Figure 3 Indirect effects model relating child diagnosis status and child functional characteristics to family health/well-being and child participation, household population aged 5 to 14 with neurodevelopmental disorders/disabilities, Canada, 2006 Figure 3 Indirect effects model relating child diagnosis status and child functional characteristics to family health/well-being and child participation, household population aged 5 to 14 with neurodevelopmental disorders/disabilities, Canada, 2006

In the indirect effects model, the direct effects of child diagnosis status on child and family outcomes disappeared when autism spectrum disorder-related functioning was added, with standardized path coefficients no longer reaching thresholds for statistical significance or effect size magnitude. Autism spectrum disorder-related functioning had a significant and meaningful direct effect on family health and well-being (standardized path coefficient = .73, p < 0.05), in-school participation (standardized path coefficient = .54, p < 0.05), and out-of-school participation (standardized path coefficient = .25, p < 0.05). As anticipated, ASD-related functioning was also significantly related to child diagnosis status (standardized path coefficient = .39, p < 0.05), meaning that absence of an autism spectrum disorder diagnosis was related to less impairment in the domains of speech and communication, cognition-learning, and emotional-behavioural/psychological functioning. Child functional characteristics comprised items from the Health Utility Index and items from the Participation and Activity Limitation Survey impairment index. The components of family health and well-being were physical, psychological and economic. Child in-school participation referred to physical education, recess/lunch activities, school outings, and classroom. Child out-of-school participation referred to summer camp, sports, organized activities, unorganized activities, non-sport lessons, and community programs.