Caregiver Attitudes of Risky Outdoor Play for Toddlers with Developmental Delays and Disabilities in St. Louis, Missouri: A Socio-ecological Perspective

Abstract: Risky outdoor play fosters autonomy, emotional regulation, and resilience in early childhood, yet caregivers of toddlers with developmental delays and disabilities often face unique barriers to supporting such play. Limited research has examined how caregivers perceive the factors shaping these decisions, particularly in the United States context. This mixed-methods cross-sectional study explored how caregivers in the St. Louis, Missouri metropolitan area perceive the socio-ecological factors shaping their attitudes toward risky outdoor play for children aged 13 to 47 months with developmental delays or disabilities. The project sought to first explore caregivers' perceptions of how interpersonal and individual factors, shape their attitudes toward risky outdoor play for this population, and second to explore caregivers’ perceptions on how physical environment and sociopolitical factors, impact these attitudes. An online survey with structured and open-ended questions was distributed through early intervention networks and community organizations. Of 38 responses, 11 met the inclusion criteria and were analyzed using descriptive statistics and reflexive thematic analysis. Four key themes emerged: (1) valuing risky outdoor play for development, (2) balancing supervision and independence, (3) negotiating external supervision expectations and family or cultural constraints, and (4) encountering variability in community infrastructure and institutional support. The results indicated that while caregivers generally endorsed risky play, their decision-making was shaped by child-specific needs, contextual tensions, and structural inequities. The study underscores the need for inclusive, equity-focused strategies to promote developmentally appropriate outdoor play, especially for young children with disabilities in underserved urban communities. Synopsis: This doctoral presentation focuses on a cross-sectional, mixed methods, exploratory study that examined the factors impacting caregivers’ decisions about risky outdoor play opportunities for toddlers with delays and disabilities in an urban U.S. setting. Findings indicate appreciation for risky outdoor play was not disputed, but supervision and autonomy were in conflict as was negotiating external supervision expectations within family communities. Additionally, variability of community infrastructure and support impacted decisions. Acknowledgements: Special thanks to Drs. Anita Bundy and Alethea Jerebine who both served as content experts contributing to the study design and plan. Special appreciation to Katherine Kristensen for her support with interpretation of data and to her and Dr. Jerebine for their commitment to serve as editorial support toward manuscript submission.