Children's Assessment Of Participation And Enjoyment Research Articles

Stability of leisure participation from school-age to adolescence in individuals with cerebral palsy

With increasing age, youth with disabilities are at risk for decreased participation in leisure activities, a key component for physical and mental health. This prospective study describes changes in leisure participation and leisure preferences from school-age to adolescence in children with cerebral palsy (CP). Participants were recruited at school-age (6–12 years) for a study on participation and reassessed for a second study on adolescents (12–19 years) if >12 years. Thirty-eight children (24 males) with CP who could actively participate in the completion of the Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC) comprised the sample. Average time between assessments was 5.0±1.3 years. Most children were ambulatory (32/38 Gross Motor Function Classification System I–II). In addition to the CAPE and PAC, children were evaluated using the Gross Motor Function Measure-66 and parents completed a socio-demographic questionnaire. Paired t-tests revealed a significant decline in leisure participation diversity and intensity (CAPE) for recreation (p<.0001), skill-based (p<.0001) and self-improvement (p<.05) activities, whereas social participation remained stable (p>.05). Diversity of active-physical activities increased modestly (p=.06) although intensity of participation in this activity domain decreased (p=.003). There was also a decline in enjoyment of leisure activities. Preferences for these leisure activities remained unchanged between school-age and adolescence, except for recreational activities. Gender, maternal education, family income and gross motor ability were not related to differences in CAPE/PAC scores with increasing age. Findings suggest that over time, children with CP's participation in leisure activities diminishes, which is of concern to their functioning and well-being. Parents may be more involved in early childhood in facilitating participation whereas in adolescence, youth may be faced with more environmental barriers and a greater awareness of challenges to participation. Adolescents demonstrated a persisting desire to do these activities, challenging rehabilitation specialists to prioritize strategies to promote greater participation as children transition to adolescence.

Influence of burn injury on activity participation of children.

Children with physical disabilities show limitations in the frequency of participation in activities and in the range of activities, such as play and recreation, chores, and social involvement, compared to their able-bodied peers. The Children's Assessment of Participation and Enjoyment (CAPE) is a standardized assessment which evaluates a child's participation in, enjoyment of, and preferences for formal and informal activities other than school activities. In this study, the CAPE was used to evaluate activity participation of children with burns to provide an understanding of the impact of the injury on their participation in activity. The results provided preliminary information that burn injury can affect the activity participation of children. The children in this study were found to participate more in informal domain activities than formal domain, yet enjoyment scores were higher for formal domain activities. It was found that children with burn injury do not participate in social activities as much as children with other physical limitations, but they scored highest in these for enjoyment. In addition, they participate more in activities at home than outside the home. Increased awareness of activity participation of children with burns can guide healthcare professionals toward appropriate interventions and help parents increase participation in desired activities to improve the children's positive adjustment and quality of life. Intervention needs to address all aspects of activity participation, particularly for domain, types of activities, and where they are done. These considerations add another dimension to the care required for children with burn injury.

Activity and participation in children with neurofibromatosis type 1.

We describe activity and participation in children and youth with neurofibromatosis type 1 (NF1), and compared an intervention and control group after a strengthening program using the Pediatric Outcomes Data Collection Instrument (PODCI) and the Children's Assessment of Participation and Enjoyment (CAPE). Questionnaires were filled out by parents at baseline, 12-weeks, and 1-year. The intervention group performed a strengthening program twice a week for ten weeks, followed by a 9-month independent program. Thirty-six participants (18 control, 18 intervention) between the ages of 5- and 18-years (mean 10.6 years, SD 4.6 years) were enrolled, and 34 completed the 1-year assessment. There were significant differences between formal and informal participation (p<0.0001) in baseline CAPE scores for the entire cohort. At 12 weeks, PODCI upper extremity function improved in intervention and decreased in controls (p=0.040), while happiness declined in intervention and increased in control (p=0.003). There were no significant differences between control and intervention groups in any of the CAPE or PODCI change scores from baseline to 1-year. Upper extremity function, sport and physical function, comfort/pain and happiness PODCI scores were lower than normative values. The NF1 cohort had low participation in formal active physical and skill-based activities. The companionship and location dimensions suggest participation occurs with family and other relatives in the home or a relative's home and reflects a pattern of social isolation from peers.

Recreational activities and motor skills of children in kindergarten

Background: Developmental theorists suggest that physical activity during early childhood promotes fundamental motor skill (FMS) proficiency; and that differences in FMS proficiency are largely related to children's experiences.Aim: To examine associations between participation in different types of recreation/leisure and FMS proficiency of boys and girls in their first year of school. We hypothesized that there would be positive associations between FMS proficiency and participation in organized sport, physical activities, and active physical recreation; but not for other types of recreation/leisure.Method: Participants (n = 74) were kindergarten children (Mage = 5y11 m; boys = 55%). Parents completed the diversity dimension of the Children's Assessment of Participation and Enjoyment (CAPE) survey. The CAPE measures children's participation in everyday activities outside of mandated school activities in the past four months in five types of formal and informal activities, specifically: Recreational activities, Physical activities, Social activities, Skill-Based activities, and Self-Improvement activities. Two categories of activities were also reported: Organized Sport and Active Physical Recreation. Locomotor and object control skills were assessed using the Test of Gross Motor Development-2 and static balance was assessed using a stork stand. Sex-based differences in motor skills and participation were examined using chi-squared analyses. Correlation coefficients were used to examine relationships between motor skills and CAPE sub-domains and categories. Linear regression was used to examine whether the type of activity predicted motor skill proficiency and the reverse.Results: There were no sex-based differences in locomotor skills; whereas boys' object control skill scores were significantly higher than girls, and girls' stork stand scores were higher than boys'. Although there were no sex-based differences in the more active categories of recreational pastimes; girls participated in significantly more formal and informal dance and the prevalence of participation in team sports was significantly higher for boys. For boys, participation in physical activities predicted both locomotor and object control skill scores, organized sport predicted object control skills, and active recreation predicted stork stand times and object control skill scores. These relationships were not evident among the girls.Conclusions: These findings illustrate that young children participate in a narrower array of physically active recreational pursuits compared with less active pursuits. There were notable sex-based differences in the relationships between participation and motor skill proficiency. For girls, none of the associations between recreational pastimes and motor skill proficiency were significant. This suggests that the motor proficiency of girls, as assessed in this study, is neither a precursor to, nor an outcome of, participation in active recreational pastimes. Contrastingly, the findings for boys support theory that suggests that physical activity is driving the acquisition of particular types of motor skills. Less active recreational activities were not associated with motor skill levels of boys, whereas each of the more active categories of recreational pastimes (active recreation, physical activities, and organized sport) predicted at least one sub-type of motor skill. It also seems clear from our findings that more light needs to be shed on how to optimally portray young girls' motor skill proficiency; as well as the relationships between their participation and motor skills.

A100: Predictors of Involvement in Leisure Activities Among Children and Youth With Juvenile Idiopathic Arthritis

Background/Purpose:Children with juvenile idiopathic arthritis may be less involved in leisure activities compared to their healthy peers in part due to disease related factors such as pain, joint stiffness and tenderness. The main purpose of our study was to describe involvement in leisure activities, as well as to identify potential socio‐demographic, disease‐related, personal and environmental determinants.Methods:Ninety three children and youth aged 8 to 18 years diagnosed with juvenile idiopathic arthritis (JIA) and their families participated in this cross‐sectional study. Children and youth were administered the Children's Assessment of Participation and Enjoyment (CAPE), which measures involvement in leisure activities (recreation, physical, social, skill‐based, self‐improvement). The disease characteristics were abstracted from the child's medical file (JIA sub‐type, active joint count, age of diagnosis), pain perception, functional status, motivation, self‐perception and perceived social support were obtained through self‐report. Parents completed questionnaires on socio‐demographic data, as well as on family function and environmental barriers. Multiple linear regression was used for data analysis.Results:The leisure activities completed by most participants (&gt;90%) were playing computer/video games, watching television, hanging out with friends and doing homework. Least popular activities were (h10%) martial arts, gymnastics and horseback riding. The level of enjoyment was highest for social activities (mean: 4.2+0.5). Involvement in active physical activities was negatively associated with the presence of active disease (β = −0.385, p = 0.028). However a higher level of perceived athletic competence was associated with greater intensity in active physical activities (β = 0.261, p = 0.037). Higher environmental barrier scores were negatively associated with involvement in social (β = −0.222, p = 0.023) leisure activities.Conclusion:Disease activity may dissuade children and youth from participating in more active pursuits, which places them at greater risk for adopting sedentary lifestyles. There is evidence that contextual factors (personal and environmental) influence leisure participation. The identification of determinants of leisure activities in children and youth with arthritis may allow healthcare professionals to assess children's health needs with more precision and promote a healthier lifestyle.

Comparing participation in out of school activities between children with visual impairments, children with hearing impairments and typical peers

Hearing or visual impairments may negatively affect child's development and participation. Yet the literature about participation of children with hearing or visual impairments is insufficient. The present study aimed to compare participation patterns of children with visual impairments to those of children with hearing impairments and to typical peers and to examine the correlations between participation and socio-demographic parameters in each group. Participants were 70 children between the ages of 6-11: 25 with hearing impairments, 20 with visual impairments and 25 typical peers. All children filled the Children's Assessment of Participation and Enjoyment (CAPE). This self-report refers to participation in daily out of school activities. Children with hearing or visual impairments showed significant limited participation compared to typical peers, expressed in lower number of activities, lower participation intensity; more activities performed at home and with someone else. The limited participation was more emphasized among children with visual impairments. Socio-demographic variables (age, mother's education and socio-economic level) correlated with participation dimensions in both study groups. In conclusion, children with hearing or visual impairments may have restricted participation in out of school activities. Socio-demographic parameters may play a role in encouraging child's participation. Participation among these populations should be further studied in order to assist service providers to create intervention programs together with the child, for enhancing his/her inclusion in the community.

The influence of participation in leisure activities on quality of life in Spanish children and adolescents with Cerebral Palsy

Participation is an important modifiable quality of life (QOL) determinant and a key outcome measure. The aim of this study was to confirm if participation in leisure activities affects the QOL domains in children and adolescents with Cerebral Palsy (CP) in Spain. A total of 206 children and adolescents with CP (and their parents), 115 boys and 91 girls, mean age of 11.96 years (SD=3.00; range 8-18 years) participated in the study. Distribution according to the Gross Motor Function Classification System (GMFCS) was 24.3% Level I, 18% Level II, 18% Level III, 12.6% Level IV, and 27.2% Level V. Participation in leisure activities was assessed using the Spanish version of Children's Assessment of Participation and Enjoyment (CAPE) and QOL using the KIDSCREEN parents' version. Diversity, intensity and enjoyment of participation explained the levels of QOL in the Physical well-being, Psychological well-being, Autonomy, Parent relation & home life and Social support & peers domains, independently of gender, age and level of impairment (motor and intellectual). We also found that intensity and enjoyment of participation in informal activities had more influence on the different QOL domains. The most influenced domain by the enjoyment of participation in all domains and types of CAPE activities was Psychological well-being. The participation in leisure activities had a positive effect on the QOL of the Spanish children and adolescents with CP.

Geographical patterns in the recreation and leisure participation of children and youth with cerebral palsy: A CAPE international collaborative network study

Purpose: To examine geographical variation in the leisure participation of children/youth with cerebral palsy (CP), using Children's Assessment of Participation and Enjoyment (CAPE) data from Australia, Canada (Ontario and Quebec) and the US.Method: Data from 1076 children/youth ages 6–20 years with CP were included. Analyses examined CAPE diversity scores in activity types as a function of region, age group and Gross Motor Function Classification System (GMFCS) group, controlling for family income, education and child gender.Results: There were only two substantial geographical differences: children/youth from the US took part in the fewest active physical activities; those from Ontario took part in the most self-improvement activities. The youngest age group took part in the most recreational activities, and those in GMFCS level IV/V had the lowest levels of participation in recreational, active physical and self-improvement activities, confirming previous findings.Conclusions: There were more similarities than differences in participation patterns for the three countries.

Picture me playing—A portrait of participation and enjoyment of leisure activities in adolescents with cerebral palsy

In recent years attention has been paid to the participation levels of children and youth with Cerebral Palsy (CP), particularly the extent to which they have the opportunity to be involved in and enjoy leisure activities. The objective of this study is to describe the level of participation and enjoyment in leisure activities among adolescents with CP and to identify potential differences in participation patterns related to sociodemographic attributes. A cross-sectional design was used. Participants were 175 adolescents 12-20 years old (M=15.3; ±2.2), GMFCS I=55/II=43/III=13/IV=18/V=39 who completed the Children's Assessment of Participation and Enjoyment (CAPE). The types of activities participants engaged in most frequently were social and recreational activities, whereas self-improvement and skill-based activities were least frequent. Social activities were the activities they enjoyed most. In general, participation decreases, as youth grow older. Girls engaged in more self-improvement activities than boys. Adolescents who study in special segregated schools experienced a lower diversity and intensity of engagement in all leisure activity domains. Adolescents who were not ambulatory and those presenting with more severe manual ability limitations participated less in all activity types except skill-based activities. Adolescents with CP place a high value on the ability to engage in activities of their own choosing and on interacting with friends. Engagement in a variety of leisure activities is important for a healthy development. Understanding the leisure patterns and preferences of this population, in addition to the contextual factors, may help in the elaboration of interventions and programs to promote a healthy development for this population.

Cross‐cultural validation of the Children's Assessment of Participation and Enjoyment (CAPE) in Spain

Despite growing interest in the topic of participation, the construct has not yet been assessed in children and adolescents with and without cerebral palsy (CP) in Spain. As there are no available instruments to measure participation in leisure activities which have been adapted in this country, the goal of this study was to validate a Spanish version of the Children's Assessment of Participation and Enjoyment (CAPE). The sample comprised 199 children and adolescents with CP and 199 without CP, between 8 and 18 years of age, from seven regions in Spain. The adaptation of the original version of CAPE was carried out through translation and backward translation, and the validity of the instrument was analysed. Construct validity was assessed through the correlation of the diverse CAPE domains and the quality of life domains (KIDSCREEN questionnaire). Discriminant validity was established by comparing children and adolescents with CP and typically developing children and adolescents. For test-retest reliability, the children and adolescents with and without CP completed the CAPE questionnaire twice within 4 weeks. The correlations found between the CAPE domains and the quality of life domains show that the CAPE presents construct validity. The CAPE discriminated children and adolescents with CP from those without any disability in the results of participation. According to most CAPE domains, typically developing children and adolescents engage in a greater number of activities than children and adolescents with CP. Test-retest reliability for the Spanish version of CAPE was adequate. The study provides a valid instrument to assess the participation of children and adolescents with and without CP who live in Spain.

Reliability of the Norwegian Version of the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC)

ABSTRACTThis study examined test–retest reliability of the Norwegian version of Children's Assessment of Participation and Enjoyment (CAPE), and Preferences for Activities of Children (PAC) in children with and without disabilities. Totally 141 children, 107 typically developing, mean age 11.1, and 34 with disabilities, mean age 14.2 years participated. A cross-sectional, test–retest design was applied. The participants completed CAPE and PAC twice within mean 19 days. Reliability was examined by Chronbach's alpha, intraclass correlation coefficients (ICC), and Kappa statistics. The alpha values for internal consistency varied between 0.53 and 0.87 for the CAPE and between 0.75 and 0.93 for the PAC. ICC coefficients varied from 0.49 to 0.83 for the CAPE and 0.50 to 0.85 for the PAC. Kappa coefficients varied from 0.30 to 0.66. The Norwegian CAPE and PAC demonstrated sufficient measurement properties of internal consistency and test–retest reliability. The reliability of the CAPE, however, was not entirely satisfactory.

Patterns and predictors of participation in leisure activities outside of school in children and adolescents with Cerebral Palsy

This study analyzed the patterns and predictors of participation in leisure activities outside of school of Spanish children and adolescents with Cerebral Palsy (CP). Children and adolescents with CP (n = 199; 113 males and 86 females) participated in this cross-sectional study. Their mean age was 12.11 years (SD = 3.02; range 8-18 years), and they were evaluated using the Spanish version of the Children's Assessment of Participation and Enjoyment (CAPE). Means, standard deviations and percentages were used to characterize the profile of participation, and linear regression analyses were employed to assess associations between the variables (child, family and environmental factors) and the diversity, intensity and enjoyment of participation. Children and adolescents with CP reported low diversity and intensity of participation and high levels of enjoyment. Participation in leisure activities outside of school was determined more by child and environmental factors than by family ones.

Coping and Participation in Youth With Spinal Cord Injury

Coping and participation are important adjustment outcomes of youth with spinal cord injury (SCI). Research addressing how these outcomes are related is limited. This cross-sectional study examined relationships between coping and participation in youth with SCI. Youth ages 7 to 18 years were recruited from 3 hospitals specializing in rehabilitation of youth with SCI. The Kidcope assessed coping strategies, and the Children's Assessment of Participation and Enjoyment (CAPE) examined participation patterns. Point biserial and Pearson correlations assessed relationships among variables, and hierarchical multiple regression analyses examined whether coping significantly contributed to participation above and beyond significant demographic and injury-related factors. The sample included 294 participants: 45% female, 65% Caucasian, 67% with paraplegia. Mean age was 13.71 years (SD = 3.46), and mean duration of injury was 5.39 years (SD = 4.49). Results indicated that higher levels of social support and lower levels of self-criticism predicted higher participation in informal activities, lower levels of social withdrawal predicted participation in informal activities with a greater diversity of individuals, lower levels of blaming others predicted higher enjoyment of informal activities, and higher levels of cognitive restructuring predicted participation in formal activities with a greater diversity of individuals and in settings further from home. Results suggest higher levels of social support and cognitive restructuring and lower levels of self-criticism, social withdrawal, and blaming others predicted favorable participation outcomes. Interventions for youth with SCI that encourage higher levels of positive coping strategies and lower levels of negative and avoidant strategies may promote positive participation outcomes.

Gaming supports youth with acquired brain injury? A pilot study

Aim: To explore the effects of usage of the Nintendo Wii on physical, cognitive and social functioning in patients with acquired brain injury (ABI).Methods: This multi-centre, observational proof-of-concept study included children, adolescents and young adults with ABI aged 6–29 years. A standardized, yet individually tailored 12-week intervention with the Nintendo Wii was delivered by trained instructors. The treatment goals were set on an individual basis and included targets regarding physical, mental and/or social functioning. Outcome assessments were done at baseline and after 12 weeks and included: the average number of minutes per week of recreational physical activity; the CAPE (Children's Assessment of Participation and Enjoyment); the ANT (Amsterdam Neuropsychological Tasks); the achievement of individual treatment goals (Goal Attainment Scaling); and quality-of-life (PedsQL; Pediatric Quality of Life Inventory). Statistical analyses included paired t-tests or Wilcoxon-Signed-Rank tests.Results: Fifty patients were included (31 boys and 19 girls; mean age 17.1 years (SD = 4.4)), of whom 45 (90%) completed the study. Significant changes of the amount of physical activity, speed of information processing, attention, response inhibition and visual-motor coordination (p < 0.05) were seen after 12 weeks, whereas there were no differences in CAPE or PedsQL scores. Two-thirds of the patients reported an improvement of the main treatment goal.Conclusion: This study supports the potential benefits of gaming in children and youth with ABI.

Participation patterns of children with acquired brain injury

Objective: To describe the participation patterns of children and youth with Acquired Brain Injury (ABI) and to compare these patterns with typically-developing peers.Methods: One hundred and thirty-five children with ABI completed the Children Assessment of Participation and Enjoyment (CAPE) to measure their participation diversity and intensity in outside-of-school activities (i.e. recreational, physical, social, self-improvement and skill-based activities). Results were compared to 354 typically-developing peers. ANOVA analyses were performed while controlling for age and gender.Results: Similar to typically-developing children, individuals with ABI proportionally participated mostly in social and recreational activities and were less likely to engage in skill-based activities. However, level of intensity and diversity within each activity type was different between the two groups. Children with ABI participated in fewer activities and were less frequently involved in all the CAPE's activity types except for intensity in social activities. These differences, characterized by small-to-medium effect sizes, were not dependent on the child's age and gender.Conclusions: Participation of children with ABI is restricted in comparison to their typically-developing peers even in a sample where minor injury is predominant. Future studies might address additional factors that potentially affect participation, e.g. child's preferences and family function.

Participation patterns of school-aged children with and without DCD

Participation is recognized as a key to one's health and well-being and is considered to be a vital part of the development of children and youth. The purpose of this study was to examine the participation patterns of children with and without Developmental Coordination Disorder (DCD) in their out-of-school-time (OST) activities, and to see whether there is a relationship between the children's motor abilities and their choices and participation. Methods: 50 children (5–7 years old), 25 who met diagnostic criteria of DCD and 25 without DCD, completed the Children Assessment of Participation and Enjoyment (CAPE) and were administered the Motor Assessment Battery for Children (MABC) and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI). Results: A relationship was found between participation patterns and motor ability. Children with DCD had limited participation diversity in which they participated less frequently, and chose activities that were quieter and more socially isolated compared to children without DCD; there were no differences in their levels of enjoyment. Conclusions: The present study emphasizes the importance of looking at the children's participation from a broad perspective, and the many difficulties children with DCD experience in OST participation. Future studies might consider other factors (e.g., environment) while examining participation among children with DCD.

Participation in leisure activities among boys with attention deficit hyperactivity disorder

ADHD is a neural developmental disorder expressed in various life settings. Yet, previous studies have focused mainly on children's function in school and academic achievement. The purpose of the present study was, therefore, to examine participation patterns in outside formal school activities among boys with ADHD compared to typical boys. Participants included 25 boys aged 8–11 years with ADHD and 25 age-matched typical boys. All participants completed the Children's Assessment of Participation and Enjoyment (CAPE). Several aspects of participation were examined: diversity, intensity, enjoyment, place, and partners in 49 extra curricular activities. The findings indicate that boys with ADHD reported significant lower intensity rates of participation in most activity domains. Furthermore, boys with ADHD also reported higher diversity scores and lower enjoyment in ‘formal’ activities. Yet, no significant differences were found with regard to activity place and partners. These findings enhance the importance of providing therapy that refers to after school activities. Accordingly, CAPE can be useful for assessing boys with ADHD and planning appropriate intervention programs.

Childhood Participation in After-School Activities: What is to be Expected?

Participation is recognised as a key to health and wellbeing and is considered to be a vital part of the development of children and youth. The purpose of this study was to examine the participation patterns of children and adolescents in their time outside formal school. More specifically, the influence of age and gender on after-school participation patterns was explored. Method: Three hundred and thirty-two children and adolescents (5 to 18 years old) were divided into five age groups and completed the Children's Assessment of Participation and Enjoyment (CAPE). To test the interaction effect of gender and age on participation measures, ANOVAs were conducted. Results: The results indicated differences with moderate to high effect size in participation patterns across age, where a decline in participation was detected as children made the transition to adolescence. Differences with negligible effect size in participation were found between boys and girls in some of the activity types. No interaction effect between age and gender was observed. Conclusion: Participation patterns change with age, particularly as children make the transition to adolescence; however, this change does not depend on gender. Intervention strategies might take into account these inherent changes. Future studies might consider additional factors (for example, environment) while examining participation throughout age.

Sensory processing abilities and their relation to participation in leisure activities among children with high-functioning autism spectrum disorder (HFASD)

Children with autism may have atypical sensory processing abilities, which are known to impact child's performance and participation. However, lack of information exists regarding the expression of these abilities in specific groups on the spectrum, as children with high-functioning autism spectrum disorder (HFASD). This study aimed to characterize the sensory processing abilities of children with HFASD and examine their relationship to participation in leisure activities. Participants were 50 children aged 6–11 years: 25 children with HFASD and 25 with typical development. Sensory processing abilities were examined by the short sensory profile (SSP). Participation was assessed by the children's assessment of participation and enjoyment (CAPE). Children with HFASD had atypical sensory processing abilities. They also had lower participation in leisure activities expressed in limited range of activities, performed less often, mainly alone and at home. Their atypical sensory processing patterns were correlated with lower participation, specifically in social, physical and informal activities. In conclusion, children with HFASD may have atypical sensory processing abilities and restricted participation. Intervention should refer to each of these parameters and to the relationship between them in order to enable optimal inclusion of children with HFASD in society.

Social and Community Participation of Children and Youth With Cerebral Palsy Is Associated With Age and Gross Motor Function Classification

Through social and community participation, children and youth with cerebral palsy (CP) form friendships, gain knowledge, learn skills, express creativity, and determine meaning and purpose in life. The purposes of this study were: (1) to determine whether social and community participation of children and youth with CP differ based on age, sex, and gross motor function, and (2) to identify the types of activities in which social and community participation are highest. A prospective cross-sectional analytic design was used. The participants were a sample of convenience of 291 children (6-12 years of age) and 209 youth (13-21 years of age) with CP (55.4% males, 44.6% females) receiving services from 7 children's hospitals. Participants completed the Children's Assessment of Participation and Enjoyment (CAPE) by structured interview. Gross Motor Function Classification System (GMFCS) level was determined by the researchers. Youth did a higher percentage of activities with friends and others and outside the home than children. Children and youth in level I did a higher percentage of activities with friends and others compared with children and youth in levels II and III and in levels IV and V. Children and youth in level I and in levels IV and V did a higher percentage of activities outside the home than children and youth in levels II and III. Differences were not found between females and males. The percentage of activities done with friends and others and outside the home was highest for physical and skill-based activities. Findings cannot be attributed only to GMFCS level. The ability to walk without restrictions is desirable for social and community participation. For children and youth with CP who have limitations in mobility, physical therapists have roles as consultants for accessibility, activity accommodations, and assistive technology and as advocates for inclusive environments.