Participation patterns and associated factors in children and adolescents with autism spectrum disorder: A nationwide population study

Background Participation is central to development and quality of life in autism spectrum disorder (ASD). Most evidence derives from Western populations, and little is known about how body function and environmental components of the International Classification of Functioning, Disability and Health (ICF) shape participation across developmental stages in East Asia. Purpose To examine participation patterns and associated factors among Taiwanese children and adolescents with ASD using a national dataset. Methods Data were drawn from the Taiwan Databank of Persons with Disabilities, including 5190 children (aged 6–12) and 3603 adolescents (aged 13–17) with clinically confirmed ASD. Participation frequency and independence across six domains were assessed using the Functioning Scale of the Disability Evaluation System–Child version (FUNDES-Child). Body function and environmental factors were evaluated with standardized subscales. Analysis of covariance compared age groups, and multiple regression identified predictors. Robustness was tested using E-values. Results Children showed lower participation frequency, whereas adolescents had reduced independence in social domains. Mental and speech impairments were the strongest limiting factors, while physical and sensory impairments were less influential. Environmental supports, particularly caregiver assistance, social attitudes, and accessibility, were significant predictors. E-values indicated moderate robustness for daily living and mobility (3.11 – 3.47), very high robustness for environmental assistance and social attitude supports (27.7). Conclusion Findings highlight the interplay of functional limitations and contextual supports. E-value analyses confirm the robustness of communication-related impairments and environmental supports, suggesting interventions in these domains are most reliable for enhancing participation in East Asian children and adolescents with ASD.