An umbrella review of barriers, facilitators, and interventions for children and youth with disabilities

Children and youth with disabilities have fewer opportunities for structured and unstructured active play than their peers without disabilities. This umbrella review explored how active play is defined and perceived among children and youth with disabilities and their adult facilitators, and identified barriers, facilitators, and interventions influencing active play among children and youth with disabilities. A total of 18 review articles were deemed eligible and synthesized guided by the Social Ecological Model (SEM). Among children and youth with disabilities, active play was defined as fun, spontaneous, and intrinsically motivated, with some seeking intense, meaningful experiences. Reviews also reported that children and youth with disabilities value active play as a means to maintain autonomy and connections but also feel excluded from peers. Adult facilitators appear to recognize the importance of active play and adapted activities to meet individual needs. This review has identified barriers and facilitators within the SEM: (i) individual: psychological factors, body function and structure, (ii) interpersonal: decision-making, social support, and socioeconomic status, (iii) organizational: adapted activity demands, program and staff availability, (iv) community: environment characteristics, activities, attitudes, and resources, and (v) public policy: policy gaps. Instructional and behavioral strategies, assistive technologies, and inclusive playground designs are identified as effective play-based interventions for children and youth with disabilities. Findings highlight the need to incorporate the perceptions and experiences of children and youth with disabilities into how active play is conceptualized and operationalized. Reframing active play in research, policy, and practice can promote equity, social inclusion, and health.