Developmental Neurorehabilitation

ISSN: 1751-8423 (Print) 1751-8431 (Online) Journal homepage: http://www.tandfonline.com/loi/ipdr20

Can you see it too? Observed and self-rated

participation in mainstream schools in students
with and without autism spectrum disorders

Marita Falkmer, Kirsty Oehlers, Mats Granlund & Torbjörn Falkmer

To cite this article: Marita Falkmer, Kirsty Oehlers, Mats Granlund & Torbjörn Falkmer (2013):
Can you see it too? Observed and self-rated participation in mainstream schools in students
with and without autism spectrum disorders, Developmental Neurorehabilitation, DOI:
10.3109/17518423.2013.850751

To link to this article: http://dx.doi.org/10.3109/17518423.2013.850751

Published online: 04 Dec 2013.

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 http://informahealthcare.com/pdr
ISSN: 1751-8423 (print), 1751-8431 (electronic)

Dev Neurorehabil, Early Online: 1–10

! 2013 Informa UK Ltd. DOI: 10.3109/17518423.2013.850751

ORIGINAL ARTICLE

Can you see it too? Observed and self-rated participation in mainstream

schools in students with and without autism spectrum disorders
Marita Falkmer1,2,3, Kirsty Oehlers3, Mats Granlund4, & Torbjörn Falkmer3,5,6
1
School of Education and Communication, CHILD Programme, Institute of Disability Research, Jönköping University, Jönköping, Sweden,
2
Department of Education, Municipality Council of Norrköping, Sweden, 3School of Occupational Therapy & Social Work, Curtin Health Innovation
Research Institute, Curtin University, Perth, WA, Australia, 4CHILD Programme, School of Health Sciences, Institute of Disability Research, Jönköping
University, Jönköping, Sweden, 5School of Occupational Therapy, La Trobe University, Melbourne, Victoria, Australia, and 6Division of Rehabilitation
Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre,
UHL, County Council, Linköping, Sweden

Abstract Keywords
Objectives: To examine the degree to which observations can capture perception of Autism, COP, involvement,
participation, observed and self-rated levels of interactions for students with and without multi-methodological design,
autism spectrum disorders (ASD) were explored. observations, questionnaires
Developmental Neurorehabilitation

Methods: Frequencies and levels of involvement in interactions with classmates were observed
and compared in 22 students with ASD and 84 of their classmates in mainstream schools, using History
a standardized protocol. Self-reported participation measurements regarding interactions with
classmates and teachers from five questionnaire items were correlated with the observations. In Received 24 September 2013
total, 51 516 data points were coded and entered into the analyses, and correlated with 530 Revised 26 September 2013
questionnaire ratings. Accepted 29 September 2013
Results: Only one weak correlation was found in each group. Compared with classmates, Published online 4 December 2013
students with ASD participated less frequently, but were not less involved when they actually
did.
Conclusions: Observations alone do not capture the individuals’ perception of participation and
are not sufficient if the subjective aspect of participation is to be measured.

Introduction [4, 5]. However, awareness that children with cognitive

impairments also experience limitations in their participation
An inclusive school has been a goal for school policies since
has emerged [3]. The notion of participation incorporates the
the Salamanca Declaration declared that all children should
importance of the perceived quality of the school experience
have access to mainstream schools [1]. Inclusive schools
[2]. Participation is therefore not only referring to a student’s
should be designed to meet the unique needs of students,
presence in an activity within a specific context, but also to
encompassing their individual characteristics, interests, abil-
the subjective feeling of having participated [6]. Students’
ities and learning needs. One remaining problem in the
perception of participation is affected both by possibilities to
attempt to evaluate the effectiveness of inclusion as a practice,
attend activities (frequency) and their involvement in a
and refine interventions to promote it, is the lack of a clear
specific activity. Involvement may also be seen as related
definition of the concept of inclusion [2]. However, the
to motivation, which is an important aspect of perceived
possibility to be present, to participate and to achieve goals is
participation [7]. The subjective aspect of participation
often defined as key elements of inclusive schools, indicating
can best be rated by the individual, but the involvement
that mere attendance at school is not enough [2].
(level of engagement) may be observed by others within that
Participation is a complex construct. Despite a general
context [6].
acceptance that participation is crucial in order to feel
It is challenging to collect information directly from
included, there is little agreement on how to document and
children and, hence, participation is often measured by
measure participation [3]. To date, many studies of partici-
observations or reports from parents/teachers rather than from
pation have included children with physical impairments
the children themselves [3]. Observations regarding the
frequency in which students participate in activities can
Correspondence: Professor Torbjörn Falkmer, Senior Research Fellow at gain important information regarding the accessibility of
the School of Occupational Therapy and Social Work, Curtin Health activities. However, students may frequently be observed
Innovation Research Institute (CHIRI), Faculty of Health Sciences, participating in activities in which they are not particularly
Curtin University of Technology, GPO Box U1987, Perth, Western
Australia 6845, Australia. Tel: +61 8 9266 9051. Fax: +61 8 9266 3636. involved [8]. It is, unfortunately, unclear to what extent
E-mail: t.falkmer@curtin.edu.au observations can capture the students’ subjective perception
 2 M. Falkmer et al.
of participation [3]. Self-reports, including the level of
involvement indicates that subjective measurements generate
additional information regarding the experience of participa-
tion [7]. Results regarding how well measurements from
observations and self-ratings correspond in regard to students
with impairments are, however, inconsistent [6, 9].
An increasing number of students with autism spectrum
disorders (ASD) are now attending mainstream schools [10].
Estimations of the prevalence of ASD in school-aged children
indicate that school services have to be prepared for the fact
that approximately 1–2% of their students are likely to have
ASD [11]. Attendance at mainstream schools offers students
with ASD the possibility to interact with peers, which is
crucial for social learning [12, 13]. However, the manifest-
ations of ASD are: impairment of social interaction, impair-
ment of social communication and impairment of social
imagination [14], and these difficulties tend to have a negative
influence on social participation [6, 15, 16]. Consequently, it
has been reported that social interactions between children
with ASD and their peers is markedly different to the social
interaction between children without ASD [17–19]. Children
with ASD tend to have difficulties engaging in spontaneous
interactions with other children, due to the social complexities
of such activities [20, 21]. Children with ASD struggle to
Developmental Neurorehabilitation
begin and maintain friendships and peer relationships often
do not go beyond task-related interactions in the classroom
[20, 22, 23]. It has been hypothesized that impaired ‘‘Theory
of Mind’’, executive functions and emotion recognition may
constitute the constructs underlying poor social competence
[24]. However, persons with ASD may have difficulties
affecting their ability to socially interact also on a basic level
that affect their ability to recognize faces and emotions in
others even though they do not have any intellectual
impairments [25–28]. This could explain the fact that it is
not uncommon that teachers underestimate students’ prob-
lems related to participation [29]. Furthermore, for students
with ASD there seems to be a discrepancy between self-
reports and observations of their involvement in social
networks in the classroom [9]. The divergence between how
students with ASD are perceived and how they perceive
themselves in relation to participation could be due to a weak
‘‘Theory of mind’’, which is regarded as a core characteristic
in ASD [30]. As a consequence, students with ASD encounter
difficulties to reflect not only upon others’ minds but also
upon their own minds. Differences between self-reported and
observed participation may therefore be a result of students
with ASD being unaware of the existence of varying levels of
participation [9]. For example, students may report that they
have lots of friends, while rarely being observed interacting
with classmates. Another possibility may be that students with
ASD do perceive their situation differently and, despite
observed lack of participation based on the observers’ norms,
still perceive their participation as satisfactory [9, 31].
Differences between self-ratings and observations can also
be due to the fact that the former represent the student’s
interpretation of how a situation generally is perceived, i.e., as
retrospectively measured, whereas observations measure
participation in specific activities as they occur [6].
Finding ways to determine students with ASDs’ level of
participation is essential for the implementation and
Dev Neurorehabil, Early Online: 1–10
evaluation of interventions to promote it [6]. In order to
develop assessment tools when planning interventions to
promote participation, knowledge regarding the correspond-
ence between self-ratings, observed participation and levels of
involvement in children with ASD in mainstream schools
needs to be further expanded. Hence, the aim of the present
study was to investigate correlations between observed and
self-rated levels of interactions in students with and without
ASD. Furthermore, the frequencies and involvement in
interactions with classmates and other activities in students
with and without ASD were compared.
Methods
Participants
Information letters and invitations were sent out to families
included in registers at The Swedish National Autism and
Asperger Association and their local associates, paediatric
clinics and local support teams in special education that had a
child with ASD in year 3–6 in Swedish mainstream schools.
For ethical reasons, the authors did not have information
about exactly how many invitations to participate were sent
out and had no information regarding the families that
received the information, since the families were identified
through the before mentioned organization. Hence, the first
author was contacted by the families that were willing to
participate but did not receive any information about families
that did not consider participating in the study. Unfortunately,
this procedure made it impossible to conduct a drop-out
analysis.
If the parents consented to their child participating in the
study, they contacted the first author. If the child, the
headmaster and the classroom teacher/teachers also all gave
their written informed consent/assent to participate, the child
was included in the study. Twenty-two students with ASD
(16 boys) 9–13 years old (mean age 10.7, median 11, standard
deviation [SD] 1.1) were included in the study. The rationale
for choosing to include students of these age groups was two-
folded. First, a self-rated measurement of participation was
administered, in which students were asked to independently
read and fill in a questionnaire. Grade 3 was considered to
constitute the lowest possible grade, in which a majority of
students could manage such a task. Second, in the Swedish
school system, students up to grade 6 are frequently taught in
one single classroom, aka a ‘‘home room’’, and the class stays
together during the majority of the school-day. In grade 7 and
onwards the students instead attend several classrooms and
are taught by numerous teachers. In order to be able to
observe the student with ASD and his/her classmates in a
well-known social environment, grade 6 was considered to
constitute the highest possible grade to be included in the
present study. The students attended 21 different mainstream
schools. Two of the students with ASD were taught in the
same classroom. As reported by their parents, the students
with ASD were diagnosed by independent medical clinics in
accordance with DSM IV criteria. For ethical reasons, no
medical records were collected. All students with ASD were
following the national curriculum and could therefore be
considered as representing students without an intellectual
impairment.
 DOI: 10.3109/17518423.2013.850751
Classmates attending the same classrooms were given
an information letter and an invitation to participate by
their schools. In accordance with the ethical approval,
the classmates were included if they and/or their parents
did not actively decline participation. Classmates that
declined participation were given alternative activities by
their teacher, whilst participating students filled in the
questionnaire that was included in the data collection of
the present study.
In addition to responding to the questionnaire, students
with ASD and four of his/her classmates (two girls and two
boys who had not declined participation) were observed
during lectures and recess. Their actions were coded with the
use of the Child Observation in Preschools (COP-2) protocol
[32]. The classmates were selected by the teacher with the
following criteria:
 they were students without any recognized special
education needs; and,
 they were the same age and if the class regularly split up
in groups they frequently attended the same group as the
student with ASD.
Since two students with ASD attended the same classroom,
84 classmates (42 boys, mean age of 10.8, median 11, SD 1.2)
were included in the present study.
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Participation questionnaire
Data on self-rated perceived participation were collected
through a questionnaire. The participation questionnaire used
in the present study consisted of a merged version from two
previously used questionnaires (Children’s participation in
school [age 7–12] and Adolescents’ participation in school
age 13–17). Both questionnaires aimed to measure aspects of
perceived participation in school. The original questionnaires
consisted of a Swedish version of an availability and
participation scale [33] and of a Swedish version of autonomy
and locus of control scales from The Arc’s self-determination
scale [34], adapted to school age children and teenagers.
When used with Swedish children with impairments, moder-
ate to high internal consistency and construct validity have
been reported for the two scales (‘‘Children’s participation
in school’’ and ‘‘Adolescents participation in school’’)
[6, 35–37]. The adaptation of the participation questionnaire
used in the present study consisted of a merged version of the
two original questionnaires. Hence, it was necessary to
minimize the number of statements. Consequently, statements
in the original questionnaire that focused on activities relevant
for students in non-mainstream school settings were removed.
However, the formulations in the original statements, i.e., the
‘‘I do’’, ‘‘I agree’’ and frequency response statements were
kept for validity and reliability reasons. The participation
questionnaire used in the present study comprised
46 statements. The statements included:
 six ‘‘I do’’ statements, e.g., ‘‘Me and my classmates
decide together what to do’’, which asked the student to
indicate what was most in accordance with what the
student usually did;
 thirteen ‘‘I agree’’ statements, e.g., ‘‘My classmates like
me’’, which asked the student to indicate to what degree
he/she agreed with the statement being true and;
Can you see it too? 3
 twenty-seven frequency statements, some of them asking
the student to rate the frequency, e.g., ‘‘I am with my
classmates during recess’’. Some of these statements
were also phrased in order to rate the level of self-
determination in regard to these activities, e.g., ‘‘I want
to be with my classmates during recess’’.
The adapted version of the questionnaire has been
described in previous studies [31, 38]. Five of the original
46 items from the questionnaire regarding interactive
activities that also could be observed according to the COP-
2 protocol were selected as measurements of self-rated
participation: ‘‘I am with my classmates during recess’’,
‘‘I talk to my classmates in the classroom’’, I talk to and am
together with friends my age’’, ‘‘I talk to teachers during
recess’’ and ‘‘My classmates like me’’. They were selected
through a consensus process among three of the authors.
Child observation protocol
COP-2 [32] has previously been used to study social
competence of children in need of special support in
Swedish pre-school classes [39, 40].
As presented in Table I, the COP-2 allows for structured
observations of nine variables, each with different coding
alternatives. The different variables provide information
regarding both frequencies (how often) and type of activity.
The observed level of the child’s engagement in, and focus on,
an activity is rated as the child’s involvement in that activity
in the COP-2. The COP-2 is used to provide a succession of
snapshots of specific child behaviours. This is done by each
observation protocol consisting of 18 snapshots. In the coding
procedure, the first student is located and observed for 3 s.
After that, scoring on all variables in the first line of the
protocol is completed, resulting in a snapshot of the students’
behaviour being recorded. The procedure is then immediately
repeated for each of the five students. This is called an
observation ‘‘sweep’’. Consequently, each ‘‘sweep’’ includes
observations of all the students that are observed, and it
captures the students’ activities within a short period of time.
Each single snapshot may in itself be regarded as providing
insufficient information. However, since each observation
consists of 18 snapshots, combined they provide aggregated
information regarding how children spend their time and
about their preferences. In the present study, the aim was to
capture activities during an ordinary school-day. Hence, the
snapshots were distributed in order to capture activities
during both lectures and recess. In addition to the original
observation guidelines, that only cover observations inside the
classroom, recess was added as a context in which observa-
tions were conducted, since spontaneous unstructured peer
interactions are even more likely to occur during recess.
Before starting the data collection, an inter-rater reliability
was conducted on COP-2, proving a 90% agreement between
the first author and a colleague experienced in child
assessments.
As presented in Table II, coding for relevant variables that
jointly would constitute an observed activity corresponding to
each of the five selected questionnaire items was defined.
If an observation contained a combination of these pre-
defined variables, it was regarded as one count representing
 4 M. Falkmer et al. Dev Neurorehabil, Early Online: 1–10

Table I. The variables constituting one COP-2 observation sweep and the coding alternatives for each variable. Only variables in bold were included in
the counts, as presented in Table II, whereas variables in italics were used for between-groups comparisons, as shown in Tables IV and V. All Materials
and Action variables (in grey) were accepted for all counts and were thus excluded from further analyses.

COP-2 variables
Verbal To whom Schedule Proximity Interaction Type task Involvement Materials Action
No Teacher(T) WG T Non-academicg Passive-instructionm High Math Math
Yes Child SGc Child Parallelh Non-sequentialn Medium/High Literacy Literacy
Listening Small Group Centres (C)d SG Associativei Sequentialo Medium Science Other
Fuss/cry (SG)a SGCe SG/T Cooperativej Fantasy/drama Medium/low Social studies No
SG/T Transition WG Alone None Low Toy
Whole group (WG)b Meal time WG/T Onlooker Otherf Art/music
WG/T Otherf Self Socialk Social Drama
Self Recess Unoccupiedl Disruptive Computer
No talk Gross Motor
TV/Video
No
Can’t code
a
To whom: SG denotes two children or more and does not include a teacher or adult.
b
To whom: WG denotes 75% or more of the class, but without the teacher being present.
c
Schedule: SG refers to non-optional activities facilitated by a teacher or an adult.
d
Schedule: C refers to arranged activities, in which the students have limited choice in regard to which one they choose to do, but they can move around
in the classroom.
e
Schedule: SGC refers to a combination of small groups and centres occurring in the classroom simultaneously.
f
Other is coded if the activity observed is not otherwise listed or described.
g
Interaction: The child is waiting, looking for material, moving from one activity to another.
h
Interaction: The child is using the same materials as the other children, although no observable interaction is occurring.
i
Interaction: The child, with or without the teacher being present, is interacting in a task or an activity with no predetermined outcome or
Developmental Neurorehabilitation

co-constructing ideas.
j
Interaction: The child engaged in formal games and activities with rules and organization.
k
Interaction: The child interacts verbally and not in relation to learning activities.
l
Interaction: Only coded if the child is still not attending any particular activity after two consecutive 3 s observations.
m
The primary task is to listen to teacher or other child.
n
Activity or material that does not include a predetermined series of steps.
o
Activity or material that includes a clear sequence of steps.

one observed activity corresponding to the related question-
naire item. The total amount of observations representing one
statement was summoned and regarded as a measurement for
how often the student was observed as being in the situation
the statement represented. As shown in Table II, the counts
were numbered according to the questionnaire item they
represented, i.e., Count 1 was regarded to correspond to the
statement ‘‘I am with my classmates during recess’’; Count 2
to the statement ‘‘I talk to my classmates in the classroom’’;
Count 3 to the statement ‘‘I talk to and am together with
friends my age’’; Count 4 to the statement ‘‘I talk to teachers
during recess’’ and Count 5 to the statement ‘‘My classmates
like me’’.
Consequently, comparisons between students with and
without ASD regarding observed activities involving different
aspects of interactions were made by comparing numbers of
noted counts. The coding for the COP-2 variable involvement
was analysed as a separate variable, in order to explore the
students’ levels of involvement whilst participating in school
activities and in interactions.
Procedures
The first author visited all classrooms on three different days.
The first day the questionnaire was distributed to all students
that were included in the study. The questionnaire was
collected on the same day. On each day a minimum of 18
observation snap shots (9  18 ¼ 162 coded variables) were
coded for each of the 106 students. The observations were
repeated over three days (486 coded variables/student).
In total, 51 516 variables were coded. Since the classroom
teacher decided which days it was possible to visit the
classroom, the observations could not target specific subjects
or be conducted at the same time of day in each classroom.
However, for all observations, classroom time and recess time
were included. The selected students were not informed that
they, in particular, were observed. Even though the observa-
tions did not take a full day to complete, the first author was
present during three full school-days, in order to make the
presence of an additional adult in the classroom and on the
playgrounds less remarkable.
Statistical analyses
All relevant variables were tested for normal distribution
with the Kolmogorov–Smirnov test. The number of Counts
1–3 and 5 fulfilled that criterion. However, Mann–Whitney
U-tests were conducted for between-groups comparisons
due to the differences in group size. Spearman’s rank
correlation tests were conducted in all correlation analyses,
since the questionnaire item ratings were made on a
Lickert scale, providing ordinal data. The percentages of
Counts were compared between the groups with the use of 2
and Fischer’s exact tests. A power calculation was made on
the assumption of an a-level of 0.05 and a b-level of 0.2,
given a sample size of 22 in the smaller group, showing that a
0.86 Cohen’s d or larger could be detected in the between-
group comparisons. For the correlation analyses, the
 DOI: 10.3109/17518423.2013.850751 Can you see it too? 5
Table II. The coding alternatives within the relevant variables presented in bold in Table I, which constituted the counts corresponding to each of the
five items from the participation questionnaire.

Variable COP-2 codes corresponding to selected questionnaire item

Questionnaire item/count Verbal To whom Schedule Proximity Interaction
‘‘I am with my classmates during recess’’/Count 1 No Child Recess Child Non-academic
Yes SG SG Parallel
Listening WG WG Associative
Fuss/cry No Talk Cooperative
Onlooker
Social
Unoccupied
‘‘I talk to my classmates in the classroom’’/Count 2 Yes Child WG Child Non-academic
Listening SG SG SG Parallel
WG C SG/T Associative
SGC WG Cooperative
Transition Onlooker
Meal time Social
Other Unoccupied
‘‘I talk to and am together with friends my age’’/Count 3 No Child WG Child Non-academic
Yes SG SG SG Parallel
Listening WG C SG/T Associative
SGC WG Cooperative
Transition Onlooker
Meal time Social
Other Unoccupied
Recess
‘‘I talk to teachers during recess’’/Count 4 Yes Teacher Recess T Non-academic
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Listening SG/T Parallel

WG Associative
WG/T Cooperative
Onlooker
Social
Unoccupied
‘‘My classmates like me’’/Count 5 No Child WG Child Non-academic
Yes SG SG SG Parallel
Listening C SG/T Associative
SGC WG Cooperative
Transition Onlooker
Meal time Social
Other Unoccupied
Recess

Table III. Correlations between self-reported and observed participation.

Questionnaire item/count Students with ASC (n ¼ 22) Classmates (n ¼ 84)

I am with my classmates during recess/Count 1 rho ¼ 0.21 (p ¼ 0.34) rho ¼ 0.22 (p ¼ 0.043)*
I talk to my classmates in the classroom/Count 2 rho ¼ 0.17 (p ¼ 0.45) rho ¼ 0.15 (p ¼ 0.18)
I talk to and am together with friends my age/Count 3 rho ¼ 0.20 (p ¼ 0.37) rho ¼ 0.22 (p ¼ 0.050)
I talk to teachers during recess/Count 4 rho ¼ 0.43 (p ¼ 0.049)* rho ¼ 0.02 (p ¼ 0.86)
My classmates like me/Count 5 rho ¼ 0.01 (p ¼ 0.97) rho ¼ 0.07 (p ¼ 0.74)

*Statistically significant correlation.

corresponding correlation coefficient was estimated to be
rho ¼ 0.43 or larger.
Ethical considerations
Information was given regarding the aim and the procedures of
the study and how data would be collected, stored confiden-
tially and published. All students were informed, verbally and
in writing, that they could choose not to fill in the questionnaire
or not to answer individual statements. No explanation for such
an action was required. All students were informed that the first
author would follow the class during three school-days,
observing school activities. However, in order not to affect
the students’ behaviour more than necessary, information
about which students were observed was not given. The study
design and procedures conformed to the Helsinki declaration
and the project was approved by the Regional Ethical
Committee in Linköping, Sweden (Dnr 175-08).
Results
As shown in Table III, a correlation was found in each group.
In classmates, the statement ‘‘I am with my classmates during
recess’’ correlated with Count 1. Another correlation was
found between the statement ‘‘I talk to teachers during
recess’’ and Count 4 in students with ASD. However, most of
 6 M. Falkmer et al. Dev Neurorehabil, Early Online: 1–10

the correlations were weak and non-significant in both
groups.
In a previous questionnaire study, perceived participation
in school activities and social interaction in mainstream
schools was compared between students with and without
ASD [31]. That questionnaire comprised, among other items,
the five items used in the present study. On four of these five
items there were significant differences between the groups,
with the students with ASD rating themselves as participating
less than their classmates. The exception was on the item ‘‘I
talk to teachers during recess’’ where no differences between
the groups was found. An analysis to examine possible
difference in observed participation was therefore conducted,
comparing the two groups in regard to each of the five defined
Counts. As shown in Table IV, there were significant
differences in observed participation in interactions in all
five Counts. Compared with classmates, the students with
ASD were observed as having fewer interactions with
classmates overall, but somewhat more frequent interactions
with teachers.
Analyses were conducted to examine possible differences
between the groups in levels of involvement in regard to the
variable interaction and in regard to specific activities,
defined by the variable type task in the COP-2 protocol.
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interactions were therefore also examined. The definitions of
interactions used in the present study align to those used in the
COP-2, as presented in Table I. The students with ASD were
observed as being alone, unoccupied or an onlooker more
often than classmates. However, no differences between the
groups were found regarding the level of involvement in these
interactions, indicating that there was no significant differ-
ence in how students with and without ASD perceived them.
As shown in Table V, the students with ASD were less
frequently, but with a higher level of involvement, observed to
take part in parallel activities compared with classmates
(mean 3.23 for students with ASD, 3.08 for classmates).
When interaction was coded as ‘‘Parallel’’, it denoted that the
student was observed in proximity to classmates and
participating in an activity in which the student was using
the same materials as the classmates, with no observable
social interaction taking place. The classmates participated
more often than students with ASD in social and cooperative
interactions. The former was defined as the student being
engaged in games and activities with rules and organization,
while the latter was defined as the student, with or without the
teacher being present, interacting in a task or an activity with
no predetermined outcome or co-constructing ideas.
However, no differences in the level of involvement were

As shown in Table V, students with ASD had a higher level
of involvement than classmates when the comparison
included all types of interaction (mean 3.24 for students
with ASD, 3.09 for classmates). Levels of involvement in
regard to specific types of interactions and the observed
frequency in which the two groups participated in specific
found between the groups in those interactions.
In accordance with the results regarding interactions,
students with ASD showed a higher level of involvement
compared with classmates when all types of tasks were
included in the comparison (mean 3.24 for students with
ASD, 3.09 for classmates). Consequently, further

Table IV. Comparisons between the two groups in regard to each of the defined counts.

Students with ASC (n ¼ 22) Classmates (n ¼ 84)

Number Number
Count of counts Mean (SD), median (IQR), range of counts Mean (SD), median (IQR), range Between-groups comparisons
1 170 7.7 (4.0), 7.5 (5.5), 16 861 10.3 (3.8), 11 (5), 17 Z ¼ 2.69, p ¼ 0.007*
2 144 6.5 (3.8), 6.5 (5.25), 14 1032 12.3 (4.9), 11.5 (7), 19 Z ¼ 4.69, p50.001*
3 452 20.6 (8.6), 23 (13.25), 32 2655 31.6 (6.4), 32.0 (10), 26 Z ¼ 5.11, p50.001*
4 20 n.a., 1 (2), 5 14 n.a., 0 (0), 3 Z ¼ 2.81, p ¼ 0.05*
5 447 20.3 (8.5), 22 (13.5), 32 2646 31.5 (6.4), 32 (10), 26 Z ¼ 5.14, p50.001*

*Statistically significant difference.

Table V. Observed level of involvement in interactions overall and across the different types of interactions defined by the coding alternatives in the
COP-2.

Students with ASC (n ¼ 22) Classmates (n ¼ 84) Between-groups comparisons

Involvement Number Median Number Median
in interactions of counts (IQR), range of counts (IQR), range Number of counts Level of involvement
Across all 1170 3, (0), 1–5 4281 3, (0), 1–5 n.a. Z ¼ 7.74, p50.001*
Non-academic 89 3, (1), 2–5 290 3, (1), 2–5 2 ¼ 1.84, p ¼ 0.18 Z ¼ 0.19, p ¼ 0.85
2
Parallel 379 3, (0), 2–5 1734 3, (0), 1–5  ¼ 16.17, p50.001* Z ¼ 4.32, p50.001*
Associative 159 3, (0), 2–5 606 3, (0), 1–5 2 ¼ 0.00, p ¼ 0.98 Z ¼ 1.67, p ¼ 0.096
Cooperative 76 3, (1), 1–5 387 3, (1), 1–5 2 ¼ 5.77, p ¼ 0.02* Z ¼ 1.11, p ¼ 0.27
Alone 175 3, (1), 1–5 171 3, (0), 1–5 2 ¼ 199.15, p50.001* Z ¼ 0.97, p ¼ 0.33
Onlooker 51 4, (1), 1–5 87 3, (0), 1–5 2 ¼ 22.57, p50.001* Z ¼0.45, p ¼ 0.66
Social 191 3, (0), 1–5 929 3, (0), 1–5 2 ¼ 11.60, p ¼ 0.001* Z ¼ 0.41, p ¼ 0.68
Unoccupied 50 5, (0.25), 3–5 77 5, (1), 3–5 2 ¼ 27.37, p50.001* Z ¼ 0.06, p ¼ 0.95
Missing data 18 n.a. 255 n.a. n.a. n.a.

n.a., Not applicable.

*Statistically significant difference.
 DOI: 10.3109/17518423.2013.850751 Can you see it too? 7
Table VI. Observed level of involvement across all tasks overall and across the different types of tasks defined by the coding alternatives in the COP-2.

Students with ASC (n ¼ 22) Classmates (n ¼ 84) Between-groups comparisons

Involvement Number Number
in tasks of counts median (IQR), range of counts Median (IQR), range Number of counts Level of involvement
Across all 1170 3, (0), 1–5 4278 3, (0), 1–5 n.a. Z ¼ 5.74, p50.001*
Passive instruction 215 3, (1), 2–5 867 3, (0), 1–5 2 ¼ 0.63, p ¼ 0.43 Z ¼ 3.92, p50.001*
Non-sequential 270 3, (0), 1–5 1111 3, (0), 1–5 2 ¼ 1.60, p ¼ 0.21 Z ¼ 2.57, p ¼ 0.010*
Sequential 291 3, (0), 1–5 915 3, (0), 1–5 2 ¼ 10.58, p ¼ 0.001* Z ¼ 0.83, p ¼ 0.41
¥
Fantasy/drama 0 n.a. 4 n.a. p ¼ 0.31 n.a.
None 89 4, (1), 3–5 147 4, (2), 3–5 2 ¼ 43.03, p50.001* Z ¼ 0.52, p ¼ 0.61
2
Other 115 3, (1), 2–5 281 4, (1), 1–5  ¼ 17.76, p50.001* Z ¼ 0.41, p ¼ 69
Social 181 3, (0), 1–5 916 3, (0), 1–5 2 ¼ 14.94, p50.001* Z ¼ 0.71, p ¼ 0.48
Disruptive 9 n.a. 37 n.a. 2 ¼ 0.04, p ¼ 0.84 n.a.
Missing data 18 n.a. 258 n.a. n.a. n.a.

n.a., Not applicable.

*Statistically significant difference.
¥
Fisher’s exact test.

examinations of the frequency and level of involvement in
specific tasks were conducted. As shown in Table VI, a
difference in the observed level of involvement was found
between the groups when the students participated in the tasks
defined as passive instructions (mean 3.36 in students with
Developmental Neurorehabilitation
A further finding of this study indicated that students with
ASD had a higher level of involvement than classmates when
measured across all interactions. However, the difference was
found only in regard to interactions coded as ‘‘Parallel’’. This
raises the question of the value of involvement itself, and

ASD, 3.17 in classmates) and non-sequential (mean 3.1 in
students with ASD, 2.9 in classmates). Compared with
classmates, students with ASD participated more frequently
in tasks defined as sequential, none and other, and less
frequently in tasks defined as social. However, no differences
in the level of involvement were found between the groups in
those tasks.
Discussion
There are several key findings in this study. First, the results
show a discrepancy between students’ self-rated/perceived
and their observed participation in interactions. However, this
was not specifically the case for students with ASD but for all
students. This is in accordance with previous results
concluding that information collected from self-ratings pro-
vides information that cannot be obtained through observa-
tions [41]. Observed and self-rated participation capture
different aspects of participation and the use of both
measurements will contribute to a better understanding of
the student’s participation in school. The self-rated/perceived
participation is probably a measurement of the students’
perception of participation as it is perceived on average, while
observed participation is more dependent on contextual
factors occurring during the observation. Self-reports may
also be influenced by the students’ desire to report in
accordance to what they perceive the researcher wants to
report [42]. However, due to ‘‘Theory of mind’’ difficulties,
this is less likely to occur in the group of students with ASD
[43]. This finding leads us to suggest that observed and self-
rated measurements could be seen as complementary. For
example, the results that students with ASD were observed
less frequently in interactions with classmates confirm the
previous results from the questionnaire study [31]. However,
observations give more detailed information regarding which
specific interactions the groups differ in and the level of
involvement in interactions [40].
queries the importance of whether that involvement relates to
participating in activities that occur with, alongside or
separate to peers. Involvement, as coded in the COP-2 tool,
is rated based on to what extent the child is observed being
intently focussed in a meaningful and purposeful way while
performing an activity. The psychological benefits of involve-
ment include the development of qualities such as persistence;
the establishment of a sense of achievement; the acquisition
of skills and the formation of a sense of well-being and
belonging [44]. These qualities heighten motivation and
involvement for children, which are important aspects of
participation [44].
Students with ASD are impaired in relation to social
functioning [45]. However, most students with ASD do have
an interest in establishing social relations, but their difficulties
with social interaction may result in few opportunities for
positive interactions with classmates [46, 47]. Our results
showed higher levels of involvement in students with ASD
compared with their classmates in parallel activities.
Interventions in order to facilitate interactions between
classmates with and without impairments have been sug-
gested as necessary in inclusive settings [18, 20, 22, 23, 40].
Parallel activities may therefore be considered as an important
means of engaging children with ASD in social interactions in
a school setting. Involvement in parallel activities in close
proximity to peers has been reported to serve an important
function in typical social development [48–50]. Parallel
activities provide an opportunity to synchronize actions to
those of others in close proximity [48]. To do the same thing
at the same time offers opportunities to interact and commu-
nicate about that particular activity. As a result, parallel
activities often transfer into more socially focused activities
[48]. Participation in age appropriate constructive parallel
activities has been reported to be positively correlated with
popularity among peers [50]. Popularity among classmates is
essential, as positive relations between students with and
 8 M. Falkmer et al.
without ASD are reported by parents as an important factor to
enhance inclusiveness in schools [51–54].
Interestingly, classmates were observed as more frequently
participating in activities in which the interaction was coded
as ‘‘Parallel’’ than students with ASD. This may be an
indication that such activities often occur in mainstream
schools. The high frequency and the fact that these activities
are less socially challenging and therefore more predictable
for students with ASD, may explain their increased involve-
ment in parallel activities. Although students with ASD
participated less frequently in social interaction and social
tasks, they were as involved whilst doing so as their
classmates. In other words, our observations indicate that
children with ASD were observed as being highly involved in
social interactions even though they participated less fre-
quently in this type of interaction. This indicates that the
students with ASD, in fact, enjoyed interacting with class-
mates. However, this finding raises an important question that
should be thoroughly assessed in each students with ASD,
namely, do they get the opportunity to interact as often as they
wish to? The finding regarding frequency and involvement in
interactions where students with ASD participated more
frequently than classmates in tasks with supposedly less social
demands (sequential, none, other) may further emphasize the
Developmental Neurorehabilitation
importance of assessing whether the students with ASD
perceive that they have the possibility to interact to the extent
they want to or not. However, they were not different in regard
to their involvement compared with their classmates in these
tasks. The fact that students with ASD were more involved
than classmates in non-sequential tasks may also indicate that,
even if activities that are predictable are perceived as safer to
participate in, unstructured tasks can be appreciated and bring
about high levels of involvement.
The outcome that students with ASD were onlookers more
often than their classmates may to some extent be due to a
lack of skills in social participation. This can also partly
explain a higher frequency in teacher interactions, since
teachers often attend to passive students [39]. An awareness
of this pattern may serve as a guide to teachers to facilitate
peer interaction as an alternative to engaging the student in
teacher/student interaction. The importance of the develop-
ment of active strategies by teachers to facilitate peer relations
rather than engaging in interaction with the student with ASD
is emphasized by findings that frequent, passive, solitary
activities tend to be associated with social isolation later in
the child’s life [55].
Some results regarding involvement in activities for
students with ASD are intriguing. They were observed as
more involved in passive instruction tasks that require
listening skills which, considering the communication
difficulties related to ASD, is somewhat surprising.
However, passive instructions are a parallel activity with
limited social demands. This fact may indicate that the
students included in the present study represented a group of
children with ASD with good language skills.
Limitations
It could be argued that the perception of being liked by
classmates (Count 5) is not possible to observe. However, an
Dev Neurorehabil, Early Online: 1–10
expected consequence of high questionnaire rankings regard-
ing the perception of being liked by classmates should be
observable as frequent, highly involved social interactions
with classmates. As a matter of fact, we found that we could
observe both frequency and involvement with respect to social
interactions, and whereas the involvement was not different
between the two groups, the frequency was much higher
among the classmates. We could also confirm the findings
regarding this item from a previous study [31], suggesting that
it may be observable after all. However, comparisons between
observed and self-rated participation measurements will
always be challenging. In the present study, two previously
validated tools, a questionnaire and COP-2 were used, but
their criterion validity has not been explored, which suggests
that the finding of the present study should be regarded with
adequate caution. With respect to the power of the study, the
sample size in the ASD group was small but large enough to
be able to identify moderate correlations and large between
group differences. However, the significant correlation
reported in the group of classmates could be due to a Type
I error.
The use of COP-2 provided a structured overview of
activities and interaction during a school-day. The protocol is
developed for pre-school classrooms but the focus of the
protocol is on the social dimension of the activity and not the
activity per se, which makes it possible to obtain useful
information regarding social participation also in older school
children. However, the aggregated time each child was
observed is limited and the observations made in the present
study do not claim to capture the full extent of the students’
activities and interactions during three school-days. In future
research, other means of observations, and other tools for self-
rated participation should be employed, in order to expand the
knowledge regarding correspondence between self-rated and
observed participation in social interactions and activities for
students with and without ASD.
A limitation of the present study was that the children’s
ASD diagnoses were not specified. Furthermore, their
diagnoses were not confirmed by independent researchers.
For ethical reasons, possible intellectual impairments were
not checked for, medical records were not collected and no
assessments of the included students’ social functioning were
done. Consequently, the fact that the students with ASD were
reported to follow the national curricula does not absolutely
ensure that they actually did meet the required standard of the
curricula. It only suggests so. Furthermore, the categoriza-
tions of children into specific diagnoses included in the ASD,
such as autism or Asperger syndrome, rely on clinical
definitions and are dependent on behavioural assessments
which are susceptible to interpretive bias [56]. The manifest-
ations of these specific diagnoses may vary greatly between
two children with the same diagnosis, which indicates the
subjectivity of determining them [57]. Nevertheless, all ASD
diagnoses include manifest impairments in regard to social
and communicational abilities and unusual, restricted or odd
behaviours, [45]. These are features that are likely to have a
negative influence on participation regardless of any specific
ASD diagnosis [58, 59]. Acknowledging that communication
and social difficulties associated with ASD may entail
specific challenges, the focus of the present study was to
 DOI: 10.3109/17518423.2013.850751
examine students with ASDs’ perception of participation and
observe it in social interaction and activities in mainstream
schools. Hence, the lack of specified diagnoses does not
diminish the results of the present study but it could be
assumed that the results are primarily valid for a verbal
subgroup of students with ASD with average or above average
intellectual functioning and academic performance.
Furthermore, the observed classmates were chosen in collab-
oration with the teacher who was explicitly asked to include
students that together represented the heterogeneity in the
classroom and to exclude students with recognized special
education needs. However, it is possible that the teachers
tended to choose well adapted and socially able students. The
observed differences may therefore be larger than if a control
group matched on social functioning had been selected.
Conclusions
Compared with classmates, students with ASD participated
less frequently, but were not less involved when they did.
However, observations do not sufficiently capture the indi-
viduals’ perception of participation and are thus not sufficient
to measure participation. Students with ASD were indeed
observed to participate less frequently in interactions with
classmates, but, no differences in level of involvement were
Developmental Neurorehabilitation
found between the groups in those interactions.
Students with ASD showed higher levels of involvement
compared to their classmates in parallel activities. Organized
parallel activities may therefore be considered as one means
of engaging children with ASD in social interactions in a
school setting. However, the findings also raise an important
question that may have to be thoroughly assessed in each
individual with ASD, namely; do they get the opportunity to
interact as often as they wish to?
Acknowledgements
The authors thank the participating students, their parents, the
schools. We also thank AUW-Konsult for their assistance in
entering data from the questionnaires.
Declaration of interest
This study was funded by The Department of Education,
Municipality Council of Norrköping, Sweden, The Swedish
Inheritance Fund, The Sunnerdahl’s Foundation, The Sven
Jerring Foundation and The Clas Groschinsky’s Foundation.
The authors report no conflict of interest. The authors alone
are responsible for the content and writing of the paper.
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