Journal of Intellectual & Developmental Disability

ISSN: 1366-8250 (Print) 1469-9532 (Online) Journal homepage: http://www.tandfonline.com/loi/cjid20

The experience of social inclusion for people

with intellectual disability within community
recreational programs: A systematic review

Jessica Merrells, Angus Buchanan & Rebecca Waters

To cite this article: Jessica Merrells, Angus Buchanan & Rebecca Waters (2017): The
experience of social inclusion for people with intellectual disability within community recreational
programs: A systematic review, Journal of Intellectual & Developmental Disability, DOI:
10.3109/13668250.2017.1283684

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JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY, 2017
http://dx.doi.org/10.3109/13668250.2017.1283684

LITERATURE REVIEW

The experience of social inclusion for people with intellectual disability within
community recreational programs: A systematic review
Jessica Merrells, Angus Buchanan and Rebecca Waters
School of Occupational Therapy and Social Work, Curtin University, Perth, Australia

ABSTRACT KEYWORDS
Background Social inclusion is a vital domain in quality of life and is enhanced through recreational social inclusion; intellectual
programs. People with intellectual disability have been provided with fewer opportunities to disability; recreation;
participate in these groups, thus hindering social inclusion. community program; leisure
Method Five databases (CINAHL, Ovid, ProQuest, ScienceDirect, and Wiley Online Library) were
electronically searched and narrowed using inclusion/exclusion criteria. The methodological
quality was assessed using standard quality assessment criteria.
Results Out of 135 retrieved results, 12 articles were included. Data were predominantly collected
using questionnaires, scales, and interviews. Ages of the people with intellectual disability
ranged from 5 to 65 years, and the sample size ranged from 30 to 2,556 persons. Four key
themes became apparent in the literature: (1) the impact of physical and social independence,
(2) the amount of social interaction and participation, (3) the impact of culture and attitudes, and
(4) the outcomes of social inclusion.
Conclusions Social inclusion and participation in leisure activities for people with intellectual
disability increase with greater functional independence and positive community attitudes. This
participation results in positive outcomes. People with an intellectual disability participate less in
recreational programs. Further research is needed regarding the experience from the person’s
point of view.

Introduction
Social inclusion for people with intellectual disability
is considered a core domain of quality of life (McIntyre,
Kraemer, Blacher, & Simmerman, 2004; Schalock, 2004)
and is essential for human functioning (Verdonschot, de
Witte, Reichrath, Buntinx, & Curfs, 2009b). Social inte-
gration, a term used as a synonym of social inclusion
(Lemay, 2006; Martin & Cobigo, 2011), is defined by
Wolfensberger (1998) to “require valued participation,
with valued people in valued activities that take place
in valued settings” (p. 123). Despite the significance of
social inclusion in a person’s life, it cannot be clearly
measured and service providers are unable to determine
whether they are achieving it (Clement & Bigby, 2009;
Martin & Cobigo, 2011). For measures of social inclusion
to be meaningful, they must provide subjective infor-
mation on the person with an intellectual disability’s
experience and satisfaction with the activity (Martin &
Cobigo, 2011). Social inclusion is not the characteristic
of a situation or of people but an interpersonal process
allowing people with limitations or differences to feel
acknowledged and valued (Meininger, 2010). It is
unique, complex, and personal, being influenced by a
number of factors including skills, wishes, and resources
(Brown & Brown, 2003; Martin & Cobigo, 2011). For
people with intellectual disability, this is particularly
influenced by policies, attitudes, and opportunities avail-
able (Duvdevany & Arar, 2004; MacNeil & Anderson,
1999). Important aspects of social inclusion include hav-
ing a valued role and participation in society, developing
relationships, and having a sense of belonging (Crane,
2002; Lemay, 2006; Wolfensberger, 1998). These needs
for social inclusion are the same for people with and
without intellectual disability (MacNeil & Anderson,
1999).
Aspects of social inclusion such as building friend-
ships, skills, and a sense of belonging for and between
people with and without a disability are promoted
through participation in community recreational pro-
grams (Duvdevany & Arar, 2004). This participation
enhances the quality of life for the individual and is an
important factor in achieving successful community
wellbeing (MacNeil & Anderson, 1999). For a person
to have meaningful involvement in a community rec-
reational program, they must have had freedom in
choosing the program or activity (MacNeil & Anderson,
1999). MacNeil and Anderson (1999) refer to recreation
and leisure as “the freedom to do what one wants when

CONTACT Angus Buchanan A.Buchanan@curtin.edu.au

© 2017 Australasian Society for Intellectual Disability, Inc.
2 J. MERRELLS ET AL.
one wants” (p. 126). Without the freedom to choose the
recreational program or activity, participation for the
person with an intellectual disability will lack meaning
and value and may not result in social inclusion
(Wolfensberger, 1998).
People with intellectual disability strive towards social
inclusion (Abbott & McConkey, 2006), and participation
in recreational programs can aid individuals with intellec-
tual disability in developing the skills needed to enhance
independent functioning (MacNeil & Anderson, 1999).
However, fewer opportunities for people with intellectual
disability to participate within the community make it an
important issue to explore and analyse (Duvdevany &
Arar, 2004; MacNeil & Anderson, 1999). In addition,
recent policies have placed a large emphasis on social
inclusion and working towards building inclusive com-
munities (Australian Government, 2009; United Nations,
2006). This paper aims to present a systematic review of
the literature since 2000 regarding the experiences of
social inclusion of people with intellectual disability,
specifically within community recreational programs.
Methods
The systemic review was conducted within the frame-
work as outlined by the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA;
Moher, Liberati, Tetzlaff, & Altman, & the PRISMA
Group, 2009), thus providing a comprehensive frame-
work that objectively assesses indicators of quality and
risk of biases of included studies. Electronic searches of
five databases were conducted for data collection:
CINAHL, Ovid, ProQuest, ScienceDirect, and Wiley
Online Library. The search was restricted to articles pub-
lished in and after 2000 to explore contemporary experi-
ences. Systematic reviews, meta-analyses, randomised
controlled trials, and qualitative research studies were
included in the search.
Boolean operators were used to combine and search
the main concepts: “social inclusi*” OR belong* OR
“community participat*” AND “intellectual disabilit*”
OR “mental* retard*” AND “community group” OR
recreation* OR leisure OR “community program.”
Searches were restricted to within title, abstract, or key-
words for the larger databases (ProQuest, ScienceDirect,
and Wiley Online Library). The following inclusion cri-
teria were applied to the articles: the participants must
have been diagnosed with an intellectual disability (or
be the proxy on behalf of an individual with an intellectual
disability), been under 65 years of age, had English as their
primary language, and lived in an urban region. The
articles needed to discuss the individual’s involvement
in community recreational/leisure activities or programs
and their experience rather than the framework of the
program. Studies that examined the social inclusion of
people with intellectual disability living in rural regions
were not included due to them experiencing further geo-
graphical isolation, which may impact the results. Exclu-
sion criteria were also applied: programs facilitated before
2000 (due to the recency of experience), people living in
developing countries, and studies that scored below 0.55
using Kmet, Lee, and Cook’s (2004) assessment of meth-
odological quality were not included (maximum score 1).
These criteria were applied first to the titles and abstracts
and then to the full text if the abstract did not provide
enough information.
Assessment of methodological quality
To assess the methodological quality of the studies used
for the review, the Standard Quality Assessment Criteria
for Evaluating Primary Research Papers from a Variety
of Fields (Kmet et al., 2004) was used. This consists of
14 questions for quantitative studies, 10 questions for
qualitative studies, and a scoring system to calculate
the quality of each paper. This assessment was applied
to the selected studies.
Data extraction
To extract the data from the potential studies, the follow-
ing headings were used: citation, publication status,
source, country of origin/region, level of evidence,
study type/design, research question/aim, patient popu-
lation, intervention/interest, comparison group (if appli-
cable), context, data collection, data analysis, themes,
and outcomes. The level of evidence of the studies was
determined using the hierarchy of evidence pyramid by
Kielhofner (2006).
Data synthesis and analysis
To synthesise and analyse the data, a narrative summary
was used to discuss the experience of social inclusion for
people with intellectual disability in a community rec-
reational program. Thematic synthesis was used to ana-
lyse the data (Thomas & Harden, 2008). This involved
gathering main themes and subthemes from the included
studies. Activities discussed were kept specific to rec-
reational and leisure programs or activities.
Results
The process of study selection can be viewed in Figure 1.
Electronic searches retrieved 135 articles in total from
the major databases, of which 123 studies were excluded
after screening for eligibility. This resulted in 12 articles
being included in the final review, as shown in Table 1.

Figure 1. Flow diagram of article selection.
The reference lists of the 12 articles were manually
scanned, producing no further articles for analysis.
Quality assessment of studies
The 12 studies included seven quantitative studies, three
qualitative studies, and two systematic reviews. The
scores from the methodological quality assessment
(Kmet et al., 2004) of these studies ranged from 0.88 to
1.0 (see Table 1). Scores were converted into decimals
from the maximum score possible for each particular
study design. Quantitative studies had scores deducted
due to analysis and results not being reported in sufficient
detail; qualitative studies lost scores for not using a theor-
etical framework or discussing reflexivity in the report.
Data extraction
Information from the data extraction process is summar-
ised in Table 2. Studies were conducted in Israel (three
studies), the Netherlands (three studies), the United States
(three studies), Australia (one study), and a five-nation
study (McConkey, Dowling, Hassan, & Menke, 2013).
JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 3
Six of the studies were based on the International Classifi-
cation of Functioning, Disability and Health (ICF) frame-
work (World Health Organization, 2001), whereas one
was based on the quality of life model (Schalock, 1996).
The remainder of the articles did not discuss a theoretical
framework for the study. The sample age ranged from 5 to
92 years and the sample size ranged from 30 to 2,556 per-
sons. Measurement instruments varied significantly
among the studies and included various validated scales,
questionnaires, and self-made interviews.
Intellectual disability was clearly defined in six studies
(see Table 2); two used an IQ score, two used the Amer-
ican Association on Mental Retardation (AAMR) defi-
nition (American Association on Intellectual and
Developmental Disabilities, 2013), and two defined intel-
lectual disability through classification with other organ-
isations (i.e., disability benefits or services).
Major findings
Four key themes became apparent in the literature: (1)
the impact of physical and social independence, (2) the
amount of social interaction and participation, (3) the
4 J. MERRELLS ET AL.

Table 1. Quality assessment of selected studies.

Quantitative studies A B C D E F G H I J K L M N Total
Azaiza et al. (2011) 2 2 2 2 N/A N/A N/A 2 2 2 2 2 1 2 0.95
Dusseljee et al. (2011) 2 2 2 2 N/A N/A N/A 2 2 2 2 2 2 2 1.00
Duvdevany (2002) 2 2 2 2 2 N/A N/A 2 2 2 2 2 2 2 1.00
Duvdevany and Arar (2004) 2 2 2 2 2 N/A N/A 2 2 1 2 2 2 2 0.96
Martin and Cobigo (2011) 2 2 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 1 2 0.88
Oates et al. (2011) 2 2 2 2 N/A N/A N/A 2 2 2 2 2 2 2 1.00
Siperstein et al. (2009) 2 2 2 2 N/A N/A N/A 2 2 2 2 2 2 2 1.00
Qualitative Studies O P Q R S T U V W X Total
Kampert and Goreczny (2007) 2 2 2 0 2 2 2 2 2 2 0.90
McConkey et al. (2013) 2 2 2 0 2 2 2 2 2 2 0.90
McIntyre et al. (2004) 2 2 2 2 2 2 2 2 2 0 0.90
Systematic reviews
Verdonschot et al. (2009a) 2 2 2 2 2 2 2 2 2 2 1.00
Verdonschot et al. (2009b) 2 2 2 2 2 2 2 2 2 2 1.00
Note. A = question/objective clearly described; B = study design evident and appropriate; C = method/comparison group selection or source of information
described and appropriate; D = subject characteristics sufficiently described; E = intervention and random allocation was described; F = interventional and
blinding of investigators was reported; G = interventional and blinding of subjects was reported; H = outcome and exposure measure(s) well defined and robust
to measurement/misclassification bias; I = sample size appropriate; J = analytic methods described/justified and appropriate; K = estimate of variance is
reported for main results; L = controlled for confounding; M = results reported in sufficient detail; N = conclusions supported by results; O = question/objective
clearly described; P = study design evident and appropriate; Q = context for study clear; R = theoretical framework/wider body of knowledge; S = sampling
strategy described relevant and justified; T = data collection methods clearly described and systematic; U = data analysis clearly described and systematic;
V = verification procedure(s) to establish credibility; W = conclusions supported by results; X = reflexivity of account; 2 = yes; 1 = partial; 0 = no; N/A = not appli-
cable to study.

impact of culture and attitudes, and (4) the outcomes of
social inclusion. Interestingly, none of the studies
reviewed clearly defined social inclusion. Some acknowl-
edged it was a concept that was difficult to define or
assess (Martin & Cobigo, 2011; McIntyre et al., 2004),
and that it may be more appropriately considered as
both a means and an end (Verdonschot, de Witte, Reich-
rath, Buntinx, & Curfs, 2009a).
Impact of physical and social independence
The impact of physical and social independence was dis-
cussed in six of the studies, and a summary of the results
can be found in Table 3. People with intellectual disabil-
ity often have reduced independence compared to others
of similar demographics without intellectual disability
due to physical, cognitive, social, or communication dif-
ficulties. Physical independence involves the level to
which a person is able to functionally care for themselves
without assistance when participating in self-care,
leisure, and productive occupations and activities.
Greater physical independence of people with intellec-
tual disability allows higher participation in community
recreational programs and leisure activities (Azaiza,
Rimmerman, Croitoru, & Naon, 2011; McIntyre et al.,
2004; Oates, Bebbington, Bourke, Girdler, & Leonard,
2011). Social independence, and therefore the amount
of social interaction and participation in the community,
is also impacted by communication and social skills
(McIntyre et al., 2004; Oates et al., 2011). One mother
of a young adult with intellectual disability described
the difficulty for her daughter to be involved in the com-
munity due to not being toilet-trained and having
reduced social skills (McIntyre et al., 2004). These social
skills are often developed through participation in com-
munity activities (Kampert & Goreczny, 2007), and if
opportunities are not provided, persons with intellectual
disability can have difficulty interacting within the
community.
Amount of social interaction and participation
The amount of social interaction and participation
people with intellectual disability experience within com-
munity recreational programs was highlighted in eight of
the studies. The main results of these studies are found in
Table 4. Five of the studies stated that people with intel-
lectual disability participate less in recreational pro-
grams/activities or in the community than those
without intellectual disability (Azaiza et al., 2011; Dussel-
jee, Rijken, Cardol, Curfs, & Groenewegen, 2011; Duvde-
vany & Arar, 2004; Kampert & Goreczny, 2007;
Siperstein, Glick, & Parker, 2009). For some, this partici-
pation involved attending an activity in the community
at least once per week; however, this was mostly with a
staff member and/or co-residents (Verdonschot et al.,
2009a). Of those people with an intellectual disability
involved in the study conducted by Dusseljee et al.
(2011), 37.5% were found to be participating in inclusive
mainstream programs. Another study found the activity
or program they were involved in was, however, not
always the adults’ preferred option, with 75.3% of adults
wanting to change the activities they were participating
in (Martin & Cobigo, 2011). Some leisure activities the
adults with intellectual disability were participating in
were found to be segregated within the community
Table 2. Characteristics of the included studies.
Theoretical Sample age range, Gender
Author (year) Country framework Sample size M and SD (years) distribution (%) Context Measurement instruments
Azaiza et al. Israel ICF 2,256 adults with ID (based on 18–65, M = 29.86, 56% male and Living in the community and receiving a Questionnaire by Strosberg, Naon, Bar, and
(2011) evaluation of medical disability SD = 8.67 44% female general disability benefit. Morginstin (2004).
from disability benefit).
Dusseljee et al. Netherlands No framework 653 people with mild or 15–88, M = 43, SD 55% male and In daytime activities (work, social Oral interview and self-made structured
(2011) moderate ID (defined by = Not specified 45% female contacts, and leisure activities). questionnaire filled in by representative if
American Association on participant could not be interviewed, as well as
Mental Retardation). data provided by care providers.
Duvdevany and Israel ICF 85 people with ID (diagnosed by 18–55, M and SD 49% male and Foster homes vs. community residential Self-made demographics questionnaire, Quality of
Arar (2004) the Ministry of Work and not specified 51% female settings. Life questionnaire (Schalock, Keith, & Hoffman,
Welfare). 1990), UCLA Loneliness scale (Russell, Peplau, &
Cutrona, 1980), Social Relationships List (Shwartz,
1994), and Leisure Activities List (Shwartz, 1994).
Duvdevany Israel ICF 64 people with mild-moderate ID 14–60, M = 36.54 27% male and In inclusive mainstream programs. Self-made demographic and background
(2002) (defined by American and SD = 16.38 73% female questionnaire, Tennessee Self-Concept Scale –
Association on Mental Second Edition (Fitts, 1996) and Adaptive
Retardation). Behaviour Scale – Residential and Community –
Second Edition (Nihira, Leland, & Lambert, 1993).
Kampert and USA No framework 1,348 individuals living with Not specified Not specified Living in residential facilities, group Self-made interview consisting of 98 questions,
Goreczny mental retardation (an IQ of 70 homes, and private residences. mostly close-ended with a few open-ended.
(2007) or below). Data used from 253.
Martin and Canada No framework 1,341 adults with ID (diagnosis 50, M = 49.8, SD = 59.4% male Institutional and community-based Scannable paper-based form and online system of
Cobigo (2011) not defined). 11.1 and 40.6% settings. “interRAI Intellectual Disability” instrument (http://
female www.interrai.org).
McConkey et al. Germany, No framework 25 youth with ID (not defined), 12–25, M and SD 81% male and Participating in the Youth Unified Sports Self-made face-to-face interview developed from

JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY

(2013) Hungary, 25 partners, 25 coaches, 25 not specified 19% female program of Special Olympics. aims of study, past research, and a pilot study
Poland, Serbia, parents, 25 community leaders, undertaken with Youth Unified Sports teams in
and Ukraine and group interviews with 20 England.
teams.
McIntyre et al. USA Quality of life 30 mothers of young adults (18– Mothers: M = 49.4, 50% male and Mothers’ thoughts and reflections. Standardised Quality of Life Questionnaire (QOL-Q;
(2004) 24) with ID (eligibility through SD = 4.3. Young 50% female Schalock & Keith, 1993) and self-made initial and
disability service). adults: 18–24, M follow-up interview.
= 21.3, SD = 1.9
Oates et al. Australia ICF 208 parents of school-aged 5–18, M and SD not Not specified Leisure participation for school-aged WeeFIM (Leonard, Msall, Bower, Tremont, & Leonard,
(2011) children with Down syndrome specified children. 2002), the Child Developmental Behaviour
(not defined). Checklist (DBC; Einfeld & Tonge, 1992), Social
Communication Questionnaire (SCQ; Rutter, Bailey,
& Lord, 2003), body mass index (NHMRC, 2003),
Family Resource Scale (FRS) (Dunst & Leet, 1987),
Family Support Scale (FRS; Dunst, Jenkins, &
Trivette, 1988), Physical Component Scores (PCS;
Bourke et al., 2008).
Siperstein et al. USA No framework 67 children; 29 with ID (IQ 8–13, M = 11, SD = 64% male and Participating in an inclusive recreational Self-made interview and “Peer hang-out-with and
(2009) between 50–75) and 38 not specified 36% female sports program. friendship inventory” modified from previous
without ID. studies.

(Continued )

5
6 J. MERRELLS ET AL.

Table 3. Impact of physical and social independence.

Author (year) Examples

different criteria lists describing informativity,

different criteria lists describing informativity,

Methodological quality assessment based on

Methodological quality assessment based on

Azaiza et al. (2011) Greater physical functioning and health condition
was related to higher participation in leisure

Measurement instruments
activities for adults with intellectual disability (ID).
Dusseljee et al. (2011) Severity of ID influences community participation;
34.9% of adults with mild ID participated in

external and internal validity.

external and internal validity.

mainstream leisure activities compared to 41.2%
of adults with moderate ID.
Duvdevany and Arar A person’s level of functioning affects their ability to
(2004) interact within community programs. Limited
functioning = limited participation.
The better an adult with ID’s social skills, the more
they are socially accepted and the less lonely they
feel.
Kampert and Community involvement, such as going to public
Goreczny (2007) places, helps develop social skills.
McIntyre et al. (2004) A young adult with ID not being toilet-trained and
(domestic life, interpersonal relations,

(domestic life, interpersonal relations,

community life) in a Western culture.

community life) in a Western culture. behavioural problems affect community

involvement in social situations and activities.
Limited verbal communication negatively affects
employment, leisure activities,

employment, leisure activities,

Participating in the community

Participating in the community

participation and involvement in recreational

major life areas, education,

major life areas, education,

activities for young adults with ID.

Oates et al. (2011) Greater functional independence increased the
Context

odds of participation in sports and hobbies for

children with Down syndrome.
Appropriate behaviour and better social
communication led to more active friendships for
children with Down syndrome.
Note. ICF = International Classification of Functioning, Disability and Health; ID = intellectual disability; USA = United States of America.

(Duvdevany & Arar, 2004). Interaction among friends

M and SD (years) distribution (%)
Most studies range Not specified

Not specified
Gender

was also minimal between children with intellectual dis-

ability, generally only seeing their friends once a week
(Oates et al., 2011). This interaction and social relation-
ships with those outside family and professionals are
Sample age range,

between 18 and

necessary yet difficult for people with intellectual disabil-

ity to promote feelings of inclusion (Duvdevany & Arar,
60 years

2004).
16–89

Impact of culture and attitudes

9 quantitative studies and 2

The impact of culture and attitudes on the experience of

social inclusion and participation in community rec-
23 quantitative studies.

qualitative studies.

reational programs was discussed in eight of the articles.

Table 5 summarises the main effects of culture on the
Sample size

people with intellectual disability’s experiences. Cultural

aspects such as socioeconomic factors and standards of
living influence the amount of participation in commu-
nity programs (Azaiza et al., 2011; Oates et al., 2011).
All people have a right to participate in occupations of
Theoretical
framework

meaning (Dusseljee et al., 2011); however, such opportu-

ICF

ICF

nities to be part of the community are limited for people

with intellectual disability (Duvdevany & Arar, 2004). A
culture that allows opportunities to make decisions, for
Netherlands

Netherlands

autonomy, and being involved in policymaking are

Country
Table 2. Continued.

important factors for participation and positive experi-

ences in the community (Verdonschot et al., 2009b).
et al. (2009b)

The attitudes and culture of the place of residence to

et al. (2009a)
Author (year)
Verdonschot

Verdonschot

impact social inclusion in the community were also dis-

cussed in two of the studies. Duvdevany and Arar (2004)
found that people living with foster families have a

Table 4. Amount of social interaction and participation in
community recreational programs.
Author (year) Examples
Azaiza et al. (2011) Adults with intellectual disability (ID) rarely
participate in leisure activities.
Dusseljee et al. (2011) People aged between 15 and 64 years with ID
participate less in the community or leisure
activities than those without ID.
68.6% of people aged between 15 and 64 years had
social contact with family, 35.4% with friends,
and 11.8% had friends without ID.
35.7% of people with ID were involved in inclusive
mainstream programs, 70.5% sometimes visited a
restaurant/café/cinema/theatre.
Older people (aged 50–64 years) had lower social
interaction and participation in mainstream
leisure activities (26%) than younger people
(aged 15–34 years) with ID.
Duvdevany and Arar Adults with ID participating in leisure activities
(2004) were segregated within the community and have
less engagement than adults without ID.
Kampert and Goreczny Adults with ID are less likely to be involved in
(2007) activities that involve others or are in the
community. 17% of adults with ID said they
would like to increase this.
Martin and Cobigo 88.6% of adults with ID had participated in leisure
(2011) activities in the last 3 days; however, 75.3% of
people desired to change these recreational
activities.
Oates et al. (2011) Children with more family and community support
were more likely to have more friends.
79.5% of children with Down syndrome had fewer
than 3 friends, with 33% having no friends. Of
these friendships, 55.9% of the children saw them
only occasionally.
64.4% of children with Down syndrome
participated in no team sports, 21.2%
participated in one team sport.
Siperstein et al. (2009) Children with ID have less social contacts and are
less socially accepted than those without ID.
After participating in a 4-week inclusive sports
program, 84% of children with ID nominated at
least one child without ID as their friend and 97%
of children without ID nominated at least one
child with ID as their friend.
Verdonschot et al. Adults with ID are involved in at least one activity in
(2009a) the community but are usually accompanied by a
staff member and/or co-residents.
Involvement in community recreational activities
increases when the adult with ID has lived in the
community for longer.
Adults with ID living in community settings
participate more in the community than people
living in segregated settings.
higher involvement in leisure activities than those in
community residential settings. Those in community set-
tings were found to have a higher involvement in the
community than those in segregated settings
(Verdonschot et al., 2009a). Social inclusion is possible
and a positive attitude should be applied while promot-
ing it (Duvdevany, 2002).
Outcomes of social inclusion for people with
intellectual disability
Discussion concerning the outcomes and impact that
social inclusion has on people with intellectual
JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 7
Table 5. Impact of culture and attitudes.
Author (year) Examples
Azaiza et al. (2011) Low socioeconomic, financial limitations, and
standard-of-living measures may contribute to low
participation for adults with intellectual disability
(ID) in leisure activities.
Dusseljee et al. (2011) People of all ages, with and without disability, have a
right to participate in leisure programs of their
choice.
Duvdevany (2002) Social inclusion is possible for people of aged 15–60
years with ID and services should continue to
promote it.
Duvdevany and Arar Adults with ID have limited opportunities to be part
(2004) of the community, which is a major barrier to
empowerment, self-determination, and successful
community adjustment.
Adults living with foster families have a higher
involvement in leisure activities than those in
community residential settings.
McConkey et al. Negative attitudes held by adolescents and adults
(2013) without ID cause them to “still have strange
reactions to disabled people, sometimes they are
ashamed, sometimes they are scared.” (p. 8)
Oates et al. (2011) Income status of parents and access to transport is
strongly linked to participation in leisure activities
and sports groups for children with Down
syndrome.
Verdonschot et al. Adults living in community settings participate in
(2009a) the community more than those living in
segregated settings.
Verdonschot et al. Opportunities for the adult with ID to make their
(2009b) own choices, have autonomy, and have
involvement in policymaking have a positive
impact on participation in community activities.
Positive staff attitude in group homes is positively
correlated with community integration of adults
with ID.
Positive attitude of adults in the community is
directly proportional to the amount adults with ID
participate in community leisure activities.
disability was found in seven of the studies. This sum-
mary can be seen in Table 6. All seven studies dis-
cussed social inclusion and participation in the
community to have a positive outcome on the lives
and wellbeing of the people with intellectual disability.
Participation in community leisure activities enhances
people’s wellbeing (Azaiza et al., 2011), quality of life
(McIntyre et al., 2004), positive attitudes, and social
interactions (Siperstein et al., 2009), and is essential
for human functioning (Verdonschot et al., 2009b).
The studies performed by Siperstein et al. (2009) and
McConkey et al. (2013) stated this outcome as a result
of those particularly participating in mainstream
leisure programs. The results of the study by Duvde-
vany (2002) found people with an intellectual disability
participating in mainstream programs to have in gen-
eral the same outcomes of positive self-concept and
adaptive behaviour to those in segregated programs.
Participation in the programs and activities also led
to increased feelings of control, friendships, indepen-
dence, and initiation of involvement in other leisure
activities (Duvdevany & Arar, 2004).
8 J. MERRELLS ET AL.
Table 6. Outcomes of social inclusion.
Author (year) Examples
Azaiza et al. (2011) Participation in leisure activities, chosen for
enjoyment and satisfaction, enhances wellbeing
and is a marker of integration in society.
Duvdevany (2002) Adults with intellectual disability (ID) who
participate in community mainstream activities
have in general the same level of positive self-
concept and adaptive behaviour than those in
segregated programs.
Adults with ID in mainstream programs compared
themselves to those without ID and felt inferior.
Duvdevany and Arar Participation in recreation activities is an important
(2004) factor in successful community adjustment and
high quality of life.
Participation in leisure activities resulted in
increased initiation of and independence in leisure
activities and increased feelings of control in
leisure.
Recreation services promote and encourage
friendship between people with and without
disability.
McConkey et al. Adolescents with ID who participated in the
(2013) mainstream sports program had broadened
opportunities to develop personally including
gaining more confidence, self-esteem, and
sporting skills.
Adolescents with ID were seen more in the
community, resulting in adolescents without ID
being less likely to exclude them from general
activities and conversations.
McIntyre et al. (2004) 73% of mothers of young adults with ID mentioned
“recreation/activities/hobbies” as being important
in promoting high quality of life for their child.
Siperstein et al. Participation in a mainstream leisure program led to
(2009) higher positive attitudes, improvement in sports
skills, and positive social interactions for children
with ID.
Verdonschot et al. Community participation is essential for human
(2009b) functioning for adults and children with and
without ID.
Discussion
The evidence found in the review suggests that people
with intellectual disability participated less in leisure
activities than those without intellectual disability
(Azaiza et al., 2011; Dusseljee et al., 2011; Duvdevany
& Arar, 2004; Kampert & Goreczny, 2007; Siperstein
et al., 2009). This is of concern because reduced partici-
pation leads to decreased opportunities to build relation-
ships, create friendships, and attribute meaning and
value to activities, all of which are required for people
to feel socially included (MacNeil & Anderson, 1999;
Wolfensberger, 1998). The review identified 12 relevant
articles to support these findings. This outcome is impor-
tant as there appears to be a paucity of research in this
important life activity area.
The review of the literature indicates that the experi-
ence of social inclusion for adults with intellectual dis-
ability both affects and is affected by four key areas: (1)
levels of participation, (2) social interaction, (3) physical
and social skills, and (4) cultural and societal factors.
Participation rates for people with intellectual disability
may be explained by the characteristics of the intellectual
disability, which limits everyday social and practical
skills (American Association on Intellectual and Devel-
opmental Disabilities, 2013). The review identified a
number of other potential factors that may be impacting
on participation. Although studies indicate that reduced
social and physical skills impact negatively on people’s
participation (Azaiza et al., 2011; Dusseljee et al., 2011;
Duvdevany & Arar, 2004; McIntyre et al., 2004; Oates
et al., 2011), it is also the case that inclusion in commu-
nity recreational programs can assist in developing these
skills (Kampert & Goreczny, 2007). This is an interesting
challenge that requires programs and services to adapt
for and accommodate difference to facilitate access to
developmental opportunities for participants. The find-
ing of this study indicates that people with intellectual
disability, on the basis of their existing level of physical
and social skills, may experience difficulties accessing
or fully participating in programs and activities. This is
a significant issue that requires a sophisticated under-
standing of enablers and barriers in programs and ser-
vices and equally effective policy, funding, and
educative responses.
It is not unexpected that it was found that culture and
attitudes impacted on a person with intellectual disabil-
ity’s experience within community recreational pro-
grams. An important issue to emerge was the impact
of limited financial resources on participation (Azaiza
et al., 2011), with people from lower socioeconomic
backgrounds being less likely to participate than their
peers with higher incomes. Opportunities to participate
in meaningful activities were found to be highest
among those living with families or foster families,
above community residential and segregated settings
(Duvdevany & Arar, 2004). This finding is of concern
given the number of people with significant intellectual
disability who live in supported accommodation services.
Resourcing of community recreation programs should
facilitate the right of people with intellectual disability to
participate in activities of their choice (Dusseljee et al.,
2011; United Nations, 2006); however, this does not
always occur (Duvdevany & Arar, 2004). With an increas-
ing focus on recreational participation, this may require
that policy and funding approaches are developed to
enable experiences for people with intellectual disability.
Well-resourced programs that promote engagement for
people with an intellectual disability provide much-
needed opportunities for individuals to express their
choices and preferences for activity and maintain a
sense of autonomy (MacNeil & Anderson, 1999).
The experience of social inclusion for people with
intellectual disability in community recreation was
found to result in several other positive outcomes,

including an increased quality of life (McIntyre et al.,
2004), enhanced wellbeing (Azaiza et al., 2011), and
higher positive attitudes (Siperstein et al., 2009). This
further supports Schalock’s (2004) view that social
inclusion is a core domain of quality of life. These find-
ings reinforce the importance of working towards
socially inclusive communities that promote recreational
programs and activities for people with and without
intellectual disability. The participation of people with
intellectual disability in community recreation programs
positively impacts their experience of social inclusion by
allowing access to an important avenue in developing
friendships, skills, and having valued roles (Crane,
2002; Duvdevany & Arar, 2004).
Limitations
Although a systematic approach was taken in developing
this review, there are some limitations that need to be
considered when interpreting the results. A thorough
search of five databases was conducted; however, there
may be additional studies that could contribute to the
themes presented in this review. Only peer-reviewed
articles found from online databases were included –
there were no searches of grey literature or texts. Despite
seven of the studies being quantitative, a narrative sum-
mary was used to analyse and summarise the findings.
This may have resulted in some aspects of the studies
being misinterpreted or lost. This study used two sys-
tematic reviews within the results. A deeper analysis of
the specific articles within these reviews may have pro-
vided a deeper richness to the findings.
Conclusion
People with intellectual disability have less frequent
experiences in community recreational programs than
those without intellectual disability and therefore are
less socially included. Social inclusion is a vital domain
of having a high quality of life resulting in positive out-
comes for people with intellectual disability and should
be promoted. Community recreational programs need
to facilitate the person with intellectual disability’s phys-
ical and social skills as well as having a supportive culture
to enhance the quality and quantity of participation and
social inclusion.
For community recreational programs to be success-
ful in enhancing wellbeing and quality of life, they
must accommodate the abilities of each individual to
ensure that the person with an intellectual disability’s
participation and contribution are beneficial and mean-
ingful (Crane, 2002). It must take place in a valued set-
ting with valued people (Wolfensberger, 1998) to
JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 9
ensure that relationships are built and a sense of belong-
ing is felt by the person with an intellectual disability
(Lemay, 2006). The programs must also have a culture
that promotes equal relationships, autonomy, and ulti-
mately social inclusion. Opportunities for participation
in programs that encourage these values should be pro-
vided for all people with an intellectual disability regard-
less of their skills and abilities. Primary involvement is
vital for people with intellectual disability so that they
can develop their skills through participation in the pro-
grams and progress towards being socially included
(Kampert & Goreczny, 2007).
Finally, the review has highlighted a potential gap in
the current understanding of social inclusion. As it is a
subjective experience, understanding social inclusion
from the individual with intellectual disability’s point
of view and their experience is of great importance
(Martin & Cobigo, 2011). No studies included in this
review discussed if the individuals felt like they were
socially included or what aspects, from their point of
view, promoted this. Abbott and McConkey (2006)
also acknowledge this gap in research. Understanding
and responding to the lived experiences of people with
intellectual disability, these views can contribute to pol-
icies and practices that provide services to people as
they require (McDonald, Kidney, & Patka, 2013).
There is a real need for future research to be increasingly
focused on hearing the voices of people with intellectual
disability to understand their perspectives and experi-
ence about and within community recreation programs.
This has the potential to provide a greater understanding
about how such activities affect participation, social
inclusion, and associated outcomes and benefits.
Disclosure statement
No potential conflict of interest was reported by the authors.
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