Introduction
Participation | |
Environment | “The physical, social, and attitudinal environment in which people live and conduct their lives” (WHO, 2007, p. 5). The environment can be a support or a barrier for participation |
Setting | Used in PEM-CY to cluster a group of contexts with similar circumstances and conditions such as “home,””school,” and “community.” |
Context | “Experienced and situated activity settings” (King et al., 2018, p. 1835) Contexts are described with five inherent elements: people, place, activity, objects, and time. Contexts are where transactions take place and their effects can be noticed |
Method
Design
Participants
Measures
Analysis
Demographics
Analysis of Environmental “Supports” and “Barriers”(Research Question 1)
Analysis of Parental Contextual Strategies to Support Participation (Research Question 2)
Results
Description of the Study Sample
Children with ASD | Adolescents with ASD | Total group of youth | ||||
---|---|---|---|---|---|---|
Age 5–11, N = 60 | Age 12–17, N = 55 | Age 5–17, N = 115 | ||||
N | % | N | % | N | % | |
Responding persons | ||||||
Mothera | 46 | 78.0 | 49 | 89.1 | 95 | 83.3 |
Fathera | 9 | 15.3 | 4 | 7.3 | 13 | 11.4 |
Both togethera | 4 | 6.8 | 2 | 3.6 | 6 | 5.3 |
Community type of living | ||||||
Urbana | 9 | 15.0 | 5 | 9.1 | 14 | 12.2 |
Rurala | 38 | 63.3 | 28 | 50.9 | 66 | 57.4 |
Agglomeration (suburbs) | 13 | 21.7 | 22 | 40.0 | 35 | 30.4 |
Family constellation | ||||||
Child lives with both parents together | 52 | 86.7 | 41 | 74.5 | 93 | 80.9 |
Parents separated; child lives in two households | 0 | 0.0 | 4 | 7.3 | 4 | 3.5 |
Parents separated; child lives overly with one parenta | 5 | 8.3 | 6 | 10.9 | 11 | 9.6 |
Child lives with one parent in a new familya | 2 | 3.3 | 2 | 3.6 | 4 | 3.5 |
Other or missinga | 1 | 1.7 | 2 | 3.6 | 3 | 2.6 |
Number of siblings of child with ASD | ||||||
No siblings | 22 | 36.7 | 13 | 24.1 | 35 | 30.7 |
One siblinga | 24 | 40.0 | 26 | 48.1 | 50 | 43.9 |
Two or more siblingsa | 14 | 23.3 | 15 | 21.7 | 29 | 25.5 |
Education of mother | ||||||
Obligatorya | 3 | 5.0 | 2 | 2.6 | 5 | 4.3 |
Secondary educationa | 17 | 28.4 | 18 | 32.7 | 35 | 30.4 |
Tertiary educationa | 40 | 66.7 | 33 | 63.6 | 75 | 65.3 |
Unknown or missinga | 0 | 0.0 | 0 | 0.0 | 0 | 0.0 |
Education of father | ||||||
Obligatorya | 1 | 1.7 | 1 | 1.8 | 2 | 1,7 |
Secondary educationa | 15 | 25.0 | 11 | 20.0 | 26 | 22.6 |
Tertiary educationa | 42 | 70.0 | 39 | 71.0 | 81 | 70.4 |
Unknown or missing | 2 | 3.3 | 4 | 7.2 | 6 | 5.3 |
Further information of the family | ||||||
Actual percentage of paid work of mother | 33.1b | 31.32c | 49.92 | 33.25c | 41.1b | 33.20c |
Actual percentage of paid work of father | 87.1b | 27.31c | 80.52 | 33.76c | 84.0b | 30.57c |
Number of languages spoken in the inner family | 1.42b | 0.72c | 1.532 | 1.42c | 1.47b | 1.1c |
Children with ASD | Adolescents with ASD | Total group of youth | ||||
---|---|---|---|---|---|---|
Age 5–11 y; N = 60 | Age 12–17 y; N = 55 | Age 5–17 y; N = 115 | ||||
N | % | N | % | N | % | |
Gender | ||||||
Malea | 51 | 85.0 | 41 | 74.5 | 92 | 80.0 |
Femalea | 9 | 15.0 | 14 | 25.5 | 23 | 20.0 |
Type of ASD | ||||||
Autism spectrum disordera | 16 | 26.7 | 11 | 20.0 | 27 | 23.5 |
Early onset autisma | 10 | 16.7 | 8 | 14.5 | 18 | 15.7 |
Asperger Syndrome | 23 | 38.3 | 33 | 60.0 | 56 | 48.7 |
Atypical autisma | 5 | 8.3 | 3 | 5.5 | 8 | 7.0 |
Other not specified | 6 | 10.0 | 0 | 0.0 | 6 | 5.2 |
Age of diagnosis | 5.62 | 2.123 | 8.52 | 3.413 | 7.02 | 3.153 |
Co-occuring diagnosis | ||||||
No co-occuring diagnosis | 34 | 56.7 | 19 | 34.5 | 53 | 46.1 |
ADHDa | 11 | 18.3 | 12 | 21.8 | 23 | 20.0 |
Anxietya | 1 | 1.7 | 4 | 7.3 | 5 | 4.3 |
Epilepsya | 0 | 0.0 | 1 | 1.8 | 1 | 0.9 |
Depressiona | 1 | 1.7 | 4 | 7.3 | 5 | 4.3 |
Motor dysfunctiona | 4 | 6.7 | 2 | 3.6 | 6 | 5.2 |
Others or unknown | 6 | 10.0 | 11 | 20.0 | 14 | 14.8 |
Schooling | ||||||
Regular setting without adjustmentsa | 8 | 13.6 | 8 | 14.8 | 16 | 14.2 |
Regular setting (minor adjustments)a | 20 | 33.9 | 13 | 24.1 | 33 | 29.9 |
Regular setting (special adjustments)a | 9 | 15.3 | 6 | 11.1 | 15 | 13.3 |
Private schoola | 7 | 11.9 | 13 | 24.1 | 20 | 17.7 |
General separate schoola | 13 | 22.0 | 8 | 14.8 | 21 | 18.6 |
Home or boarding schoola | 1 | 1.7 | 2 | 3.8 | 3 | 2.7 |
Vocational apprenticeship | 0 | 0.0 | 3 | 5.6 | 3 | 2.7 |
None or misssinga | 1 | 1.7 | 3 | 5.6 | 4 | 3.6 |
Friendships (outside school) | ||||||
Personal friends meeting per week | 1.4b | 2.04c | 0.7b | 0.94c | 1.1 | 1.64c |
Informal peers meeting per weeka | 2.4b | 4.64c | 3.0 | 4.22c | 2.8 | 4.41c |
Peers meeting via social media per week | 0.6b | 1.81c | 3.1 | 4.33c | 1.8 | 3.55c |
Parents’ Perceptions of Environmental Aspects in Three Settings
N | Supports | Barriers | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
All | < 11 | > 11 | All | < 11 | > 11 | All | < 11 | > 11 | All | < 11 | > 11 | ||||
Home environment | Helpfulness | "Do the following things help or make it harder to participate in activities at home?" | "Not an issue" | "Usually helps" | "Sometimes helps, sometimes makes harder" | "Usually makes harder" | |||||||||
1. Physical layout | 113 | 35 | 13 | 21 | 24 | 14 | 10 | 36 | 21 | 15 | 5 | 3 | 3 | ||
2. Sensory quality | 113 | 19 | 10 | 10 | 15 | 7 | 8 | 42 | 20 | 22 | 23 | 14 | 9 | ||
3. Physical demands of activity | 114 | 35 | 16 | 13 | 16 | 8 | 8 | 39 | 21 | 18 | 16 | 7 | 9 | ||
4. Cognitive demands of activity | 113 | 27 | 12 | 15 | 21 | 12 | 9 | 37 | 21 | 16 | 15 | 6 | 9 | ||
5. Social demands of activity | 113 | 16 | 7 | 9 | 27 | 14 | 12 | 40 | 23 | 17 | 18 | 7 | 11 | ||
6. Relations with family members | 114 | 16 | 8 | 8 | 32 | 18 | 15 | 46 | 25 | 22 | 5 | 2 | 4 | ||
7. Attitudes | 106 | 33 | 16 | 17 | 28 | 17 | 11 | 39 | 10 | 19 | 9 | 7 | 3 | ||
Resources | "Are the following available and/or adequate to support your child’s participation at home?" | "Not needed" | "Usually yes" | "Sometimes yes, sometimes no" | "Usually not" | ||||||||||
8. Services | 115 | 76 | 37 | 39 | 10 | 7 | 3 | 7 | 4 | 3 | 8 | 4 | 3 | ||
9. Supplies | 115 | 90 | 47 | 43 | 10 | 5 | 4 | 8 | 4 | 3 | |||||
10. Information | 115 | 76 | 41 | 37 | 20 | 10 | 10 | 2 | 1 | 1 | |||||
11. Time | 115 | 52 | 25 | 26 | 47 | 27 | 20 | 2 | 0 | 2 | |||||
12. Money | 115 | 65 | 33 | 35 | 23 | 16 | 8 | 9 | 3 | 5 | |||||
School environment | Helpfulness | "Do the following things help or make it harder to participate in activities at school?" | "Not an issue" | "Usually helps" | "Sometimes helps, sometimes makes harder" | "Usually makes harder" | |||||||||
1. Physical layout | 111 | 21 | 8 | 13 | 27 | 15 | 12 | 36 | 17 | 19 | 16 | 10 | 6 | ||
2. Sensory quality | 111 | 4 | 0 | 4 | 14 | 7 | 7 | 29 | 17 | 12 | 53 | 26 | 27 | ||
3. Weather conditions | 111 | 42 | 18 | 24 | 8 | 5 | 4 | 34 | 14 | 20 | 15 | 14 | 2 | ||
4. Physical demands of activity | 111 | 16 | 4 | 13 | 14 | 8 | 5 | 37 | 20 | 17 | 33 | 19 | 14 | ||
5. Cognitive demands of activity | 110 | 13 | 4 | 9 | 20 | 11 | 9 | 35 | 19 | 15 | 33 | 16 | 16 | ||
6. Social demands of activity | 110 | 6 | 3 | 4 | 12 | 6 | 5 | 44 | 21 | 23 | 50 | 20 | 18 | ||
7. Attitudes | 108 | 5 | 1 | 4 | 44 | 28 | 17 | 40 | 17 | 23 | 11 | 6 | 6 | ||
8. Relations with peers | 110 | 10 | 5 | 5 | 22 | 14 | 8 | 48 | 23 | 25 | 20 | 8 | 12 | ||
9. Safety | 109 | 22 | 8 | 14 | 37 | 18 | 18 | 24 | 16 | 8 | 17 | 7 | 10 | ||
Resources | "Are the following available and/or adequate to support your child’s participation at school?" | "Not needed" | "Usually yes" | "Sometimes yes, sometimes no" | "Usually not" | ||||||||||
10. Personal transportation | 112 | 63 | 32 | 30 | 34 | 18 | 16 | 4 | 1 | 3 | 0 | 0 | 0 | ||
11. Public transportation | 112 | 60 | 37 | 23 | 37 | 13 | 24 | 1 | 0 | 1 | 3 | 1 | 2 | ||
12.Programs and services | 112 | 14 | 6 | 8 | 49 | 26 | 23 | 19 | 8 | 11 | 18 | 11 | 7 | ||
13. Policies and procedures | 111 | 22 | 9 | 13 | 43 | 20 | 23 | 20 | 10 | 10 | 15 | 12 | 4 | ||
14. Supplies | 112 | 77 | 38 | 39 | 19 | 12 | 7 | 4 | 2 | 3 | |||||
15. Information | 111 | 63 | 32 | 32 | 30 | 15 | 14 | 7 | 4 | 4 | |||||
16. Time | 113 | 67 | 35 | 32 | 31 | 16 | 15 | 2 | 0 | 2 | |||||
17. Money | 112 | 75 | 35 | 40 | 19 | 12 | 7 | 6 | 4 | 2 | |||||
Community environment | Helpfulness | "Do the following things help or make it harder to participate in activities at school?" | "Not an issue" | "Usually helps" | "Sometimes helps, sometimes makes harder" | "Usually makes harder" | |||||||||
1. Physical layout | 114 | 47 | 20 | 27 | 16 | 11 | 5 | 27 | 15 | 12 | 10 | 6 | 4 | ||
2. Sensory quality | 114 | 9 | 2 | 7 | 8 | 4 | 4 | 39 | 20 | 18 | 45 | 26 | 20 | ||
3. Physical demands of activity | 113 | 24 | 8 | 16 | 9 | 2 | 7 | 35 | 24 | 11 | 33 | 19 | 14 | ||
4. Cognitive demands of activity | 114 | 30 | 9 | 21 | 7 | 4 | 4 | 29 | 18 | 11 | 34 | 21 | 13 | ||
5 Social demands of activity | 113 | 11 | 4 | 7 | 9 | 5 | 4 | 40 | 23 | 17 | 40 | 20 | 20 | ||
6. Relations with peers | 113 | 15 | 3 | 9 | 13 | 7 | 6 | 42 | 24 | 18 | 31 | 15 | 16 | ||
7. Attitudes | 113 | 7 | 3 | 4 | 19 | 11 | 9 | 48 | 25 | 23 | 26 | 13 | 13 | ||
8. Weather conditions | 114 | 45 | 19 | 25 | 4 | 2 | 2 | 40 | 21 | 19 | 11 | 10 | 2 | ||
9. Safety | 114 | 18 | 9 | 9 | 32 | 16 | 17 | 28 | 17 | 11 | 22 | 11 | 10 | ||
Resources | "Are the following available and/or adequate to support your child’s participation in the community?" | "Not needed" | "Usually yes" | "Sometimes yes, sometimes no" | "Usually not" | ||||||||||
10. Personal transportation | 115 | 17 | 8 | 10 | 76 | 39 | 37 | 5 | 4 | 1 | 2 | 1 | 1 | ||
11. Public transportation | 115 | 29 | 18 | 10 | 68 | 31 | 37 | 3 | 3 | 0 | 1 | 0 | 1 | ||
12. Programs and services | 115 | 30 | 16 | 14 | 37 | 17 | 20 | 18 | 9 | 10 | 15 | 10 | 5 | ||
13. Information | 112 | 55 | 25 | 30 | 31 | 18 | 13 | 13 | 8 | 5 | |||||
14. Equipment and supplies | 112 | 65 | 30 | 35 | 28 | 18 | 10 | 7 | 3 | 4 | |||||
15.Time | 111 | 57 | 31 | 26 | 29 | 20 | 18 | 4 | 1 | 3 | |||||
16. Money | 113 | 70 | 34 | 36 | 22 | 13 | 9 | 8 | 4 | 4 |
Clusters of strategies | Single strategies | Explanation of parental contextual strategies | Three settings (H) (S) (C) | Children (age 5–11 years) exemplary quotes from home (H), school (S), and community(C) | Adolescents (age 12–17 years) exemplary quotes from home (H), school (S), and community(C) | ||
---|---|---|---|---|---|---|---|
Theme: “PEOPLE”: parents use their relationship to support participation (257 comments: 130 children; 127 adolescents) | |||||||
Encouraging participation (62 comments) | Confirming and motivating (46 comments) | Parents try to motivate. They give positive feedback and encourage involvement | x | x | x | “Confirm what we do together with a lot of pride and praise” (H) “We praise him” (S) “We try a lot and encourage him” (C) | “Motivation plan” (H) “Encouragement” (S) “Give him tips and motivate him” (C) |
Applying a needs and age-oriented attitude (16 comments) | Parents are sensitive to children’s needs and treat them age-appropriately | x | x | x | “Listen carefully to the child: sometimes something works and sometimes it doesn’t. But we often don’t know why either” (H) “Adjustments according to his needs” (C) | “Make sure that information that might be of interest arrives and is read” (H) “I always remind him of his career aspirations so that he can find the strength and motivation for school” (S) | |
Accompanying, sharing, and supervising activities and participation (118 comments) | Accompanying child’s participation (41 comments) | Parents accompany their children on the way to school, at school, and while they participate in the community | x | x | “We accompany him to school, otherwise it wouldn’t work” (S) “If there is no teaching staff, I help out or the child stays at home” (S) “Mother always comes with him”(C) | “Sometimes bring her to school to relieve the stress of transferring in the morning so that she can bring all her energy to school” (S) “We support him by providing transport to the places, stay with him there and bring him home again” (C) | |
Performing school activities at home (32 comments) | Parents accompany children in doing homework, repeating school tasks, or preparing for exams | x | x | “I stopped working … to be able to support him doing his homework better” (H) “We repeat the school lessons at home so that he progresses at school” (S) “Intensive support with homework” (S) | “Prepare for activities he will do at school (e.g. skiing or giving a lecture)” (S) | ||
Shared family activities (23 comments) | Parents expect their children to participate in family activities | x | x | “Joint activities of the family” (H) “Just take the child with you and include it, just like another child” (C) | “Nothing, he just goes along with it” (H) “Count on his participation” (C) | ||
Supervising (22 comments) | Parents organize care or supervision for their children | x | x | “Always make sure that someone is present” (H) “We applied for 100% teaching assistance” (S) “I stopped working … to be able to support him doing his homework better” (H) | “Check e.g. that he doesn't run from the bathroom to his computer” (H) “Involve external professionals, from school we do not expect a lot” (S) | ||
Enhancing social relations and bridging (56 comments) | Building relationships with school personnel (30 comments) | Parents keep regular positive contact with teachers or other personnel at school to be informed and influence decisions | x | “Close collaboration with kindergarten teacher”(S) “Many talks with head of school and teachers, initiated through us” (S) | “Good contact with special needs teacher and main teacher” (S) “Regularly contact with school so we can support their decisions”(S) | ||
Reframing (26 comments) | Parents explain to the social environment (such as siblings, teachers, organizers, or parents of other children) the needs or behavior of their children | x | x | x | “We try to explain it to the little sister and thus bridge the gap between the two age groups” (H) “We speak openly with her teachers, explain her anxieties and try to find solutions together” (S) “To inform organizers and trainers in advance about possible complications or premature termination” (C) | “We are engaging in the relationship with parents of children our daughter is friends with” (H) “High transparency about diagnosis and problems with teachers” (S) “We try to inform children and parents about autism to increase their comprehension” (C) | |
Inviting wider family and friends to participate (10 comments) | Parents maintain contact with wider family, friends, and parents of peers and invite them to participate with their children or visit them | x | x | x | “Using his sister as a motivator” (H) “We maintain good relationships with parents of peers” (S) “Invite a friend with kids or family member to participate with us” (C) | “Family cohesion” (C) | |
Bringing in peers or other children (8 comments) | Parents invite or include peers or other children to support the participation of their child | x | x | x | “Invite the best friend of our daughter to come along” (H) “Bringing in his best friend who is a class above him” (S) “Emphasize that school friends are also there” (C) | “Laying a good foundation with peers from an early age (offering opportunities to play, cultivating relationships) so that the child experiences himself as an equal member and is more self-confident” (S) “Organizing with his friend play dates to make them more smooth” (C) | |
Theme: “ACTIVITIES”: parents influence participation through activities (219 comments: 104 children; 115 adolescents) | |||||||
Searching for and choosing interesting activities (58 comments) | Meeting interests of the child and conveying joy and fun (41 comments) | Parents address the interest of their children or make them attractive by conveying joy and fun. They also support implementing interests for participation | x | x | x | “He loves household experiments, cooking has a lot to do with physics” (H) “Refer to the things that are fun such as swimming in school, singing gymnastics” (S) “Interest-related activities (planetarium or museum)” (C) | “Include existing preferences and interests” (H) “Report on own experiences, how much fun they were” (S) “We encourage and support her to implement their own ideas, e.g. climate demonstration” (C) |
Giving them choices and asking for help (17 comments) | Parents offer choices or ask for help from their children to let them decide actively for their participation | x | x | “Let him choose the order of the tasks to be done” (H) “We make suggestions and let him choose” (C) | “We ask him for support” (H) “Give him opportunities” (C) | ||
Planning and organizing activities and preparing the children and adolescents with ASD (127 comments) | Preparing children in detail beforehand (90 comments) | Parents prepare their children by informing them in advance (goal -oriented/repeatedly) and in great detail (precisely/instructively) about future participation. Additionally, parents of adolescents discuss a lot | x | x | x | “We discuss with him in advance possible difficulties that can occur during an activity and how one can then react to them” (H) “Short, clear instructions, no small talk, no questions, avoid filler words and focus on key communication” (H) “Ask carefully how the day was or otherwise get detailed information elsewhere and re-enact conflicts with Playmobil characters to prepare for the next school day” (S) “Provide enough information beforehand” (C) | “Early planning and information with multiple repetitions until the activity is carried out” (H) “A lot of discussions in advance” (S) “Precise preliminary information per activity who, how, when, what, where, how long, which goal” (S) “Convey security by preparing him for what to expect” (C) “Win argumentatively and create meaningfulness” (C) |
Planning and organizing (37 comments) | Parents plan activities beforehand and organize to benefit their children’s participation | x | x | “Pack the school bag” (S) “We arrange for our child organizational aspects” (C) “Endless search for hobby opportunities that fit the framework” (C) | “Checking the timetable, reminding when there are special events” (S) “We plan activities before we inform him” (C) “We pay for a painting course” (C) “Gather information about possible activities” (C) | ||
Performing adapted activities (34 comments) | Starting, modelling, and grading (34 comments) | Parents start an activity and model for their children. They also grade the demands of activities | x | x | “Activities are graded, he takes part in sub-steps” (H) “Introduce the activity and observe him very closely to be aware of any questions or barriers” (C) | “Show and invite the child to involve himself” (H) “Again and again make offers for participation” (C) | |
Theme: “TIME” parents use aspects of time to support participation (70 comments: 34 children; 36 adolescents) | |||||||
Opting for regularity, more time and the right moment (70 comments) | Regularity and rituals (30 comments) | Parents stick to regularity and rituals to make daily tasks for their children more predictable | x | x | x | “We try to establish precise rules and rituals for as many activities as possible” (H) “Regularly daily routine” (S) “Try regularly” (C) | “Clear, non-negotiable minimum rules (getting up in the morning, showering, dinner together, handing over your mobile phone)” (H) “Regularly repeated events” (C) |
Creating and adapting time (25 comments) | Parents know that their children sometimes need more time and breaks in-between activities. Thus they use more time to reduce stress | x | x | x | “Take a break before some activities so that the child can adjust to it” (H) “A lot of recovery time at home” (S) “ Limit time (visits no longer than max 1–2 h depending on the activity” (S) | “Reduce the pace” (H) “Allowing time and avoiding pressure is usually successful, but it is difficult to get the child to school on time” (S) “…leave between every activity 1–2 h unplanned time” (C) | |
Adapt to the state of mind at the moment (15 comments) | Parents are mindful about the right moment to address new topics or changes | x | x | “Introduction of the activity when the child is "on the receiving end", i.e. after being reasonably well-rested” (H) | “Wait for the right time” (H) “Align with his state of mind in the moment” (C) | ||
Theme: “OBJECTS”: parents use objects to communicate and motivate (40 comments: children 17; adolescents 23) | |||||||
Providing visual communication and rewards (40 comments) | Visualizing (19 comments) | Parents communicate with graphical or visual methods | x | x | x | “Time timer” (H) “Pictograms such as weather app to understand weather conditions” (S) “Visualization with pictures or maps” (C) | “Partly detailed process plans that enable independent action” (H) “Prepare with maps or material from the internet” (S) |
Offering rewards (21 comments) | Parents offer rewards and incentives to acknowledge efforts and to motivate them to participate in unpleasant activities | x | x | x | “Promise the fulfillment of a greater wish and give points for successfully dealing with unpleasant things” (H) “Lure him with snails, his favorite animal, to motivate him to walk with us to school” (S) | “Offer of favorite food or favorite TV show” (H) “Incentives” (S) “"Horse trading" with rewards, e.g. media time” (C) | |
Theme: “PLACE”: parents chose places with just the right amount of stimuli (38 comments; children 26: adolescents 12) | |||||||
Choosing rooms to avoid or react to sensory overload (38 comments) | Organize possibilities for withdrawal and rest (20 comments) | Provide opportunities for withdrawal or rest to avoid sensory overload | x | x | “Provide relaxation and opportunities for withdrawal at home, to allow his adaptation capacity, which is overstretched through school, to be balanced again.” (S) “Codeword "car" or "home" when it gets too much” (C) | “Adjust the furniture (hammock for reading, works very well)” (H) “We stop the activities early to avoid overload” (C) | |
Choosing rooms and furniture based on sensory aspects (18 comments) | Parents adapt rooms and furniture to the needs of their children or teach them coping strategies | x | x | x | “Learn strategies to cope with sensory overload” (H) “Organize edge seating, window seat” (C) | “Avoid bad-smelling situations” (H) “Familiar surroundings are important. We only go shopping at certain supermarkets, as there are fewer attractions there than at others. According to our son, these discount stores are structured logically and are clearer” (C) |