International Journal of Inclusive Education

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A comparison of the participation levels of

Taiwanese children with autism spectrum
disorders in inclusive vs. segregated settings

Chiao-Ju Fang , S. L. Weinberg & K. Patten

To cite this article: Chiao-Ju Fang , S. L. Weinberg & K. Patten (2020): A comparison
of the participation levels of Taiwanese children with autism spectrum disorders in
inclusive vs. segregated settings, International Journal of Inclusive Education, DOI:
10.1080/13603116.2020.1777332

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INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION
https://doi.org/10.1080/13603116.2020.1777332

A comparison of the participation levels of Taiwanese children

with autism spectrum disorders in inclusive vs. segregated
settings
a b c
Chiao-Ju Fang , S. L. Weinberg and K. Patten
a
Occupational Therapy, San José State University, San Jose, CA, United States; bApplied Statistics and
Psychology, New York University, New York, NY, United States; cOccupational Therapy, New York University,
New York, NY, United States

ABSTRACT ARTICLE HISTORY

The aim of this study was to help educators and clinicians better Received 7 November 2019
identify and understand the various participation levels of Accepted 21 May 2020
Taiwanese children with autism spectrum disorders (ASDs) in two
KEYWORDS
different classroom settings. Greater participation is linked to Participation; children with
positive health, developmental outcomes and improved physical autism spectrum disorders;
and mental health. It is also considered a critical indicator of inclusive; segregated settings
quality of life. However, general limitations are identified among
the population of children with ASDs. One hundred four
Taiwanese parents/caregivers of children with ASDs having a
disability certificate with a moderate degree of severity completed
the Chinese version of the Participation and Environment Measure
for Children and Youth. Participation frequency and the extent of
involvement were outcome variables to compare Taiwanese
children with ASDs in inclusive versus segregated settings based
on the perspectives of their parents/caregivers. The children with
ASDs in inclusive settings demonstrated a greater involvement in
community activities than those in segregated settings. Also, the
findings of this study indicate that age, gender and extracurricular
activities should be taken into consideration when developing
intervention plans for improving participation levels for children
with ASDs. The knowledge gained from this study has the
potential to benefit children, parents, educators, and clinicians.

Introduction
Over the last decade, a growing number of children have been diagnosed with autism spec-
trum disorders (ASDs), disorders that often hinder full social inclusion and participation
in daily activities in different contexts, including school, home, and community (Baio et al.
2018; Dovgan and Mazurek 2019; Zingerevich and LaVesser 2009). For children with
ASDs, participation is an important indicator of quality of life (Pfeiffer et al. 2017;
World Health Organization 2001). Children with ASDs increasingly are being placed in
inclusive educational settings (Hu and Kärnä 2019; Watkins et al. 2019) despite the fact
that currently there is a lack of comprehensive knowledge regarding the participation of

CONTACT Chiao-Ju Fang [email protected] Department of Occupational Therapy, Room: HB 233, San Jose
State University, San Jose, CA 95192-0059, USA
© 2020 Informa UK Limited, trading as Taylor & Francis Group
2 C.-J. FANG ET AL.

the children with ASDs in daily activities within inclusive settings. Researchers have ques-
tioned whether children with ASDs demonstrate participation or experience isolation in
inclusive settings (Majoko 2016; Symes and Humphrey 2010). Accordingly, in some
countries, like Taiwan, for example, where children with ASDs represent the third-
largest disability group, debate persists over whether children with ASDs should be
placed in inclusive settings (Chen and Chiu 2015; Wu 2007).
Over the past 15 years, educators in Taiwan have emphasised inclusive education for
children with disabilities (Chen and Chiu 2015; Huang and Chen 2017; Wu 2007; Wu
et al. 2019), giving children with disabilities more access to general education curricula
and social interactions with their typically developing peers (Cheng 2012a; Wang 2011).
Article 11 of Taiwan Special Education Act, defines inclusive educational setting as a
place where children with disabilities receive appropriate education alongside children
without disabilities; whereas segregated setting is defined as noninclusive, with children
with disabilities being taught by a special education teacher in a class without general edu-
cation students (Ministry of Education 2019).
Although most children with ASDs in Taiwan are placed in inclusive settings, little is
known about their level of participation in such settings as compared to children in seg-
regated settings. In Western countries, research comparing inclusion versus segregated
settings for educating children with ASDs has revealed mixed results. Some studies
have reported that children with ASDs are well accepted by their peers (Falvey, Givner,
and Kimm 1995) and teachers (Robertson, Chamberlain, and Kasari 2003), but others
report that children with ASDs reported less frequent participation in school activities
(Falkmer et al. 2012), increased loneliness (Locke et al. 2010), and decreased acceptance
by peers compared to typically developing children (Rotheram-Fuller et al. 2010).
While most Taiwanese special education teachers support the concept of inclusion, they
express concerns about placing children with ASDs in general education settings.
Factors affecting the success of inclusion are known to include peer support (Carter
et al. 2015; McCurdy and Cole 2014), perceptions of school staff (Chhabra, Srivastava,
and Srivastava 2010), and parent and/or caregiver attitudes and support (Hornby 2014).
According to Wang (2011), most survey studies in Taiwan have focused on investigating
the attitudes of teachers or peers toward inclusion, current practices, challenges, and
coping strategies, while few have involved parents or caregivers of children with disabilities
as participants (Wang 2011). Therefore, this research gathered data from the parents or
caregivers of children with ASDs in both inclusive and segregated settings.
Since adoption of the definition of participation into the International Classification of
Functioning, Disability and Health for Children and Youth, an increasing number of par-
ticipation measures have been developed. Among these measures, the Participation and
Environment Measure – Children and Youth (PEM-CY) (Coster et al. 2014) is the first
instrument that combines parental assessment of children’s participation in home,
school, and community activities with the qualities of each environment that are perceived
to support or hinder participation. This combined format helps to clarify the relative
impact of environmental factors (including the natural and built environment) compared
to personal factors with regard to children’s participation in specific settings. Further, the
PEM-CY affords greater specificity in assessing environmental impact between or across
settings. The PEM-CY includes: (1) a comprehensive assessment of children’s partici-
pation across a broad range of home, school, and community-based activities; (2)
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 3

assessment of multiple dimensions of a child’s participation (frequency, involvement,

change desired); (3) assessment of a broad range of environmental factors (e.g. physical
layout; physical, social, and cognitive demands of activities; transportation, etc.) in
terms of their perceived impact on the child’s participation in a specific setting (home,
school, community); and (4) relevant content and response options for parents of
youth with and without diverse disabling conditions.
Gender, age, and the amount of time children participate in extracurricular activities are
factors associated with the participation levels of children with ASDs. Research has consist-
ently supported ASDs being more prevalent in males than females (Fombonne 2003; Worley
et al. 2011); however, research comparing participation levels of males and females has been
limited and has had inconsistent results. Thus, the effect of gender on the participation levels
of children with ASDs remains unclear. In addition, age is a critical factor related to the par-
ticipation levels of children with ASDs. Church, Alisanski, and Amanullah (2000), in a study
of 40 children with Asperger’s found that middle school children expressed sadness, anxiety,
and feelings of rejection while older teenagers experienced anxiety, obsessive-compulsive
tendencies, and behavioural challenges. Also, school-age children with ASDs appear to par-
ticipate less frequently than typically developing children in unstructured activities, social
activities, and hobbies, such as recreational and after-school activities (Hochhauser and
Engel-Yeger 2010; Reynolds et al. 2011). Parents of youth with ASDs report that their chil-
dren often have difficulty in traditional extracurricular activities and may not enjoy or
experience the same levels of success as their typically developing peers (Diener et al.
2016). However, knowledge about extracurricular activity participation levels among chil-
dren with ASDs is still very limited.

Research aim and research question

The aim of this study was to help educators and clinicians better identify and understand the
various participation levels of Taiwanese children with autism spectrum disorders (ASDs) in
inclusive versus segregated settings across different contexts (at home, at school, and in the
community). Research in this area should help interventionists better understand level of
participation and involvement of children with ASDs in daily activities across a variety of
environments, and evaluate whether programmes for such children are meeting their
needs. Accordingly, the following research question was explored in this study: After con-
trolling for gender, age, and the amount of time the children with ASDs participate in extra-
curricular activities, are there any differences in the levels of participation in inclusive versus
segregated settings across different contexts (at home, at school, and in the community)?

Methods
Participants
Parents/caregivers (n = 108) who mainly care the children with ASDs were asked to com-
plete the Chinese version of the Participation and Environment Measure – Children and
Youth (CPEM-CY) (Fang 2018), which has been culturally translated and adapted from
the original English version of the PEM-CY. After excluding cases with missing data,
the questionnaires of 104 parents/caregivers who answered at least 95% of the questions
4 C.-J. FANG ET AL.

were included in the sample for the current study. Given the nature of the analysis used,
the 104 participants yielded a power of 0.80 to detect a medium effect size, with a two-
tailed α level of 0.05. According to Table 1, the working sample of children with ASDs
is predominantly male (88.5%) in both settings. Thirty-six (34.6%) of the parents or
primary caregivers report their children with ASDs are in segregated settings, while 68
(65.4%) report their children with ASDs are in inclusive settings. The majority of the
respondents were mothers of children with ASDs (79.8%) and in the 40–49-year age
range (55.8%). The mean age of the children with ASDs is 10.56 years old in inclusive
versus 10.42 years old in segregated setting.
For inclusion in this study, a child with ASD must have received a medical diagnosis
and a disability certificate from a Taiwanese paediatrician. In Taiwan, disability certificates
of children with ASDs are divided into three levels of severity: mild, moderate and severe.
Children with mild levels of ASDs are mainly assigned to inclusive classrooms; those with
severe levels of severity are assigned to segregated settings. Only children with moderate
levels of ASDs are placed in either inclusive or segregated settings. Because of this, children
with moderate levels of ASDs operationally defined as ‘children with ASDs’, and their
parents or caregivers were asked to participate in this study.

Data collection
Institutional review board approvals for this study were obtained from the University
Committee on Activities Involving Human Subjects at New York University and partici-
pating institutions prior to data collection. The parents or primary caregivers of the chil-
dren with ASDs were recruited from regular schools, special schools, hospitals (outpatient
only), and clinics. After informed consent was obtained, each parent or primary caregiver
of a child with ASD received a package including the demographic information question-
naire and the CPEM-CY.

Instrumentation
The CPEM-CY has been cross-culturally translated and adapted from the English version
of the PEM-CY, showing adequate psychometric properties including validity and

Table 1. Demographic data of the children with ASDs in the inclusive and segregated setting and their
main caregivers (N = 104).
Inclusive Segregate Total
N % N % N %
Child’s Gender Male 62 91.2 30 83.3 92 88.5
Female 6 8.8 6 16.7 12 11.5
Child’s Age 9.0–9.9 years 21 30.9 11 30.6 32 30.8
10.0–10.9 years 16 23.5 13 36.1 29 27.9
11.0–11.9 years 31 45.6 12 33.3 43 41.3
Participant’s Role Mother 52 76.5 31 86.1 83 79.8
Father 14 20.6 4 11.1 18 17.3
Female Guardian 2 2.9 1 2.8 3 2.9
Participant’s Age 30–39 years 26 38.2 14 38.9 40 38.5
40–49 years 39 57.4 19 52.8 58 55.8
50–59 years 3 4.4 2 5.5 5 4.8
60 or above 0 0 1 2.8 1 1
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 5

reliability relative to a population of Taiwanese children with ASDs (Fang 2018). The
School Participation and School Environment sections of the CPEM-CY have been
given to teachers, who indicated excellent inter-rater reliability (Fang 2018). The instru-
ment consists of a questionnaire that can be completed by parents or caregivers who
are familiar with the children and have thus observed them frequently in different settings.
The 25-item CPEM-CY assesses a child’s participation in broad types of activities in the
home (10 items), school (5 items), and community (10 items). For each item, participants
assess three dimensions of participation: (1) frequency (8-point scale from never [0] to
daily [7]); (2) level of involvement (5-point scale from minimally involved [1] to very
involved [5]); and (3) their desire for change in the child’s participation (yes or no; if
yes, is change desired for frequency, level of involvement, and/or involvement in a
broader variety of activities of that type). However, for the purposes of this study, the
researchers only used the scores of the participation frequency and extent of involvement.
For the psychometric characteristics of the CPEM-CY, the internal consistency was
moderate to good (.64 to .86) for the participation frequency and participation involve-
ment scales (Fang 2018). Test-retest reliability of the CPEM-CY over a two-week
period was good to excellent (.60 to .86) for all participation scales across home, school,
and community settings. Inter-rater reliability of the CPEM-CY varied from moderate
to excellent (.58 to .91) for the participation scales (Fang 2018).

Data analysis
Data were analysed using IBM SPSS Statistics for Windows, Version 24.0. Univariate and
bivariate analyses were conducted prior to using multiple linear regression for addressing
the research question. The dependent variables were participation frequency and involve-
ment scores from home, school, and community as measured by the CPEM-CY. Covari-
ates to be controlled included gender, age, and the amount of time the children participate
in extracurricular activities, and the research variable of interest was the dichotomous vari-
able denoting placement (1 and 0) in an inclusive versus segregated setting. A statistically
significant coefficient of the research variable of interest would indicate a significant differ-
ence in participation levels between the two settings controlling for covariates included in
the model.

Results
Summary scores for the CPEM-CY were constructed to provide information for the
intended purpose of the instrument, following the exact guidelines of the original
English version. Table 2 contains descriptive statistics for the set of control and dependent
variables for the entire working sample. As shown in Table 2, none of the variables is par-
ticularly skewed, eliminating the need for transformation. The mean number of extracur-
ricular activity hours is 3.26 in inclusive versus 3.03 in segregated settings. Of the CPEM-
CY participation scores, the mean for home is highest (88.97 in inclusive versus 81.94 in
segregated settings), next for school (68.82 in inclusive versus 66.67 in segregated settings)
and lowest for community (57.5 in inclusive versus 52.22 in segregated settings). Of the
CPEM-CY involvement scores, the mean is highest for home (3.39 in inclusive versus
3.02 in segregated settings), next for school (3.06 in inclusive versus 2.68 in segregated
6 C.-J. FANG ET AL.

Table 2. Age, extracurricular activity hours, participation frequency and involvement of children with
ASDs in the different settings rated by CPEM-CY.
Inclusive (N = 68) Segregated (N = 36) Total (N = 104)
M SD S M SD S M SD S
Age 10.56 .94 −.24 10.42 .97 .27 10.51 .95 −.07
Extracurricular Activity Hours 3.26 4.17 1.44 3.03 2.99 .64 3.18 3.79 1.37
Home Participation Frequency 88.97 15.94 −1.49 81.94 23.03 −1.23 86.54 18.89 −1.5
School Participation Frequency 68.82 23.28 −.53 66.67 20.84 .23 68.08 23.39 −.31
Community Participation Frequency 57.5 28.41 −.05 52.22 27.89 .03 55.67 28.21 −.02
Home Participation Involvement 3.39 .69 −.07 3.02 .81 −.36 3.26 .75 −.29
School Participation Involvement 3.06 .95 .46 2.68 .81 .75 2.92 .92 .57
Community Participation Involvement 3.01 1 −.80 2.35 .91 .67 2.78 1.02 .15
Note: S = Skewness.

settings) and lowest for community (3.01 in inclusive versus 2.35 in segregated settings).
All the participation and involvement scores of the children with ASDs in inclusive set-
tings are higher than those in segregated settings.
T-tests and chi-squared tests run prior to testing the regression model yielded no sig-
nificant differences between the children based on age, gender, or amount of time children
participate in extracurricular activities. Accordingly, at least for this set of variables, the
children in the two types of classroom settings appear similar. Table 3 contains the corre-
lation matrix between all pairs of variables in the analysis, including demographic vari-
ables (age, gender, and extracurricular activity hours), the different classroom settings,
as well as the dependent variables, participation frequency and participation involvement
as measured by the CPEM-CY at home, at school, and in the community for the total
group of 104 participants. Based on the relatively low correlation values in Table 3, multi-
collinearity is not an issue for this dataset. Also, because some dependent variables are
related significantly to each other, children who participate in one setting tend to do so
in another setting as well.
Statistically significant relationships were found between dependent and independent
variables including: home participation frequency, gender, and the number of hours
spent in extracurricular activities (r = 0.25 and 0.28, p < 0.01); school participation

Table 3. Pearson correlation matrix of age, gender (female as the reference group), extracurricular
activity hours, classroom setting (segregated setting as the reference group) and the summary
scores of participation frequency and participation involvement (N = 104).
Variables 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
1. Age 0.10 −0.06 0.07 0.11 0.03 −0.003 0.21* 0.17 −0.09
2. Gender 0.06 0.12 0.25** 0.08 0.20* 0.08 −0.07 0.10
3. Extracurricular Activity Hours 0.03 0.28** 0.24* 0.08 0.02 0.01 0.06
4. Classroom Settings 0.18 0.05 0.09 0.24* 0.20* 0.31**
5. Home Participation Frequency 0.55** 0.53** 0.37** 0.04 0.26**
6. School Participation Frequency 0.53** 0.31** 0.26** 0.35**
7. Community Participation 0.08 −0.01 0.06
Frequency
8. Home Participation 0.60** 0.45**
Involvement
9. School Participation 0.46**
Involvement
10. Community Participation
Involvement
Note: *p < 0.05, **p < 0.01.
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 7

frequency and the number of hours spent in extracurricular activities (r = 0.24, p < 0.05);
community participation frequency and gender (r = 0.20, p < 0.05); home, school, and
community participation involvement and classroom setting (r = 0.24, 0.20, and 0.31; p
< 0.05); and home participation involvement and age (r = 0.21, p < 0.05). These corre-
lations suggest that the participation frequency of children with ASDs in three settings
tends to relate to their gender and the number of hours spent in extracurricular activities.
However, age and children with ASDs in the inclusive or segregated settings tend to relate
to their actual participation involvement.
As shown in Table 3, gender and extracurricular activity hours each correlate signifi-
cantly with participation frequency and age correlate significantly with the extent of invol-
vement. These bivariate results indicate that males tend to participate more at home than
females, and children with ASDs who participate in more extracurricular activities tend to
have higher participation frequency at home and at school. Also, gender is correlated sig-
nificantly with community participation frequency, with males being more likely to par-
ticipate in the community than females. Finally, the findings of this study indicate that age
is correlated significantly with home participation involvement, with older children with
ASDs being more involved at home than younger ones.
In order to examine these bivariate relationships within a multivariate framework, a
multiple linear regression analysis was conducted on each of the six dependent variables,
participation frequency and participation involvement at each of the three setting. For
each of the six multiple regressions, the control variables (age, gender, and extracurricular
activity hours) were entered first as a block and the indicator variable representing chil-
dren with ASDs in inclusive settings versus segregated settings was entered next as the
second block. In this way it could be determined whether the school type indicator variable
significantly related to the participation and involvement dependent variables over and
above the covariates entered in the first block.
As shown in Table 4, with respect to home, school, and community participation fre-
quency. after controlling for age, gender, and extracurricular activity hours, there were no
significant differences between children with ASDs in inclusive settings and segregated set-
tings (the reference group). The value of R 2 for the model predicting home participation

Table 4. Multiple linear regression analysis of the participation levels of children with ASDs in inclusive
and segregated settings as measured by the CPEM-CY (N = 104).
Control Variables Predictor
Equation Model Intercept Age Gender EAH Classrooms F R2
1 1 48.78 2.05 13.41 1.36* 5.67* 0.15
Home Participation Frequency 2 47.90 1.88 12.52 1.34* 5.46 4.86* 0.16
2 1 50.15 0.93 4.14 1.41 2.25 0.06
School Participation Frequency 2 49.92 0.89 3.91 1.41 1.40 1.70 0.06
3 1 44.31 −0.55 17.53 0.52 1.61 0.05
Community Participation Frequency 2 43.68 −0.68 16.90 0.51 3.94 1.32 0.05
4 1 1.40 0.16 0.13 0.01 1.71 0.05
Home Participation Involvement 2 1.35 0.15 0.08 0.01 0.35 2.62 0.10
5 1 2.85 0.02 −0.20 0.002 0.17 0.01
School Participation Involvement 2 2.78 0.01 −0.26 0.001 0.40 1.23 0.05
6 1 3.55 −0.10 0.34 0.01 0.73 0.02
Community Participation Involvement 2 3.61 −0.14 0.22 0.01 0.67* 3.11* 0.12
Note: *p < 0.008 after the Bonferroni adjustment applied; EAH = extracurricular activity hours; children with ASDs in special-
ized settings and females as the reference group.
8 C.-J. FANG ET AL.

frequency that includes only the covariates is 0.16, indicating that the set of covariates (age,
gender, extracurricular activity hours) explains a statistically significant 16% of the var-
iance in participation frequency as measured by the CPEM-CY. The analogous results
with respect to both the school and community participation frequency dependent vari-
ables were not statistically significant.
Also, as shown in Table 4, after controlling for age, gender, and extracurricular activity
hours, there were no significant differences between children with ASDs in inclusive set-
tings versus segregated settings with respect to the extent of involvement at home and
school, but there was with respect to the extent of involvement in the community. This
result suggests that after controlling for age, gender, and time spent in extracurricular
activities, children with ASDs in inclusive settings have 0.67 more units of community par-
ticipation involvement, on average, than those in segregated settings. The R 2 associated
with this model equals 0.12, suggesting that all variables included explain 12% of the var-
iance in community participation involvement as measured by the CPEM-CY.

Discussion
The purpose of this study was to help educators and clinicians better understand the
different participation levels of children with autism spectrum disorders in different
class settings. To the best of the researchers’ knowledge, this current study may be one
of the first investigation to examine in a more comprehensive way the participation
levels of children with ASDs in inclusive versus segregated settings across different con-
texts (at home, at school, and in the community). The findings of this study show that chil-
dren with ASDs in different classroom settings experience statistically significant
differences with regard to the extent of involvement in the community, but not with
regard to the other outcome measure variables.
After controlling for age, gender, and extracurricular activity hours, the community
participation involvement of Taiwanese children with ASDs was found to be significantly
influenced by the different classroom settings. This study revealed that children with ASDs
in inclusive educational settings demonstrated a higher extent of involvement in commu-
nity activities than those in segregated settings. This is congruent overall with the findings
of previous studies. The United Nations Children’s Fund (UNICEF) in 2014 indicated that
in many places around the globe, inclusive education indeed improves community life and
is used to encourage and achieve social participation. Haines et al. (2015) also asserted that
inclusive settings in schools, emphasising the inclusion of all students and providing all
with an excellent education, profoundly influence how typically developing students per-
ceive disability and how students with disabilities use their new knowledge in other set-
tings to increase participation in the community. In Taiwan, children with ASDs are
restricted in their activities. Many children with ASDs do not get outdoor playtime
because of parental fears of uncontrolled environments (Baxter, Cummins, and Yiolitis
2000). This study suggests that children with ASDs in inclusive settings in Taiwan have
more chances to learn, play, and participate in activities with normally developing children
and, in this way, can associate with their community participation involvement.
Unlike the extent of the involvement in community settings, no other summary scores
of participation in this study were related to the children with ASDs in inclusive settings.
Children in segregated settings typically have more severe disabilities/functional
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 9

limitations in comparison with children in general schools (inclusive settings) (Forness

et al. 2012; Ministry of Education 2020; Wei et al. 2014). This study controlled for severity,
with only the parents/guardians of children with moderate ASDs being asked to partici-
pate. This, therefore, may explain why there were no significant differences in most of
the participation patterns of children with ASDs in the inclusive versus segregated settings.
The results of this study also indicate that the gender may associated with the home and
community participation frequency. The results show that for the children with ASDs,
males are more likely to participate in activities at home and in the community than
females. Previous studies support these findings, in that boys with ASDs tend to have
higher motor skills and social competence (which relates more to the participation fre-
quency questions asked in this survey) than girls with ASDs (Carter et al. 2007;
Memari et al. 2015). In addition, the results of this study show that the age may associated
with the home involvement. The results show that for the children with ASDs, older chil-
dren are more likely to involve in more activities at home than the younger one. The
findings concurre with previous studies have found that there are age effects to the partici-
pation of children (Law et al. 2013; Rosenberg et al. 2010).
The study also found that children with ASDs who participate in more extracurricular
activities have a higher home and school participation frequency. This result is consistent
with those of Brooks et al. (2015) and Stewart, Reid, and Mangham (1997), whose studies
showed that children with disabilities who participate more in extracurricular activities
experience a decrease in behavioural and emotional difficulties. In addition, Masten and
Coatsworth (1998) found that activity participation in youth leads to decreased
numbers of school dropouts, improved engagement in school, and more effective social
relationships with peers. And per my findings, the participation in extracurricular activi-
ties of children with ASDs in Taiwan (including both non-academic [sports and perform-
ing arts] and academic activities) can help with participation levels in school settings.

Limitations
The first limitation related to methodology is the nature of convenience sampling using a
sample from specific cities in Taiwan and not randomly selected. Thus, the results may not
be representative of the entire Taiwanese population and the generalisability of the results
is limited due to the method of convenience sampling. In addition, the educational system
in Taiwan may be very different from systems in other countries. Chinese culture views
academic achievement as the most important – indeed the only – pursuit for children.
This is not the case for children in other countries (Larson and Verma 1999; Yelland,
Muspratt, and Gilbert 2017).
Furthermore, the cross-sectional study focused on children with ASDs aged nine years
to 11 years, 11 months. However, participation levels across the home, school, and com-
munity settings can be different if different age groups are studied (Coyne et al. 2014;
Dunst et al. 2002). Thus, the participation levels of children with ASDs are worth inves-
tigating using a wider age range. Finally, although this analysis controls for a number of
observed covariates (age and gender), because the individuals in this study were not ran-
domly assigned to segregated or inclusive settings, this is an observational study. The pres-
ence of unobserved variables related to self-selection that have not been controlled may
serve to make the two groups unbalanced in ways that could influence participation.
10 C.-J. FANG ET AL.

Implications
The findings of this study have several implications for occupational therapists, educa-
tors, and clinicians working with school-aged children with ASDs in inclusive and/or
segregated settings. In this study, the children with ASDs in inclusive settings demon-
strated greater involvement in community activities than those in segregated settings.
This information increases our understanding of children with ASDs within a commu-
nity context, reminding occupational therapists, educators, and clinicians that educating
children with ASDs in inclusive settings may positively affect their community partici-
pation involvement levels. Also, the findings of this study indicate that age, gender and
extracurricular activities should be taken into consideration when developing interven-
tion plans for improving participation levels for children with ASDs in inclusive and
segregated settings. As no other summary scores of participation levels at home
and at school were related to the children with ASDs in the inclusive versus segregated
settings, occupational therapists, educators, and professionals should keep in mind that
inclusive education may simply not be the way to relate to home and school partici-
pation. They also need to consider each child’s unique needs to determine which
setting is better.

Acknowledgements
We would like to express our deepest gratitude to Dr. Jim Hinojosa, who passed away in August of
2018. He was a dedicated professor in the Department of Occupational Therapy at New York Uni-
versity, with a passion for research and guiding students in the field. Dr. Hinojosa’s kind emails over
the years, containing wise suggestions and warm blessings, significantly impacted Dr. Fang’s aca-
demic life.

Disclosure statement
No potential conflict of interest was reported by the author(s).

Notes on contributors
Chiao-Ju Fang is an Assistant Professor in the Department of Occupational Therapy at San José
State University. A bilingual researcher, Dr. Fang’s primary research interest is the development
of conceptually grounded, psychometrically sound tools measuring the activities, participation
levels, and environmental supports of children and adolescents with disabilities. Over the years,
she has specialised in cross-cultural and international research, establishing strong connections
in the occupational therapy and education fields in the United States and Asia.
Sharon L. Weinberg is a Professor of Applied Statistics and Psychology, a core member of
PRIISM (Centre for Practice and Research at the Intersection of Information, Society, and Meth-
odology) and former Vice Provost for Faculty Affairs at New York University. Her research
focuses on applying innovative statistical methods to address problems in the behavioural and
social sciences. Her most recent work addresses inequities in test-taking for gifted education
in New York City.
K. Patten is an Associate Professor and Chair in the Department of Occupational Therapy at
New York University. Dr. Patten Koenig’s research focuses on strength based practices in inclusive
school settings for children and youth on the autism spectrum and supporting neurodiversity in
university settings.
 INTERNATIONAL JOURNAL OF INCLUSIVE EDUCATION 11

ORCID
Chiao-Ju Fang http://orcid.org/0000-0002-2229-2556
S. L. Weinberg http://orcid.org/0000-0002-1283-7639
K. Patten http://orcid.org/0000-0001-5881-008X

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