Ta
authors.initials: WT
authors.lastname: Chiu
mesh_terms: D000293:Adolescent; D017028:Caregivers; D002648:Child; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012042:Registries; D011795:Surveys and Questionnaires; D013624:Taiwan