Infants & Young Children

Vol. 23, No. 3, pp. 169–183

Copyright  c 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Young Children With

Physical Disabilities
Caregiver Perspectives About
Assistive Technology
Adria Kling, OTR/L; Philippa H. Campbell, PhD;
Jeanne Wilcox, PhD
Caregiver reports of problematic activities/routines with their young children with physical dis-
abilities and types of assistive technology used as solutions were investigated in this study. In
addition, caregiver competence with assistive technology use and ways in which caregivers re-
ceived information and training were also examined. A subset of 164 caregivers who identified
their children as having physical disabilities was retrieved from an archived database and used for
analysis. Results indicated that children experienced various problems when participating in daily
activities/routines. An average of 60.4% of their caregivers found solutions to these problems and
64.5% of these solutions involved the use of assistive technology. Only a small percent (13.4%) of
caregivers reported feeling very competent at using assistive technology and 68.2% of those had
received information from an early intervention provider. This research exemplifies the impor-
tance of both using assistive technology interventions for children with physical disabilities and
ensuring that early intervention providers are sufficiently knowledgeable to train caregivers so that
their children gain maximal opportunities to participate and learn. Key words: assistive devices,
assistive technology, caregiver, cerebral palsy, early intervention, physical disabilities

A SSISTIVE TECHNOLOGY has the poten-

tial to enhance the lives of all people, in-
cluding infants and toddlers with disabilities,
by providing the means to actively participate
in daily activities/routines. The barriers to ac-
tive participation that are often present may
be circumvented by assistive technology, al-
lowing young children to explore, learn, and
play within their natural environments (Mis-
trett, 2001; Sullivan & Lewis, 2000). When
assistive technology is used as an interven-
tion and incorporated into a child’s natural en-
vironment, learning opportunities that were
previously unavailable will emerge, encourag-
Author Affiliation: Thomas Jefferson University,
Philadelphia, Pennsylvania (Ms Kling and
Dr Campbell); and Arizona State University, Tempe
(Dr Wilcox).
Corresponding Author: Adria Kling, OTR/L, Thomas
Jefferson University, 130 South 9th St, Ste 500, Philadel-
phia, PA 19107 (adria.kling@gmail.com).
ing the child’s active engagement with both
the physical environment and the children,
parents, and other adults within that envi-
ronment (Langone, Malone, & Kinsley, 1999).
The increased learning opportunities afforded
through assistive technology support chil-
dren’s growth and development, promote the
acquisition of new skills, and foster indepen-
dence (Mistrett, 2001; Weintraub & Wilcox,
2006). The use of assistive technology may
also allow for more efficient and effective
caregiving even for children with severe and
profound disabilities (Daniels, Sparling, Reilly,
& Humphry, 1995).
Assistive technology is defined as “any
item, piece of equipment, or product system,
whether acquired commercially off the shelf,
modified, or customized, that is used to in-
crease, maintain, or improve functional capa-
bilities of individuals with disabilities” (IDEA,
2004). This definition includes both low-tech
and high-tech devices. Low-tech items tend
to be more readily available and of lower
169
170 INFANTS & YOUNG CHILDREN/JULY–SEPTEMBER 2010
cost and are generally used by all young chil-
dren, such as bath seats, Velcro, and adap-
tive spoons and bowls. In contrast, high-tech
items are typically more specialized, difficult
to obtain, complex, and costly. These include
items such as computerized devices, alterna-
tive and augmentative communication, and
powered wheelchairs (Campbell, Milbourne,
Dugan, & Wilcox, 2006).
CEREBRAL PALSY AND
PHYSICAL DISABILITIES
Infants and toddlers with cerebral palsy and
other physical disabilities often experience
difficulties participating in their daily activi-
ties/routines due to impairments in mobility
and positioning as well as other neurologi-
cal limitations (Chung et al., 2008). A wide
range of environmental modifications may be
used with these children to support participa-
tion including adaptations to the environment
and assistive technology devices (Østensjø,
Carlberg, & Vøllestad, 2005). In interviews
with 204 parents of children of all ages with a
neurological diagnosis (89% were diagnosed
with cerebral palsy), 77% of the parents re-
ported that technical aids lightened the care-
giver’s burden and promoted the child’s in-
dependence (Korpela, Seppänen, & Koivikko,
1992). In a second study where 95 children
with cerebral palsy were assessed and their
caregivers were interviewed, assistive tech-
nology was reported as having a large effect
on mobility, self-care, and social functioning
(Østensjø et al., 2005).
UNDERUTILIZATION OF
ASSISTIVE TECHNOLOGY
Assistive technology is underutilized with
children receiving early intervention services
despite the legislative mandates and re-
search supporting its use (Dugan, Campbell,
& Wilcox, 2006; Judge, Floyd, & Wood-Fields,
2010; Long, Woolverton, Perry, & Thomas,
2007; Wilcox, Dugan, Campbell, & Guimond,
2006). Reports concerning both the extent of,
and reasons for, underuse are conflicting and
suggest many potential reasons to account for
underuse ranging from cost/funding, parents’
unwillingness to accept the device, insuffi-
cient emphasis on training about assistive
technology for both parents and providers,
and provider biases to work on typical
skill development (Campbell, Milbourne, &
Wilcox, 2008; Kemp & Parette, 2000; Lahm
& Sizemore, 2002). In addition, reports sug-
gest that because caregivers are unlikely to
receive training, device use may not be well
integrated into naturally occurring activities/
routines, and situations may be inadvertently
created, where caregivers view the devices
as a burden and abandon them (Lesar,
1998; Parette, VanBiervliet, & Hourcade,
2000). However, underutilization has not
been reported in other studies where care-
givers (Cardon, Wilcox, & Campbell, in press;
Wilcox, Dugan, et al., 2006) and early inter-
vention providers (Wilcox, Guidmond, Camp-
bell, & Weintraub, 2006) were asked ques-
tions in surveys about their use of assistive
technology. For example, 55% of the
providers who completed an online sur-
vey regarding their knowledge, beliefs, and
practices reported using assistive technology
with infants and toddlers.
COMPETENCY WHEN USING
ASSISTIVE TECHNOLOGY
Psychologist Albert Bandura referred to
“self-efficacy” as a belief in one’s ability to
successfully perform a specific behavior (Ban-
dura, 1989, as cited in Weintraub & Wilcox,
2006). Self-efficacy, or confidence, tends
to increase with training and experience
according to Weintraub & Wilcox (2006),
who studied the confidence levels of early
intervention providers at using assistive tech-
nology with infants and toddlers. Training and
experience, such as workshops or on-the-job
training experiences, had the greatest influ-
ence on providers’ confidence. Few studies
of caregiver confidence when using assistive
technology with very young children have
been conducted; however, on the basis of
these findings and Bandura’s theory, it would
be expected that caregiver competence
would also increase with more training and
 Caregiver Perspectives on Assistive Technology
experience. For example, in a study where
caregivers of children with autism were
asked about competence, few caregivers
(6.9%) felt very competent when using
assistive technology with their children and
17.2% reported being not at all competent.
These caregivers were most likely to receive
information and training about assistive
technology from other parents or by using
trial-and-error tactics as opposed to receiving
it from early intervention providers (Cardon
et al., in press). Similarly, in telephone inter-
views with caregivers whose children were
using assistive technology, the majority of
respondents reported learning about devices
through friends and families (Wilcox, Dugan,
et al., 2006).
RESEARCH OBJECTIVES
The extent to which caregivers of young
children report competence in using assistive
technology with their children and the ways
in which they learn about assistive technol-
ogy varies across studies. Yet the use of as-
sistive technology impacts in major ways on
young children with physical disabilities’ per-
formance in activities/routines. The purpose
of this research was to investigate the per-
spectives of caregivers of children with phys-
ical disabilities about their daily activities/
routines and the use of assistive technology.
Specifically, the research was designed to
• examine which activities/routines are
most problematic for these children;
• determine to what extent caregivers find
solutions to their problems and to what
degree assistive technology is used as a so-
lution;
• identify the amount of information and
training caregivers receive about assistive
technology and the sources of that infor-
mation; and
• examine the impact of these factors on
caregiver-reported competence levels.
METHODS
An archival database of caregiver responses
to a Tots ‘N Tech Research Institute (http://
171
tnt.asu.edu) Web-based survey served as the
data source. A total of 549 nationally dis-
tributed caregivers of infants or toddlers with
disabilities responded anonymously to ques-
tions focused on their use of assistive technol-
ogy within their daily activities/routines.
Survey
The survey consisted of a combination of
forced choice and open-ended questions re-
lated to 10 activities/routines in which infants
and toddlers typically participate. These in-
cluded bath time, morning routine, evening
routine, mealtime, play, physical activities,
leaving the house, running errands, family
outings, and family chores. Caregivers were
asked whether there was ever a time their
child was unable to fully participate in the
activity/routine. If the caregivers reported
“yes,” they were asked a sequence of ques-
tions regarding solutions to the problem.
They were asked whether they were able to
find a solution, and if so, did it include as-
sistive technology (yes/no). They were then
asked to describe the solution in an open-
ended format so that both assistive technol-
ogy and non–assistive technology solutions
were described. Definitions of assistive tech-
nology were not provided for the respon-
dents. For each activity/routine, caregivers
were also asked how they found out about the
solution and what type of information or train-
ing they had received about its implementa-
tion. After responding to these questions for
each activity/routine, caregivers were asked
general questions regarding the use of assis-
tive technology with their children, includ-
ing how much information and training they
had received, the ways it had been received,
and how competent they felt at using assistive
technology.
Two of the survey questions were open-
ended and responses were coded into differ-
ent categories. For the first question, care-
givers were asked to describe the problem
within each activity/routine. Responses were
coded into the following categories: (a) Mo-
tor Disability or Significant Delay: Child
has motor disability or motor delay that
impacts on performance of the particular
172 INFANTS & YOUNG CHILDREN/JULY–SEPTEMBER 2010
activity/routine (eg, “child with cerebral
palsy cannot sit up in tub due to tone”);
(b) Motor Inability: Child cannot perform the
activity/routine or participate because of mo-
tor skill limitations that are not linked with
the motor disability or significant delay in mo-
tor skills (eg, “child unable to open hands to
use wash cloth to wash face”); (c) Position-
ing: Child’s positioning during the activity/
routine is the primary issue identified; (d)
Independence/Self-Help: Includes activities/
routines such as bathing, dressing, and play
(eg, “child afraid to ride bike alone”); (e) Eat-
ing: Includes general problems with eating
such as chewing, swallowing, and self-feeding
as well as issues related to learning to eat in-
dependently (eg, “using silverware appropri-
ately”) and oral motor situations (eg, “child
cannot swallow without gagging”); (f) Prob-
lems With Behavior: Primary issue relates to
behavior and includes negative or uncooper-
ative behavior related to sensory processing
problems; (g) Problems With Communica-
tion: Child is unable to talk or vocalize, so-
cialize with others, listen, understand, or fol-
low directions; and (h) Other: Child’s diag-
nosis is stated as the problem, problem does
not fit the previous categories, or there is
not enough information provided to code the
statement.
In the second open-ended question, care-
givers described how they had solved a re-
ported problem within an activity or rou-
tine. The open-ended responses were coded
into the following categories: (a) grips, mats,
Velcro, duct tape, bath mats, or grips to use
in securing objects; (b) pictures to illustrate
steps in a routine, daily schedule, or labeling
of items related to a schedule or routine; (c)
communication aids such as pictures, PECS,
picture boards, or single or few choice de-
vices such as Big Mac or cheap talk; (d) child
positioning devices (low-tech) such as bath
seats, strollers, pillows, stools, bean bags, and
towels; (e) eating utensils such as sippy cups,
bent spoon, deep dishes, or items used to hold
utensils and tableware in place; (f) personal
care items for dressing, bathing, etc, such as
adapted clothing, vibrating toothbrushes, and
elastic shoelaces; (g) mobility devices such as
push walker toys, strollers, and riding vehi-
cles; (h) play items such as switch operated
toys or specially selected materials to address
the child’s interests/abilities; (i) customized
positioning or mobility equipment (fabricated
to address individual child needs or purchased
from an equipment vendor); (j) other: low-
tech device or adaptation that does not fit
previous categories; and (k) high-tech devices
such as computers and assistive listening de-
vices.
Frequency counts for the demographic in-
formation and to determine the percentage of
caregiver responses for each survey question
were obtained. Chi-square and ANOVA analy-
ses were also conducted to measure distribu-
tion and variance, respectively.
Participants
A subset of 164 caregivers who described
their children as having a physical disability or
cerebral palsy was extracted from the larger
database and used as the sample for address-
ing the research questions for this study. The
characteristics of the caregivers are outlined
on Table 1. A majority of the sample com-
prised of white mothers with college educa-
tions who lived in 2-parent households. In-
come was reported as distributed across all
categories. The children’s average age was
26 months. Approximately half of the chil-
dren were male. Cerebral palsy was selected
as the category to describe the child’s disabil-
ity by 54 caregivers, 121 identified the child
as having a physical disability, and 11 checked
both categories. These 3 response categories
were combined into 1 category of 164 chil-
dren with physical disabilities.
RESULTS
Responses from the archived database were
analyzed to gain a clearer understanding of the
perspectives of caregivers of children with
physical disabilities regarding their daily activ-
ities/routines and the use of assistive technol-
ogy. Responses were used to identify the types
 Caregiver Perspectives on Assistive Technology 173

Table 1. Demographic Characteristics of Table 2. Caregiver Perspectives on Problems

Caregivers Within Activities and Routines

Percentage of Problem Count, %

Caregiver All Caregivers Routine (Count)
Characteristics (n = 164)
Bath time 17.4 (128)
Person reporting Morning routine 14.4 (106)
Mother 68.9 Evening routine 9.2 (68)
Father 25.0 Mealtime 13.3 (98)
Grandmother 3.7 Play 9.0 (66)
Grandfather 1.2 Leaving the house 6.7 (49)
Sister 0.6 Running errands 5.6 (41)
Brother 0.6 Family routines 7.2 (53)
Household structure Physical activities 11.7 (86)
Two-parent 83.5 Family outings 5.6 (41)
One-parent 16.5
Household income
Under $15 000 4.3 nology, and their perceived level of compe-
$15 000–29 999 14.6 tence at using assistive technology.
$30 000–49 999 28.0
$50 000–74 999 24.4 Caregivers’ perceptions about daily
$75 000–99 999 17.1 activities and routines
$100 000+ 6.7
Caregivers were asked to indicate activities/
Did not report 4.9
Race/ethnicity routines in which their child was unable to
White 68.9 participate and to describe the problem that
African-American 7.3 prevented their participation. Table 2 illus-
Asian/Pacific Islander 12.8 trates that bath time was the most problem-
Hispanic/Latino 4.3 atic routine with 17.4% of caregivers report-
Native American 1.8 ing a problem within this routine. Morning
Multiracial 4.9 routine (14.4%), mealtime (13.3%), and phys-
Education ical activity (11.7%) were also among the
Less than high school 2.4 most problematic routines for infants and tod-
High school/GED 15.9
dlers with a physical disability. Caregivers
Some college 20.1
were also asked to report the type of prob-
Associates degree 10.4
College/university degree 40.2 lem that inhibited their child’s participation
Graduate school degree 11.0 for each of the activities/routines reported
Community setting in Table 3. Overall, motor inabilities (30.1%)
Urban/large city 23.8 and a lack of independence/self-help skills
Suburban 50.3 (25.2%) were reported most frequently. Mo-
Rural 25.6 tor inabilities were reported as being most
Did not report 0.3 problematic during play (62.2%) and physi-
cal activities (57.7%). This category included
problems such as not being able to reach
of problems affecting the child’s participation to play games or use arms to swim. A lack
in activities/routines and the extent to which of independence/self-help skills was reported
caregivers found solutions to these problems. most problematic during morning (53.5%)
The data were also used to examine whether and family routines (57.5%) and included situ-
caregivers used assistive technology as a solu- ations such as not brushing teeth or zippering
tion, ways they learned about assistive tech- jacket independently.
 174

Table 3. Types of Problems Within Daily Activities and Routinesa

Motor
Disability/ Independence/ Eating/
Routine Delay Motor Inability Positioning Self Help Feeding Behavior Communication Other

Bath time 4.1 (4) 29.6 (29) 16.3 (16) 31.6 (31) 0 12.2 (12) 2.0 (2) 4.1 (4)
Morning 8.1 (7) 25.6 (22) 2.3 (2) 53.5 (46) 1.2 (1) 4.7 (4) 0 4.7 (4)
Routine
Evening 1.7 (1) 15.5 (9) 10.3 (6) 37.9 (22) 3.4 (2) 22.4 (13) 1.7 (1) 6.9 (4)
Routine
Mealtime 1.1 (1) 7.9 (7) 3.4 (3) 1.1 (1) 79.8 (71) 3.4 (3) 1.1 (1) 2.2 (2)
Play 8.9 (4) 62.2 (28) 0 11.1 (5) 0 6.7 (3) 8.9 (4) 2.2 (1)
Leaving the house 5.1 (2) 43.6 (17) 2.6 (1) 28.2 (11) 0 15.4 (6) 2.6 (1) 2.6 (1)
Running 22.2 (6) 44.4 (12) 7.4 (2) 0 0 22.2 (6) 0 3.7 (1)
Errands
INFANTS & YOUNG CHILDREN/JULY–SEPTEMBER 2010

Family 7.5 (3) 12.5 (5) 0 57.5 (23) 0 12.5 (5) 7.5 (3) 2.5 (1)
Routines
Physical 11.5 (6) 57.7 (30) 1.9 (1) 5.8 (3) 0 7.7 (4) 1.9 (1) 13.5 (7)
Activities
Family 6.7 (2) 36.7 (11) 13.3 (4) 0 3.3 (1) 23.3 (7) 3.3 (1) 13.3 (4)
Outings
Total 6.4 (36) 30.1 (170) 6.2 (35) 25.2 (142) 13.3 (75) 11.2 (63) 2.5 (14) 5.1 (29)

a Full titles and operational definitions can be found in the “Methods” section. Values represent % (count).
 Caregiver Perspectives on Assistive Technology 175

Table 4. Caregiver Reports of Solutions to Problems, the Use of AT, and Actual Use of ATa

Routine Solution Count Caregiver Reports Use of AT Actual Use of AT

Bath time 71.9 (92/128) 66.3 (61/92) 47.6 (39/82b )
Morning routine 56.2 (59/105) 57.6 (34/59) 38.9 (21/54b )
Evening routine 60.3 (41/68) 61.0 (25/41) 48.6 (18/37b )
Mealtime 62.2 (61/98) 75.4 (46/61) 57.5 (31/54b )
Play 61.2 (41/67) 56.1 (23/41) 44.4 (16/36b )
Leaving the house 53.1 (26/49) 69.2 (18/26) 60.8 (14/23b )
Running errands 65.9 (27/41) 70.4 (19/27) 56.6 (13/23b )
Family routines 43.4 (23/53) 78.3 (18/23) 68.5 (13/19b )
Physical activities 58.6 (51/87) 58.8 (30/51) 42.6 (20/47b )
Family outings 58.5 (24/41) 54.2 (13/24) 45.5 (10/22b )
Totals 60.4 (445/737) 64.5 (287/445) 49.1 (195/397)

Abbreviation: AT = assistive technology.

a Values represent % (count).
b Responses that could not be coded because of insufficient information or no description provided were omitted from

the calculation.

Solutions and use of assistive technology
Caregivers were asked whether they were
able to find a solution to their problem and,
if so, were asked whether the solution in-
cluded assistive technology. Table 4 indicates
that overall, caregivers found solutions to
their problems 60.4% of the time and when
solutions were found, caregivers identified a
majority (64.5%) of these solutions as assis-
tive technology. They were asked to provide
descriptions of all solutions (ie, all assistive
technology or non–assistive technology solu-
tions). These descriptions of solutions were
coded by categories of types of assistive tech-
nology and, during the coding process, a num-
ber of the solutions identified as assistive tech-
nology by caregivers did not meet the assistive
technology coding categories. For example, 1
caregiver reported, “his sister washes his hair
when they take baths together.” Since this is
not considered assistive technology, a third
column was created in Table 4 to represent
the actual use of assistive technology (49.1%)
as determined by the coders (and not by the
caregivers’ categorizations).
The open-ended descriptions of solutions
were coded into 10 different categories that
are reported in Table 5. More than 45.1%
of the described solutions were positioning
devices, with 26.3% being classified as low-
tech devices such as pillows, pool noodles,
or rolled towels and with 18.8% being catego-
rized as customized positioning devices such
as wheelchairs and gait trainers. Personal care
items, such as a vibrating tooth brush or a hair
brush with a built-up handle, were also fre-
quently reported (17.9%). Caregivers did not
report any instances in which high-tech de-
vices had been used.
Amount and sources of information
and training
A general question was asked about ways
in which caregivers had received information
and training about assistive technology using
response options from a fixed choice list. A
total of 46% of the caregivers reported receiv-
ing information and training from an early in-
tervention provider compared with 54% who
learned about assistive technology from more
than 6 different combined sources reported
in Table 6 (eg, lending library; expo or fair).
In addition, caregivers were also asked about
how they learned about assistive technology
for each specific activity/routine. For 7 of the
10 activities/routines, the early intervention
 176

Table 5. Types of AT Reported by Caregiversa

Grips/ Communication LT Custom Eating Personal

Routine Velcro Pictures Aids Positioning Positioning Utensil Care Mobil. Play Other

Bath time 3.8 (2) 0 0 56.6 (30) 9.4 (5) 0 30.2 (16) 0 0 0
Morning routine 0 3.7 (1) 7.4 (2) 11.1 (3) 11.1 (3) 0 59.3 (16) 3.7 (1) 0 3.7 (1)
Evening routine 0 0 0 16.7 (3) 11.1 (2) 0 33.3 (6) 27.8 (5) 0 11.1 (2)
Mealtime 0 0 0 9.7 (3) 6.5 (2) 77.4 (24) 0 3.2 (1) 0 3.2 (1)
Play 5.9 (1) 0 0 17.6 (3) 41.2 (7) 0 0 0 23.5 (4) 11.8 (2)
Leaving the house 0 0 0 7.7 (1) 53.8 (7) 0 7.7 (1) 0 0 30.8 (4)
Running errands 7.1 (1) 0 0 35.7 (5) 35.7 (5) 0 7.1 (1) 7.1 (1) 0 7.1 (1)
Family routines 0 7.1 (1) 7.1 (1) 21.4 (3) 14.3 (2) 7.1 (1) 0 7.1 (1) 0 35.7 (5)
INFANTS & YOUNG CHILDREN/JULY–SEPTEMBER 2010

Physical Activities 12.0 (3) 4.0 (1) 0 28.0 (7) 20.0 (5) 0 0 8.0 (2) 12.0 (3) 16.0 (4)
Family outings 0 0 16.7 (2) 8.3 (1) 33.3 (4) 0 0 41.7 (5) 0 0
Total 3.1 (7) 1.3 (3) 2.2 (5) 26.3 (59) 18.8 (42) 11.2 (25) 17.9 (40) 7.1 (16) 3.1 (7) 8.9 (20)

a Full titles and operational definitions can be found in ”Methods” section. Values represent % (count).
 Caregiver Perspectives on Assistive Technology 177

Table 6. Caregivers Report on Ways They Re- received more information and training were
ceived Information or Training About AT more competent than those who received less
information and training. Results were signifi-
cant for both the received amount of informa-
Information/Training
tion [χ 2 (9, N = 164) = 58.85, P = .0001] and
Source % (Count)
training [χ 2 (9, N = 164) = 64.61, P = .0001]
Formal workshops 11.7 (40) indicating that these variables were related
Local expos/fairs 8.2 (28) to competence. Figure 1 indicates that care-
Local lending library 12.3 (42) givers who felt very competent received more
Program specific training 4.4 (15) information (77.3% caregivers) and training
Early intervention personnel 46.0 (157)
(45.5% caregivers) than those who were not
provided information
at all competent. None of the caregivers who
Help from another parent 15.5 (53)
Other 1.8 (6) reported receiving a lot of information and
only 5.3% who reported receiving a lot of
training felt not at all competent. Chi-square
analyses were also used to examine compe-
provider was the primary source of care- tency and the source identified by caregivers
givers’ information and training (Table 7). as the way in which they learned about as-
Caregivers were asked to report how com- sistive technology. Results were significant
petent they felt about using adaptations or [χ 2 (3, N = 164) = 9.69, P = .02], suggesting
assistive technology with their child using a that the source of information was related to
scale from “not at all” to “very” competent. competence. Competency when information
A total of 10.4% caregivers self-reported that and training were received from an early in-
they were “not at all competent,” 51.2% re- tervention provider was compared with com-
ported that they were “competent in some sit- petency when received from another source,
uations but not in others,” 25.0% felt “overall, such as another parent, local expos or fairs,
somewhat competent in all areas,” and 13.4% a local lending library as represented in
felt “very competent.” Figure 2. Of the caregivers who reported be-
Caregiver self-ratings of competency and ing very competent, 68.2% had received in-
the general question about sources of informa- formation from an early intervention provider
tion and training were analyzed using the χ 2 and 31.8% received it from another source. Of
statistic to examine whether caregivers who the caregivers who reported being not at all

Table 7. Caregivers Report Sources for AT Solutions for Specific Activities and Routinesa

Routine EI Provider Internet Workshop Friend/Family Trial and Error

Bath time 33.9 (41) 17.4 (21) 9.1 (11) 17.4 (21) 22.3 (27)
Morning routine 32.5 (25) 18.2 (14) 13.0 (10) 15.8 (12) 20.8 (16)
Evening routine 36.7 (18) 8.2 (4) 8.2 (4) 22.4 (11) 24.5 (12)
Mealtime 47.3 (35) 12.2 (9) 5.4 (4) 8.1 (6) 27.0 (20)
Play 45.7 (21) 10.9 (5) 4.3 (2) 10.9 (5) 28.3 (13)
Leaving the house 35.3 (12) 8.8 (3) 11.8 (4) 14.7 (5) 29.4 (10)
Running errands 30.3 (10) 15.2 (5) 9.1 (3) 12.1 (4) 33.3 (11)
Family routines 26.9 (7) 19.2 (5) 7.7 (2) 11.5 (3) 34.6 (9)
Physical activities 30.0 (20) 9.0 (6) 7.5 (5) 11.9 (8) 41.8 (28)
Family outings 36.4 (12) 9.1 (3) 9.1 (3) 15.4 (5) 30.3 (10)

a Values represent % (count).

178 INFANTS & YOUNG CHILDREN/JULY–SEPTEMBER 2010

100
Number of Caregivers (%) 90
80
70
60 Very competent Not competent
50 caregivers caregivers

40
30
20
10
0
A lot Some A little None A lot Some A little None
Amount of information and training

Information Training

Figure 1. Amount of information and training received and competency.

competent, only 23.5% had received informa- tence on success in finding a solution for the 4
tion from an early intervention provider and competence levels (F3,152 = 2.66, P = .050).
76.5% had received it from another source. Post hoc comparisons using the Tukey HSD
test indicated that the mean score for care-
Caregivers’ report of finding solutions givers rating themselves as very competent
and using assistive technology (M = 0.82, SD = 0.28) was significantly dif-
A series of one-way ANOVAS was con- ferent from the mean score of caregivers
ducted to examine the relationship between who rated themselves as not at all competent
competency and solutions and competency (M = 0.51, SD = 0.32), P = .06. The mean
and assistive technology. A one-way between- score of caregivers who rated themselves as
subjects ANOVA (with P value set to .10) com- competent in some situations (M = 0.59,
pared the effect of number of times a solution SD = 0.38) was different from that of care-
was found when caregivers identified them- givers who rated themselves as overall com-
selves as not at all competent, competent in petent (M = 0.61, SD = 0.28), P = .06. Signif-
some situations but not others, overall com- icant differences were not found between the
petent in all areas, and very competent. There other groups.
was a significant effect of reported compe- A one-way between-subjects ANOVA (with
P value set to .10) was conducted to com-
100 pare the effect of reported competency on the
Frequency (%)

80 extent to which the identified solution was

60 assistive technology use. There was a signif-
40 icant effect of reported competence on suc-
20 cess in finding a solution for the 4 compe-
0 tence levels (F3,152 = 7.98, P < .0001). Post
EI provider Other
hoc comparisons using the Tukey HSD test
Sources of AT
indicated that the mean score for caregivers
Not competent Very competent
rating themselves as very competent (M =
Figure 2. Sources of assistive technology and com- 0.68, SD = 0.33) was significantly different
petency. from the mean score of caregivers who rated
 Caregiver Perspectives on Assistive Technology
themselves as not at all competent (M = 0.17,
SD = 0.29), P = .00; somewhat competent
(M = 0.31, SD = 0.35), P = .00; and over-
all competent (M = 0.68, SD = 0.33), P =
.01. Significant differences were not found be-
tween the other groups.
DISCUSSION
Caregivers in this study reported that their
children faced barriers and obstacles through-
out their day that prevented them from fully
participating in their daily activities/routines,
a finding that is consistent with other pub-
lished reports (Chung et al., 2008; Korpela
et al., 1992; Mistrett, 2001; Østensjø et al.,
2005; Wilcox, Dugan, et al., 2006). Motor in-
abilities such as postural misalignment or po-
sitioning limitations were the most frequent
caregiver-reported problems but deficits in
self-help/independence were also frequently
reported. These barriers and obstacles such as
postural misalignment, positioning, and self-
help/independence resulted in identification
of bath time, morning routine, mealtime, and
physical activities as the most problematic of
the listed activities/routines. These problem
activities/routines were similar to those re-
ported by caregivers of children with autism
who also identified bath time and morning
routine as problems for their children and re-
ported difficulties performing the task or do-
ing it independently as main reasons why the
activity/routine was a problem (Cardon et al.,
in press).
Nearly half of the children with physical dis-
abilities’ caregivers used some type of posi-
tioning device, including both low-tech items
and customized devices, a not surprising find-
ing based on the types of problems these chil-
dren commonly experience. Positioning de-
vices allow children to maintain proper posi-
tioning and posture as well as provide trunk
support and stability to enable movement of
arms and legs, thereby promoting participa-
tion in a multitude of activities such as feed-
ing or playing games (Chung et al., 2008).
Only 7% of caregivers reported using some
type of mobility device. The low use of mo-
179
bility devices may have been associated with
the young age of the study children and a
lack of priority for mobility due to children’s
ages. In addition, the children’s caregivers did
not report high numbers of communication
problems. Consistent with these low reports,
pictures and communication aids were rarely
used with these children.
Implications for early
intervention providers
Early intervention providers play instru-
mental roles in teaching caregivers about as-
sistive technology use. The opportunities that
providers have to work directly with children
and caregivers within activities/routines con-
tribute to caregivers’ feelings of competence
in using adaptation and assistive technol-
ogy interventions with their children. When
providers and caregivers work together to use
assistive technology, caregivers report feel-
ing competent particularly in identifying so-
lutions for facilitating their children’s involve-
ment in activities/routines and in using assis-
tive technology to do so. The most competent
caregivers in this study reported receiving a
lot of information and training from their early
intervention providers, emphasizing the im-
portant role that early intervention providers
play as a source of information about assistive
technology for children’s caregivers.
Providers help families find solutions to
problem situations, first by learning that there
is a challenge being faced by caregivers and
second by working together to design and im-
plement successful solutions. Although care-
givers were successful in finding solutions for
60% of the situations they identified as prob-
lems, 40% of the reported problems remained
unsolved, indicating a need for providers to
help caregivers address all problems and to
be knowledgeable about a range of assistive
technology devices since these have been re-
ported as successful solutions in this as well
as other research studies (Dugan et al., 2006;
Long et al., 2007; Wilcox, Guidmond, et al.,
2006).
Providers are also teachers of caregivers.
Once solutions are identified, providers can
180 INFANTS & YOUNG CHILDREN/JULY–SEPTEMBER 2010
teach caregivers how to successfully use
assistive technology within activities/
routines. Training includes ensuring that the
caregiver understands what the device is,
how to use it, why it is being used, or what
skills are being addressed. This training may
include demonstration, modeling, having the
caregiver practice, and offering feedback.
Since children are constantly growing and
developing, assessing the effectiveness of the
assistive technology in promoting the child’s
participation within an activity/routine is an
ongoing role of the provider. Making adapta-
tions and modifications and even fabricating
simple devices are other roles for providers.
Caregivers need to feel supported so they are
able to feel confident when using assistive
technology with their children and so they
continue to use it in order to provide their
children with the maximum opportunities
to actively engage within their environments
(Judge, 2000).
Providing assistive technology devices and
services to children and their caregivers is a
process that extends further than simply sug-
gesting particular devices. It is imperative that
caregivers be included in the assistive technol-
ogy process from the beginning. Caregivers
must be considered part of the team and play
a major role in the assessment process by
providing essential information about their
children (Parette, VanBiervliet, & Hourcade,
2000). Providers can then present caregivers
with appropriate options and together make
a decision about what is best for the child.
It is important for providers to consider cul-
tural and family values when selecting devices
in order to increase the likelihood the device
will be used and eliminate the possibility of
abandonment as much as possible (Parette &
Brotherson, 2004).
Competency and assistive
technology use
A majority of caregivers in this study re-
ported feeling competent at using a device in
one situation but not others and only 13.4%
felt very competent across all situations. Care-
givers with the highest levels of competency
were more likely to find solutions to their
problems, thereby promoting children’s par-
ticipation in activities/routines; however, dis-
appointingly, the percentage of caregivers re-
porting high competence was very low. That
caregivers who had received more training
and information felt more competent sug-
gests that information and training activities
are 1 strategy to use to increase caregivers’
competency. A similar finding resulted when
measuring competency of early intervention
providers (Weintraub & Wilcox, 2006) where
the amount of training and experience with
assistive technology was related to increased
competency.
These implications are 2-fold. Results sug-
gest that information and training from early
intervention providers increases both care-
giver competence and successful use of
assistive technology as a solution to problems
encountered in their children’s activities/
routines. However, increased information and
training also contribute to providers’ com-
petence and effectiveness in adequately sup-
porting caregivers. When early intervention
providers do not or are unable to provide
caregivers with information and training, care-
givers are not likely to learn about different as-
sistive technologies or feel competent in using
them as solutions for children’s participation
in activities/routines.
Early intervention providers need to have
a lot of information and training about as-
sistive technology because they are a pri-
mary source of information for caregivers.
Providers may not be receiving enough infor-
mation and training about assistive technol-
ogy that may be the root of their inadequacy
in helping caregivers. Some evidence suggests
that providers are not receiving enough ed-
ucation in school about assistive technology,
especially for young children with recommen-
dations for more emphasis be placed on as-
sistive technology during preservice prepa-
ration (Campbell, Milbourne, Chiarello, &
Wilcox, 2009; Weintraub & Wilcox, 2006).
However, technology is ever-changing and ed-
ucation needs to continue beyond school.
Providers need to take on the responsibility
 Caregiver Perspectives on Assistive Technology
of keeping up-to-date about the latest assistive
technology approaches and ideas. Training
and continuing education courses empha-
sizing the use of assistive technology with
infants, toddlers, and caregivers should be
offered by professional development organi-
zations, early intervention agencies, or profes-
sional associations.
Limitations
The caregivers of infants and toddlers with
physical disabilities who participated in this
study are not a good representation of the
general population. A majority of caregivers
were middle-class white mothers with a col-
lege degree living in a 2-parent household in
the suburbs. A more diverse population may
not have participated since the survey was ad-
ministered online and access to a computer or
Internet may not have been possible for peo-
ple from low socioeconomic status or various
age or culture groups. Further investigation
with a more representative sample may yield
different results.
There are also inherent limitations in survey
research that was the way in which data were
collected in this study. There is often discon-
nect between what respondents report and
what actually occurs (Wilcox, Dugan, et al.,
2006). The survey data provide important in-
formation as an initial investigation; however,
additional research needs to be conducted
that utilizes different methodologies in order
to yield more accurate results and better rep-
resent the general population.
Future research
Information resulting from this study of-
fers a starting base on which to build addi-
tional research studies. Qualitative method-
REFERENCES
Besio, S. (2002). An Italian research project to study the
play of children with motor disabilities: The first year
of activity. Disability and Rehabilitation, 24(1–3),
72–79.
Brotherson, M. J., Cook, C. C., & Parette, H. P. (1996).
A home-centered approach to assistive technology
181
ologies such as interviews or focus groups
provide a way in which a greater depth of in-
formation could be obtained. For example, in-
terviews with caregivers may result in more
information about assistive technology includ-
ing how the early interventionist introduced
the device, how the device is used, and other
devices or methods used by the caregiver to
find a successful solution. Direct observation
methods would also be useful in eliminating
the disconnect between what is reported by
caregivers and what is actually occurring by
allowing researchers to identify strategies that
providers use to explain and teach use of
assistive technology to caregivers. Similarly,
conducting interviews and focus groups with
providers would provide information about
how they have been trained and how they
teach caregivers to use assistive technology
within activities/routines.
Assistive technology continues to be under-
utilized, which suggests that traditional meth-
ods of disseminating information are not ef-
fectively reaching targeted audiences. Finding
ways in which information can be better dis-
seminated to early intervention providers may
be 1 strategy to help increase the use of assis-
tive technology. Early intervention providers
need to receive updated information about as-
sistive technology, receive training on how to
use it in order to increase their competency,
and be educated on how to best support care-
givers when using assistive technology. The
benefits of assistive technology have been
established; however, more information on
its specific uses with infants and toddlers
is needed. Strategies for increasing assistive
technology use are also needed so that under-
utilization and abandonment do not continue
to be reported trends.
provisions for young children with disabilities. Focus
on Autism and Other Developmental Disabilities,
11(2), 86–95.
Campbell, P. H. (2004). Participation-based services: Pro-
moting children’s participation in natural settings.
Young Exceptional Children, 8(1), 20–29.
182 INFANTS & YOUNG CHILDREN/JULY–SEPTEMBER 2010
Campbell, P. H., Milbourne, S., Chiarello, L., & Wilcox,
M. J. (2009). Preparing related services personnel for
work in early intervention. Infants & Young Chil-
dren, 22(1), 21–31.
Campbell, P. H., Milbourne, S., Dugan, L. M., & Wilcox,
M. J. (2006). A review of evidence on practices for
teaching young children to use assistive technology
devices. Topics in Early Childhood Special Educa-
tion, 26, 3–13.
Campbell, P. H., Milbourne, S., & Wilcox, M. J. (2008).
Adaptation interventions to promote participation in
natural settings. Infants & Young Children, 21(2),
94–106.
Cardon, T. A., Wilcox, M. J., & Campbell, P. H. (in press).
Young children with ASD: Caregiver perspectives
about assistive technology use during activities/
routines. Unpublished manuscript, Arizona State
University.
Chung, J., Evans J., Lee, C., Lee, J., Rabbani, Y., Roxbor-
ough, L., et al. (2008). Effectiveness of adaptive seat-
ing on sitting posture and postural control in children
with cerebral palsy. Pediatric Physical Therapy, 20,
303–317.
Daniels, L. E., Sparling, J. W., Reilly, M., & Humphry, R.
(1995). Use of assistive technology with young chil-
dren with severe and profound disabilities. Infant-
Toddler Intervention, 5, 91–112.
Dugan, L. M., Campell, P. H., & Wilcox, M. J. (2006). Mak-
ing decisions about assistive technology with infants
and toddlers. Topics in Early Childhood Special Ed-
ucation, 26(1), 25–32.
Dunst, C. J., Hamby, D., Trivette, C. M., Raab, M., &
Bruder, M. B. (2000). Everyday family and commu-
nity life and children’s naturally occurring learning
opportunities. Journal of Early Intervention, 23(3),
151–164.
Holder-Brown, L., & Parette, H. P. (1992). Children with
disabilities who use assistive technology: Ethical con-
siderations. Young Children, 47(6), 73–81.
Individuals with Disabilities Education Act reautho-
rization (1997). Washington, DC: US Government,
Department of Education.
Isabelle, S., Bessey, S. F., Dragas, K. L., Blease, P., Shep-
herd, J. T., & Lane, S. J. (2002). Assistive technology
for children with disabilities. Occupational Therapy
in Health Care, 16(4), 29–51.
Judge, S. L. (2000). Accessing and funding assistive tech-
nology for young children with disabilities. Early
Childhood Special Education, 28(2), 125–131.
Judge, S. (2002). Family-centered assistive technology
assessment and intervention practices for early in-
tervention. Infants & Young Children, 15(1), 60–
68.
Judge, S., Floyd, K., & Wood-Fields, C. (2010). Creating a
technology-rich learning environment for infants and
toddlers with disabilities. Infants & Young Children,
23(2), 84–92.
Judge, S. L., & Parette, H. P. (1998). Family-centered assis-
tive technology decision making. Infant-Toddler In-
tervention, 8(2), 185–206.
Kemp, C. E., & Parette, H. P. (2000). Barriers to minority
family involvement in assistive technology decision-
making processes. Education and Training in Men-
tal Retardation and Developmental Disabilities,
35(4), 384–392.
Kinsley, T. C., & Langone, J. (1995). Applications of tech-
nology for infants, toddlers, and preschoolers with
disabilities. Journal of Special Education Technol-
ogy, 12(4), 312–324.
Korpela, R. A., Seppänen, R.-V., & Koivikko, M. (1992).
Technical aids for daily activities: A regional survey
of 204 disabled children. Developmental Medicine
and Child Neurology, 34, 985–998.
Lahm, E. A., & Sizemore, L. (2002). Factors that influence
assistive technology decision-making. Journal of Spe-
cial Education Technology, 17(1), 15–26.
Lane, S. J., & Mistrett, S. G. (1996). Play and assistive
technology issues for infants and young children
with disabilities: A preliminary examination. Focus
on Autism and other Developmental Disabilities,
11(2), 96–104.
Lane, S. J., & Mistrett, S. G. (2000). Let’s play! Assis-
tive technology interventions for play. Young Excep-
tional Children, 5(2), 19–27.
Langone, J., Malone, D. M., & Kinsley, T. (1999). Technol-
ogy solutions for young children with developmental
concerns. Infants & Young Children, 11(4), 65–78.
Lesar, S. (1998). Use of assistive technology with young
children with disabilities: Current status and training
needs. Journal of Early Intervention, 21(2), 146–
159.
Long, T., Huang, L., Woodbridge, M., Woolverton, M.,
& Minkel, J. (2003). Integrating assistive technology
into an outcome-driven model of service delivery. In-
fants & Young Children, 16(4), 272–283.
Long, T., Woolverton, M., Perry, D. F., & Thomas, M.
J. (2007). Training needs of pediatric occupational
therapists in assistive technology. The American
Journal of Occupational Therapy, 61(3), 345–354.
Mistrett, S. (2001). Synthesis on the use of assistive tech-
nology with infants and toddlers (birth through
age two) (Contract No. HS97017002, Task Order No.
14). Washington, DC: U.S. Department of Education,
Office of Special Education Programs, Division of Re-
search to Practice.
Mistrett, S. (2004). Assistive technology helps young chil-
dren with disabilities participate in daily activities.
Technology in Action, 1(4), 1–8.
Msall, M. K., Rogers, B. T., Ripstein, H., Lyons, N., &
Wilczenski, F. (1997). Measurements of functional
outcomes in children with cerebral palsy. Mental Re-
tardation & Developmental Disabilities Research
Reviews, 3(2), 194–203.
Østensjø, S., Carlberg, E. B., & Vøllestad, N. K. (2005).
The use and impact of assistive devices and other en-
vironmental modifications on everyday activities and
 Caregiver Perspectives on Assistive Technology
care in young children with cerebral palsy. Disability
and Rehabilitation, 27(14), 849–861.
Parette, H. P. (1997). Assistive technology devices and ser-
vices. Education and Training in Mental Retarda-
tion and Developmental Disabilities, 32(4), 267–
280.
Parette, H. P., & Brotherson, M. J. (2004). Family-
centered and culturally responsive assistive technol-
ogy decision-making. Infants & Young Children,
17(4), 355–367.
Parette, H. P., & McMahan, G. A. (2002). What should
we expect of assistive technology?: Being sensitive to
family goals. Teaching Exceptional Children, 35(1),
56–61.
Parette, H. P., & VanBiervliet, A. (1991). Rehabilitation as-
sistive technology issues for infants and young chil-
dren with disabilities: A preliminary examination.
Journal of Rehabilitation, 57(3), 27–36.
Parette, H. P., VanBiervliet, A., & Hourcade, J. J. (2000).
Family-centered decision-making in assistive tech-
nology. Journal of Special Education Technology,
15(1), 45–55.
Ryan, S. E., & Campbell, K. A. (2009). Evaluation of a
parent-report diary of the home use of assistive de-
vices by young children with cerebral palsy. Disabil-
183
ity and Rehabilitation: Assistive Technology, 4(3),
189–197.
Stremel, K. (2005). DEC recommended practices: Tech-
nology applications. In S. Sandall, M. L. Hemmeter,
B. J. Smith, & M. E. McLean (Eds.), DEC recom-
mended practices: A comprehensive guide for prac-
tical applications in early intervention/early child-
hood special education (pp. 147–162). Longmont,
CO: Sopris West Educational Services.
Sullivan, M., & Lewis, M. (2000). Assistive technology for
the very young: Creating responsive environments.
Infants & Young Children, 12, 34–52.
Weintraub, H., & Wilcox, M. J. (2006). Characteristics of
early intervention practitioners and their confidence
in the use of assistive technology. Topics in Early
Childhood Special Education, 26(1), 15–23.
Wilcox, M. J., Dugan, L. M., Cambell, P. H., & Guimond,
A. (2006). Recommended practices and parent per-
spectives regarding AT use in early intervention. Jour-
nal of Special Education Technology, 21(4), 7–16.
Wilcox, M. J., Guidmond, A., Campbell, P. H., &
Weintraub-Moore, H. (2006). Provider perspectives
on the use of assistive technology for infants and tod-
dlers with disabilities. Topics in Early Childhood Spe-
cial Education, 26(1), 33–49.