Development and initial validation of the Environmental RestrictionQuestionnaire (ERQ)

Limor Rosenberg a,*, Nava Z. Ratzon a,1, Tal Jarus b,2, Orit Bart a,3

a Department of Occupational Therapy, School of Health Professions, Sackler Faculty of medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 69978, Israelb Department of Occupational Science and Occupational Therapy, CanDo Research Center, Faculty of Medicine, University of British Columbia, Vancouver, Canada

1. Introduction

One of the main contributions of the International Classification of Functioning, Disability and Health is its integrativeapproach to health conditions (WHO, 2001). According to this prevailing model environmental factors are determinants of achild’s participation as well as his personal factors. Environmental factors, which are the external factors that influenceparticipation, either as a barrier or a facilitator, include the physical, social and attitudinal environment in which people liveand conduct their live (Whiteneck et al., 2004).

Understanding the impact of the environment on a child’s function, and analyzing the interaction between the child’spersonal and environmental factors is recently a new challenge for researchers and clinicians who are studying theparticipation of children with disabilities (Mihaylov, Jarvis, Colver, & Beresford, 2004; Rosenbaum, 2007). The impact ofvarious human and physical environmental factors on a child’s outcomes (such as development, intelligence, behavior or

Research in Developmental Disabilities 31 (2010) 1323–1331

A R T I C L E I N F O

Article history:

Received 28 June 2010

Accepted 8 July 2010

Keywords:

Environmental restriction measurement

Parent’s questionnaire

A B S T R A C T

The purpose of this manuscript was to develop and test the psychometric properties of the

Environmental Restriction Questionnaire (ERQ) a parent-reported questionnaire for

measuring perceived environmental restrictions for young children participation.

Reliability and homogeneity were tested by Cronbach’s alpha and inter-item correlations.

Construct validity was computed by factor analysis and known group differences analysis.

Convergent and divergent validities were calculated by correlation with the Children

Participation Questionnaire (CPQ). Participants were 290 children and their parent.

Seventy-five children who were referred to occupational therapy evaluation as

consequence of moderate developmental disabilities and 215 children without any

disability (mean age� standard deviation for total sample, 5 y, 3 mo� .65 y; range, 3 y, 11 mo

to 6 y, 10 mo). The ERQ has good internal reliability. Cronbach’s alpha for the ERQ measures

ranged between .75 and .91, indicating adequate homogeneity. Factor analysis yielded three

factors that explained almost 48% of the total variance. Significant differences were found

between known groups. Convergent and divergent validity were supported by various

correlations with the Children Participation Questionnaire (CPQ). The ERQ has demonstrated

good psychometric properties and can be used as a reliable and valid measure to assess

perceived environmental restriction at the age of 4–6 y.

� 2010 Elsevier Ltd. All rights reserved.

* Corresponding author. Tel.: +972 3 6409104; fax: +972 3 640 9933.

E-mail addresses: Limbo@bezeqint.net (L. Rosenberg), navah@post.tau.ac.il (N.Z. Ratzon), tal.jarus@ubc.ca (T. Jarus), oritbert@post.tau.ac.il (O. Bart).1 Tel.: +972 3 6405334; fax: +972 3 640 9933.2 Tel.: +1 604 827 3392; fax: +1 604 822 7624.3 Tel.: +972 3 6409104; fax: +972 3 640 9933.

Contents lists available at ScienceDirect

Research in Developmental Disabilities

0891-4222/$ – see front matter � 2010 Elsevier Ltd. All rights reserved.

doi:10.1016/j.ridd.2010.07.009

school achievements) of children without disabilities is well studied and documented by various disciplines (Brody & Flor,1998; Brooks Gunn, Duncan, Klebanov, & Sealand, 1993; Linver, Brook Gunn, & Kohen, 2002; Peisner Feinberg et al., 2001). Yet,the studies concerning how environment affects participation of children with and without developmental disabilities arerelatively sparse, and mostly focused on children with severe disabilities; e.g. Cerebral Palsy (Erikson, 2005; Fauconnier et al.,2009; Hammal, Jarvis, Colver, 2004; King et al., 2006; Law, Petrenchik, King, & Hurley, 2007; McManus et al., 2006). For childrenwith severe developmental disabilities it was found that environmental restrictions increased with age (Law et al., 2007), hadindirect but significant impact on participation’s intensity in formal and informal activities (King et al., 2006), were varied inrelation to place of living (Hammal et al., 2004; Fauconnier et al., 2009), and probably best related to participation whenassessed by own perceptions of the children and their parents (Erikson, 2005; McManus et al., 2006). Yet, we could not find anystudy that assesses the impact of environmental factors on children with moderate developmental disabilities.

Moreover, the foregoing studies either used non-standardized assessment tools (Erikson, 2005; Fauconnier et al., 2009;Hammal et al., 2004; McManus et al., 2006) or explored the environmental factors affecting child participation by using anevaluation tool which originally was constructed for adult populations (King et al., 2006; Law et al., 2007), i.e. the CraigHospital Inventory of Environmental Factors, CHIEF (Whiteneck et al., 2004). To the best of our knowledge there are only twocommon tools to assess environment for young children, i.e. the Home Observation for Measurement of the Environment,HOME (Bradley, Corwyn, Pipes McAdoo, & Coll, 2001) and the European Child Environment Questionnaire, ECEQ (Forsyth,Colver, Alvanides, Wooly, & Lowe, 2007). Even though the HOME is well established it is focused only on environmentalaspects at the child’s home. The ECEQ, has been described in a number of papers, but has not yet been formally published andmoreover was developed in order to assess environmental aspects for children with severe disabilities. Therefore, theobjective of our study was to develop and test the psychometric properties of a parent-reported questionnaire, theEnvironmental Restriction Questionnaire – ERQ; measuring perceived environmental restrictions for participation oftypically developed young children aged 4–6 y and their peers with moderate developmental disabilities.

In light of the ICF model and previous findings that demonstrated how environmental factors affected the participation ofchildren, we hypothesized that the ERQ will be internally reliable and valid. We also hypothesized that the ERQ will be able todifferentiate between groups of children with diverse levels of participation, and between children from families withdifferent income levels. Finally, we hypothesized that construct validity will be supported by factor analysis, morespecifically we searched for a three factor solution according to our assumption that a child is participating in three mainenvironments, at home, at the educational setting and in the community (Chen & Cohn, 2003). Based on an ecologicalapproach to child occupation development (Case-Smith, 2005), we assume that participation of children at this young age isinfluenced mostly by factors within their immediate environment. Therefore, in order to support convergent and divergentvalidity we predicted higher correlations between child participation and environmental restrictions at home and at theeducational setting than the correlations between child participation and restrictions in accessibility to facilities in theircommunity; which is a more remote environment.

1.1. Construction of the questionnaire

1.1.1. Development of the Environmental Restriction Questionnaire (ERQ)

The ERQ was developed as part of a larger study aimed to assess participation of preschool children with and withoutmoderate developmental disabilities. ERQ description: the ERQ is a parent-completed questionnaire for children aged 4–6,intended to measure the parental perception of environmental factors as restrictions to their children’s participation in dailyactivities. The ERQ consists of 35 items that cover a wide range of physical and human environmental factors at home, in theeducational setting, and in the community. Parents are requested to rate the extent to which, in their opinion, each itemrestricts their child’s participation. Each item was scored on a 1–6 Likert scale, where higher scores indicate higherparticipation restriction (see Appendix A). Parents can also mark the ‘‘Irrelevant’’ column if they perceived any item as non-relevant to their child participation. For example families which had no TV, may consider item 29 ‘‘Habits of TV watching inthe family’’ as a non-relevant item. All Irrelevant items were excluded from further analyses.

1.1.2. ERQ content validity

In the first phase of the ERQ construction, we studied the relevant literature (Bradley et al., 2001; Evans, 2005; Maxwell,2007; Mihaylov et al., 2004; Saelens, Sallis, Black, & Chen, 2003; Teel, Dunn, Jackson, & Duncan, 1997; Whiteneck et al., 2004),and identified 50 factors having a potential influence on child’s participation. In the second phase content and face validitieswere established by 15 occupational therapist experts in developmental pediatrics. They were asked to rate on a 1–6 Likert scaleto what extent, in their perception, each item can influence a child’s participation in his/her daily life activities. A mean score foreach item was calculated and items that their mean score was less than 3.5 were excluded. The ERQ final version consists of 35items that covered a wide range of physical and human environmental factors at home, at the educational setting, andaccessibility to facilities in the community. In the third phase of the ERQ construction five parents of typically developedchildren and five parents of children with moderate developmental disabilities were asked to complete the ERQ. Theircomments helped the research team to clarify and revise the ERQ instructions. Following those steps, a final version wasdesigned (see Appendix A). Four environmental restriction measures are yielded from the questionnaire: ERQ-total is based onthe mean total of all the items (excluding irrelevant items), and three more sub ERQ-factors; Home, Education, and Communitysettings.

L. Rosenberg et al. / Research in Developmental Disabilities 31 (2010) 1323–13311324

2. Methods

2.1. Participants

Two hundred and ninety parents (Table 1) were recruited through a convenience sampling method, and wereasked to complete the ERQ and the Children Participation Questionnaire – CPQ. Two hundred and fifteen parents ofchildren without developmental disabilities (84 girls, 131 boys, mean age 5 y, 3 mo� .66 y) participated in the study.In addition, seventy-five parents whose children are being treated in seven pediatric occupational therapy clinics incentral and northern Israel were recruited. To be included in this group (moderate developmental disabilities group),their children had to attend regular preschool and had to be referred to occupational therapy evaluation, due todevelopmental disability including but not limited to Developmental Coordination Disorder, Attention Deficit Disorder,Sensory Modulation Disorder or Learning Disabilities (15 girls, 60 boys, mean age 5 y, 2 mo� .53 y). There were no statisticaldifferences between the two groups in relation to age of children or parents, family income, and living setting (urban orrural).

2.2. Measurements

Children Participation Questionnaire (CPQ; Rosenberg, Jarus, & Bart, in press). The CPQ is a parent-completedquestionnaire for children aged 4–6 y old. It is designed to measure a child’s participation patterns in six areas ofoccupations: Activities of Daily Living (ADL; e.g. dressing), Instrumental Activities of Daily Living (IADL; e.g. setting thetable), Play (e.g. imaginative play, computer games), Leisure (e.g. bicycle riding, listening to story), Social Participation(e.g. visiting a friend), and Education (e.g. drawing and grapho-motor exercises in preschool). Five participationmeasures are yielded from the questionnaire: (1) Participation Diversity is the number of activities a child participatesin (max 44); (2) Participation Intensity is the child’s mean participation frequency ranging from 0 (never) to5 (everyday); (3) Independence Level is the mean assistance level of the child ranging from 1 to 6, where six means fullyindependent; (4) Child Enjoyment is the mean level of enjoyment for the child ranging from 1 to 6; and (5)Parent Satisfaction is the mean parent satisfaction for their child’s performance ranging from 1 to 6, where six indicateshighest satisfaction. Those scores are calculated for each subscale and for all activities as total scores. Preliminaryfindings suggest that the CPQ has good internal reliability (Cronbach’s coefficient alpha ranges between .79 and .90)and good temporal stability (ICC .84–.89). The CPQ has established convergent and divergent validity (Rosenberg et al.,in press).

Table 1

Demographic characteristics of the child, parents and families respondents (n = 290).

Characteristics Frequency Valid %

Gender

Boys 191 66

Girls 99 34

Child age (mean� sd) 5 y, 3 mo� .65 y (range 3 y, 11 m to 6 y, 11 mo)

Diagnostic group

Children with moderate developmental disabilities 75 26

Children without any developmental disabilities 215 74

Parents age (mean� sd)

Mother 34 y, 1 mo� 4.99 y (range 21–47 y)

Father 37 y, 3 mo� 6.24 y (range 25–71 y)

Mother education

High school 67 23

Professional 43 15

Academic 173 60

Missing 7 2

Father education

High school 102 35

Professional 39 13

Academic 133 46

Missing 16 6

Total family incomea

Below average 39 13

Average 67 23

Above average 180 62

Missing 4 1.4

Place of living

City 226 78

Other 64 22a According to the Israeli Central Boreau of Statistic, average income was 7500 NIS per month, at the time of the data collection.

L. Rosenberg et al. / Research in Developmental Disabilities 31 (2010) 1323–1331 1325

2.3. Procedure

Ethical approval was provided by the Healthcare Services and the Behavioral Research Ethics Board of Tel Aviv University.Parents of children without disabilities, who agreed to participate in the study, received information about the procedureand purpose of the study by trained Occupational–Therapy students. The parents of children with disabilities received thisinformation from a certified Occupational–Therapist. All the parents signed a consent form and completed the ERQ and CPQindependently at their own convenience. Parent respondents were mothers. All questionnaires were collected a few dayslater.

2.4. Data analysis

All the analyses were conducted after omitting the items which parents rated as irrelevant. Eighty percent of the parentschecked only three items or less as ‘‘irrelevant’’ (mean� sd = 2.2� 2.8 items), and in total, only 6% of all responses(responses = 35 items� 290 participants) were omitted. For establishing the ERQ homogeneity (internal consistency), we usedCronbach’s alpha coefficients, and Spearman correlations to calculate inter-item correlations. Construct validity was establishedthrough a factor analysis. All the following analyses were conducted using the three yielded factors, which have been labeledHome, Education and Community. Kolmogorov–Smirnov analysis was used to assess normal distribution of the dependentvariables, i.e. ERQ-total and ERQ-3 factors. As data did not conform to normal distribution further analyses were conducted byusing non-parametric tests. In order to further assess construct validity, known-groups differences method was used. Based onthe CPQ independence level measure, participants were assigned to two groups either independent group (above the median) orless independent group (under the median). One hundred and forty four participants were assigned to the less independent group(M = 4.90, SD = .43, range 2.20–5.35). Of these, 50 children were from the moderate developmental disabilities group (whocomprised 75% of this group). One hundred and forty-six participants (25 children from the moderate developmental disabilitiesgroup) were assigned to the independent level group (M = 5.37, SD = .16, range 5.37–6.00). There were no statistical differencesbetween the two groups in relation to gender, family income level, living environment (urban or rural) and parents’ education.Mann–Whitney U tests were performed to establish known-groups differences with Group (independent and less independent)as ‘between-group’ factors and the ERQ-total and environmental factors (Home, Education, Community) as a ‘within-subject’factor. Kruskal–Wallis tests were performed to establish known-groups differences with Family Income level (below average,average, above average) as ‘between-group’ and environmental factors (Home, Education, Community) as a ‘within-subject’factor. Convergent and divergent validities were calculated using Spearman correlation between the ERQ-factors and the CPQmeasures. To support convergent validity, based on similar validity studies (King et al., 2006; Missiuna, Pollock, Law, Walter, &Cavey, 2006), we expected significant, small to moderate correlations (around .4) between the ERQ-Home and Education factorsand the CPQ. To support divergent validity we expected non-significant correlations between the ERQ-Community factor and theCPQ.

3. Results

3.1. Internal consistency reliability

Inter-item correlations for all 35 items ranged between .33 and .63. (only six correlations were poor, i.e. less than .40)Cronbach’s coefficient alpha was calculated to examine how well all items measured the same construct and contributed tothe total assessment score, with .70 specified as an acceptable level (Bland & Altman, 1997). The alpha coefficient for theERQ-total mean score for all sample was .915. The alpha coefficients for children without developmental disabilities and forchildren with moderate developmental disabilities separately were .93 and .85, respectively.

3.2. Construct validity

3.2.1. Factor analysis

An initial common factor analysis (Principal Component) with varimax rotation was performed. The analysis wasconducted on the 35 items of the ERQ. Results of the analysis revealed 10 factors with eigenvalues over 1.0 accounting for66.83% of the cumulative variance. The scree plot revealed that although the 10 factors had eigenvalues higher than 1, theeigenvalue dropped off dramatically after the extraction of the first factor (eigenvalues for the first and second factors were9.79, and 3.92, respectively).

Based on the theoretical background discussed, a 3-factor structure was also explored. Varimax rotation with a 3-factorsolution explained 47.52% of the existing variance. The three factors which emerged (Table 2) retained 33 items (two itemsthat loaded less than .35 were removed, item 18 and item 27, see Appendix A). The first factor accounted for 16.67% of thevariance, contains eight items regarding the perceived physical restrictions at home, these have been labeled the Home

factor. The second factor accounted for 16.18% of the variance, contains 12 items regarding the physical accessibility in theneighborhood and accessibility to information, and therefore has been labeled the Community factor. Finally, the third factorwhich accounted for an additional 14.68% of the variance, contains 13 items regarding the educational setting, and parentalroutines, habits and attitudes at home, and has been labeled the Education factor (see Table 2 and Appendix A). Coefficients

L. Rosenberg et al. / Research in Developmental Disabilities 31 (2010) 1323–13311326

alpha was calculated to determine the internal consistency for each of the three factors which were .75, .87, and .79,respectively. These results can be interpreted to adequately reflect and support the underlying theoretical concepts of theERQ.

3.2.2. Homogeneity

Estimating correlations between subtests with the total score is a known procedure to analyze homogeneity. Homogeneityof subtests, i.e. medium to high correlations between subtests and total score, indicates a single construct (Gregory, 2001). Thecorrelations between the ERQ-Home, Community, and Education factors with the ERQ-total were .71, .84, and .83, respectively.All correlations were significant at the .01 level (two-tailed) and thus support the homogeneity of the ERQ.

3.2.3. Group differences – participation independence level

Mann–Whitney tests were computed with Group (independent or less independent) as a between-group factor and theERQ-total and environmental factors (Home, Community, and Education) as a within-subject factor. Table 3 presents meanand standard deviations of the ERQ-total and the three ERQ-factors. As a whole, parents perceived the various environmentalfactors as a minor restriction to their children’s participation. Yet, significant differences were found between childrenaccording to their independence level on all the ERQ measures. Parents of less independent children reported higherenvironmental restrictions.

3.2.4. Group differences – income level

Kruskal–Wallis tests were performed with Family Income (below average, average, above average) as a ‘between-group’factor and the ERQ-total and environmental factors (Home, Community, Education) as a within-subject factor. Table 4

Table 2

Common factor analysis with varimax rotation: for 3-factor solution (n = 290).

Items factor loadings Communalities

1 2 3

1 .55 .344

2 .724 .587

3 .786 .618

4 .715 .516

5 .87 .761

6 .76 .708

7 .572 .421

8 .576 .443

9 .644 .545

10 .72 .635

11 .865 .772

12 .796 .701

13 .739 .626

14 .484 .401

15 .764 .612

16 .832 .73

17 .771 .637

18 .287

19 .431 .287

20 .356 .257

21 .644 .424

22 .776 .645

23 .716 .546

24 .627 .501

25 .595 .377

26 .469 .294

27 .272

28 .642 .465

29 .563 .363

30 .588 .405

31 .381 .175

32 .43 .323

33 .359 .236

34 .403 .326

35 .539 .394

Eigen values 9.79 3.92 2.91

Total variance explained (%) 16.67 16.17 14.68

Reliability .75 .87 .79

Factor label Home Community Education

For items content see Appendix A.

L. Rosenberg et al. / Research in Developmental Disabilities 31 (2010) 1323–1331 1327

presents means and standard deviations of the ERQ-total and the three ERQ-factors. Significant differences were foundbetween children from families with diverse income on the ERQ-total and two of the ERQ-factors, i.e. Home and Community.Generally, parents of children with a family income below average reported on the highest environmental restrictions on allthe ERQ measures except for the Education factor.

3.3. Convergent and divergent validities

Convergent and divergent validities were computed using Spearman correlations between the ERQ-factors (Home,Community, and Education) and the CPQ total measures (Diversity, Intensity, Independence, Child Enjoyment, and ParentSatisfaction; see Table 5). Convergent validity was partially supported by the significant, low to moderate correlationsbetween the Home and the Education Factor with all the CPQ participation measures (except Home factor with Diversity).Conversely, the divergent validity of the CPQ was not supported as we expected non-significant correlations between theERQ-Community factor and the CPQ. However, we found very low yet significant correlations between the Community factorand all the CPQ total participation measures expect Enjoyment.

4. Discussion

This study offers a new tool, the ERQ, for measuring parental perceived environmental restrictions for their youngchildren participation. In light of the ICF model, the ERQ is grounded in an ecological model of child participation, whichclaims that child participation is also affected by environmental factors. Therefore comprehensive assessment of theenvironment should be an essential part of any evaluation of participation of children, as a basis for intervention planning,parents’ consultation and prevention. ‘‘In addressing environment explicitly we may expand the opportunities available tous to be helpful to the children and their families’’ stated Rosenbaum (2007). Our findings suggest adequate initialpsychometric support for the ERQ as a promising new measure for assessing environmental restrictions for young childrenparticipation in everyday activities.

The internal consistency of the ERQ-total measure was found to be good based on Cronbach’s alpha coefficient values.These results substantiate the evidence that all items measure the same underlying construct and are internally consistent.The ERQ is reliable and can be used for children without developmental disabilities as well as for children with moderate

Table 3

Means and standard deviations of the ERQ measures by high and low independence level groups.

Independence level High independence (means� SD) n = 144 Low independence (means� SD) n = 146 Z (sig.)

ERQ-total 1.68� .56 1.97� .59 �4.43 (.001)

ERQ-factors

Home 1.34� .40 1.71� .68 �5.48 (.001)

Accessibility 1.94� 1.04 2.08� .85 �2.22 (.027)

Education 1.68� .55 1.99� .65 �4.36 (.001)

Table 4

Means and standard deviations of the ERQ measures by family income level.

Family Income Below average (means� SD) n = 39 Average (means� SD) n = 67 Above Average (means� SD) n = 180 x2 (2) (sig.)

ERQ-total 2.01� .45 1.93� .63 1.75� .59 12.11(.002)

ERQ-factors

Home 1.72� .47 1.55� .47 1.48� .64 15.78(.001)

Community 2.44� 1.04 2.28� 1.07 1.83� .83 16.87(.001)

Education 1.86� .44 1.83� .64 1.84� .64 1.28(.528)

Table 5

Spearman correlations between the ERQ-factors (Home, Accessibility, Education) and the CPQ measures

(Diversity, Intensity, Independence, Child Enjoyment, Parent Satisfaction) (n = 290).

ERQ-factors Home Community Education

r(sig.) r(sig.) r(sig.)

CPQ – measures

Participation diversity �.13(.024) �.15(.009) �.08(.183)

Participation intensity �.22(.001) �.14(.021) �.22(.001)

Independence level �.37(.001) �.15(.010) �.30(.001)

Child enjoyment �.26(.001) �.08(.183) �.26(.001)

Parent satisfaction �.32(.001) �.13(.025) �.35(.001)

L. Rosenberg et al. / Research in Developmental Disabilities 31 (2010) 1323–13311328

developmental disabilities. The internal consistency of the ERQ is also supported by coefficient alpha values for each of thethree factors of the ERQ.

In order to examine the construct validity of the ERQ we used factor analysis. The results partially supported the originaltheoretical approach used for constructing the ERQ. Our findings revealed that the three common factors resulting from theanalysis explained 47.52% of the total variance. The three factors accounted for almost the same amount of explainedvariance (16.67%, 16.18%, and 14.68%). A finding which reflects that home, education and community contexts, do have thepotential to restrict children’s participation. Of note, the items that loaded on the ERQ-Education factor are a combination ofhuman (e.g. attitudes) and physical (e.g. equipment) environmental factors. Moreover, these items are linked to the homesetting as well as to the educational setting. This finding might implies that the home and the educational settings are nottotally unrelated contexts.

To further establish the construct validity of the ERQ, a known-group’s differences comparison procedure was used todetermine that the questionnaire could distinguish between children with diverse participation according to theirindependence level. Although all parents reported on relatively low level of environmental restriction, Mann–Whitney testsrevealed significant differences in the ERQ measures (ERQ-total and ERQ-three factors scores) between the twoindependence level groups. Parents of children with less independence level (under the median) reported on higherenvironmental restriction level. Nevertheless, it is worth to mention that low level of perceived environmental restrictionswas previously reported in a study of children with severe developmental disabilities (Law et al., 2007). The question ofwhether the environmental restrictions are the primary cause for the relatively decreased independence level needs to befurther studied. Such studies may allow assessing causality.

In addition Kruskal–Wallis tests revealed significant differences in the ERQ-total measure, Home and Community factors,but not in the Education factor, between participants according to their Income level. Parents of families with below averageincome reported on the highest environmental restrictions in all the ERQ measures, except for the Education factor. TheHome and Community factors consist of items that relate mostly to physical environmental aspects and therefore maycorrelate with income level. Although, a few items in the Education factor relate to physical aspects in the educational settingas well, most items at this factor relate to parental attitudes, routines and practices which may be less affected by economicalresources, i.e. income level (Amato & Fowler, 2002). Taking together these results, we may conclude that the known-groupsdifferences analyses do contribute to the ERQ construct validity.

Convergent and divergent validities of the ERQ were moderately demonstrated by correlations with the CPQ. On the onehand higher levels of convergent validity (expressed by relatively higher significant correlations) were found between theERQ- Home and Education factors and all the CPQ measures (except CPQ-Diversity and ERQ-Education). On the other handthe correlations between ERQ-Community and all the CPQ measures were very weak as expected, yet significant, except forCPQ-Enjoyment which was not statistically significant. These results are compatible with the theoretical approach on whichthe ERQ was developed (Case-Smith, 2005). Participation of young children is affected primarily by variables within theirimmediate environment at home and at the educational setting and secondly by variable within the broader environment,i.e. their community (Bronfenbrener, 1999, chapter 1).

5. Conclusions and limitations

The ERQ has demonstrated acceptable psychometric properties. Therefore, the ERQ can be used as a reliable and validmeasure to assess parental perceptions of environmental restrictions on the participation of their 4–6 y old children. Thusthe ERQ will enable us to derive valuable information, broaden our understanding about the nature of children participationand accomplish the ICF perspective beyond child factors (Rosenbaum, 2007). Apart from its apparent advantages, somelimitations should be outlined. The ERQ reliability should be further assessed, as temporal stability was not tested in thecurrent study. The ERQ divergent validity should be further assessed as well, as the current results are somewhatinconclusive. In addition our findings may be limited to young children with and without moderate developmentaldisabilities. Further studies should assess the reliability, validity and usability of the ERQ in wider age groups and diversepopulations.

Acknowledgements

This work was performed in partial fulfillment of the requirements for a Ph.D. degree of Limor Rosenberg, Sackler Facultyof medicine, Tel Aviv University, Israel.

We are grateful to the parents and children who participated in this study. We thank our diligent students for theirassistance in data collection.

Appendix A. Environmental Restriction Questionnaire (ERQ)

This questionnaire is intended to learn about the physical and human factors in your living environment, in your family and in

your house that effect your child in their daily functioning and in daily activities. For example: activities of daily living,

instrumental activities of daily living, play, leisure, social participation and education. Please answer to what degree, in your

L. Rosenberg et al. / Research in Developmental Disabilities 31 (2010) 1323–1331 1329

opinion, each of the factors limits the functioning or independence of your child in their various daily activities (6 – the factor

limits my child’s functioning to a great degree, 1 – the factor does not limit my child’s functioning at all).

Example: In our building, there are no other children of my child’s age; this factor limits my child’s social participation. Or: in

our neighborhood, there are many children at the age of my child; this factor does not limit my child’s social participation.

The factor Does not

at all limit

Limits to a

great degree

Irrelevant

1. The location of our residence (city, town, village) 1 2 3 4 5 6 7

2. Distance of the public park from our house 1 2 3 4 5 6 7

3. Distance of the preschool from our house 1 2 3 4 5 6 7

4. Distance of shopping centre from our house 1 2 3 4 5 6 7

5. Distance of our house from child’s friends houses 1 2 3 4 5 6 7

6. The location of the community centre 1 2 3 4 5 6 7

7. The roads and traffic in our neighborhood 1 2 3 4 5 6 7

8. The level of safety in our neighborhood 1 2 3 4 5 6 7

9. The structure and plan of our house 1 2 3 4 5 6 7

10. The types of games and toys in our house 1 2 3 4 5 6 7

11. The location of the toys and games in our house (e.g. toys are in a

hard to reach space or an accessible place)

1 2 3 4 5 6 7

12. The location of the paints and papers in our house 1 2 3 4 5 6 7

13. Location of crafts in our house (glue, scissors) 1 2 3 4 5 6 7

14. Maintenance of home cleanliness and organization 1 2 3 4 5 6 7

15. Height of water taps in our home 1 2 3 4 5 6 7

16. The height of the table and chair at which my child sits to eat 1 2 3 4 5 6 7

17. The height of the table and chair at which my child draws 1 2 3 4 5 6 7

18. My job (e.g. type of work, work schedule, number of hours) 1 2 3 4 5 6 7

19. My partner’s job (e.g. type of work, work schedule, number of hours) 1 2 3 4 5 6 7

20. The time at which my child returns home from educational facility 1 2 3 4 5 6 7

21. The treatment my child receives from preschool staff 1 2 3 4 5 6 7

22. The number of staff members at my child’s preschool 1 2 3 4 5 6 7

23. The number of children in my child’s preschool 1 2 3 4 5 6 7

24. The equipment and games in my child’s preschool 1 2 3 4 5 6 7

25. My involvement in my child’s preschool 1 2 3 4 5 6 7

26. My family’s income 1 2 3 4 5 6 7

27. The mobility of the family (public transportation, private vehicle) 1 2 3 4 5 6 7

28. Computers employed by the family 1 2 3 4 5 6 7

29. Habits of TV watching in the family/amongst my children 1 2 3 4 5 6 7

30. My educational views (e.g. what I allow or prohibit my child to do) 1 2 3 4 5 6 7

31. My preferences for spending free time 1 2 3 4 5 6 7

32. The people caring for/surrounding my child the afternoon 1 2 3 4 5 6 7

33. The nanny/babysitter in our house 1 2 3 4 5 6 7

34. My parental habits (e.g. I dress my child although they are capable in

doing so themselves)

1 2 3 4 5 6 7

35. My accessibility to resources and consultation regarding child health,

raising and development

1 2 3 4 5 6 7

References

Amato, P., & Fowler, F. (2002). Parenting practices, child adjustment and family diversity. Journal of Marriage Family, 64, 703–716.Bland, J., & Altman, D. (1997). Statistics notes: Cronbach’s alpha. British Medical Journal, 314, 570–572.Bradley, R., Corwyn, R., Pipes McAdoo, H., & Coll, C. (2001). The home environment of children in the United States. Part I: Variations by age, ethnicity and poverty

status. Child Development, 72, 1844–1867.Brody, G., & Flor, D. (1998). Maternal resources, parental practices and child competence in rural single parent African American families. Child Development, 69,

803–816.Bronfenbrener, U. (1999). Environments in developmental perspective: Theoretical and operational models. In Friedman & Wachs (Eds.), Measuring environment

across the life span: Emerging methods and concepts. Washington: APA.Brooks Gunn, J., Duncan, J., Klebanov, P., & Sealand, N. (1993). Do neighborhoods influence child and adolescent development? The American Journal of Sociology,

99, 353–395.Case-Smith, J. (2005). Development of childhood occupations. In J. Case-Smith (Ed.), Occupational therapy for children (5th ed., pp. 88–116). St. Louis, MO Mosby Inc.Chen, H., & Cohn, E. (2003). Social participation for children with DCD: Conceptual, evaluation and intervention considerations. Physical and Occupational Therapy

in Pediatrics, 23, 61–78.Erikson, L. (2005). The relationship between school environment and participation for student with disabilities. Developmental Neurorehabilitation, 8, 130–139.Evans, G. (2005). Child development and the physical environment. Annual Review Psychology, 57, 423–451.Fauconnier, J., Dickinson, H., Beckung, E., Marcelli, M., McManus, V., Michelsen, S., et al. (2009). Participation in life situations of 8–12 year old children with

cerebral palsy: Cross sectional European study. British Medical Journal, 338, b1458.Forsyth, R., Colver, A., Alvanides, S., Wooly, M., & Lowe, M. (2007). Participation of young severely disabled children is influenced by their intrinsic impairments

and environment. Developmental Medicine and Child Neurology, 49, 345–349.Gregory, R. (2001). Psychological testing: History, principles, and applications. Boston, MA: Allyn and Bacon.Hammal, D., Jarvis, S., & Colver, A. (2004). Participation of children with cerebral palsy is influenced by where they live. Developmental Medicine and Child

Neurology, 46, 292–298.King, G., Law, M., Hanna, S., King, S., Hurley, P., Rosenbaum, P., et al. (2006). Predictors of the leisure and recreation participation of children with physical

disabilities: A structural equation model analysis. Children’s Health Care, 35, 209–234.

L. Rosenberg et al. / Research in Developmental Disabilities 31 (2010) 1323–13311330

Law, M., Petrenchik, T., King, G., & Hurley, P. (2007). Perceived environmental barriers to recreational, community, and school Participation for children and youthwith physical disabilities. Archives of Physical Medicine and Rehabilitation, 88, 1636–1642.

Linver, M., Brook Gunn, J., & Kohen, D. (2002). Family processes as pathways from income to young children development. Developmental Psychology, 38, 719–734.Maxwell, L. (2007). Competency in child care settings, the role of the physical environment. Environment and Behavior, 39, 229–245.McManus, V., Michelsen, S., Parkinson, K., Colver, A., Beckung, E., Pez, O., et al. (2006). Discussion groups with parents of children with cerebral palsy in Europe

designed to assist development of a relevant measure of environment. Child: Care, Health and Development, 32, 185–192.Mihaylov, S., Jarvis, S., Colver, A., & Beresford, B. (2004). Identification and description of environmental factors that influence participation of children with

cerebral palsy. Developmental Medicine and Child Neurology, 46, 299–304.Missiuna, C., Pollock, N., Law, M., Walter, S., & Cavey, N. (2006). Examination of the perceived efficacy and goal setting system (PEGS) with children with

disabilities, their parents and teachers. American Journal of Occupational Therapy, 60, 204–214.Peisner Feinberg, E., Burchinal, M., Clifford, R., Culkin, M., Howes, C., Lynn Kagan, S., et al. (2001). The relation of preschool child-care quality to children’s cognitive

and social developmental trajectories through second grade. Child Development, 72, 1534–1553.Rosenbaum, P. (2007). The environment and childhood disability: Opportunities to expand our horizons. Developmental Medicine and Child Neurology, 49, 643–

1643.Rosenberg, L., Jarus, T., & Bart, O. (in press). Development and initial validation of the Child Participation Questionnaire (CPQ). Disability and Rehabilitation.Saelens, B., Sallis, J., Black, J., & Chen, D. (2003). Neighborhood based differences in physical activity, an environmental scale evaluation. Journal of Public Health, 93,

1552–1558.Teel, C., Dunn, W., Jackson, S., & Duncan, P. (1997). The role of the environment in fostering independent: Conceptual and methodological issues in developing an

instrument. Topics in Stroke Rehabilitation, 4, 28–40.Whiteneck, G., Harrison Felix, C., Mellick, D., Brooks, C., Charlifue, S., & Gerhart, K. (2004). Quantifying environmental factors: A measure of physical, attitudinal,

service, productivity, and policy barriers. Archive of Physical Medicine Rehabilitation, 85, 1324–1335.World Health Organization. (2001). International classification of functioning, disability and health (ICF). Geneva, Switzerland: World Health Organization.

L. Rosenberg et al. / Research in Developmental Disabilities 31 (2010) 1323–1331 1331