Preferences for Activities of Children

1. Abstract

The Preferences for Activities of Children (PAC) is an established, child-centric psychometric instrument designed to assess the activity preferences of children and youth with and without physical, developmental, and neurological disabilities. Developed alongside its companion measure, the Children’s Assessment of Participation and Enjoyment (CAPE) by Gillian King and colleagues (2004), the PAC directly captures a child’s intrinsic motivation and desire to engage in discretionary, out-of-school day-to-day pursuits. The instrument comprises 55 items spanning everyday recreational, social, and developmental endeavors. Administration is conducted using a structured, visual card-sorting procedure featuring a 3-point pictorial rating scale (1 = I would not like to do at all, 2 = I would sort of like to do, 3 = I would really like to do) accompanied by expressive facial icons (frowning, neutral, smiling) to facilitate cognitive comprehension across varied developmental stages.

The PAC provides a comprehensive profile across five distinct activity domains: Recreational, Active Physical, Social, Skill-Based, and Self-Improvement, which can further be aggregated into two overarching higher-order categories: Formal and Informal activities. Empirical validation studies across North American, European, and Australian cohorts demonstrate solid psychometric integrity. Internal consistency reliability coefficients (Cronbach’s alpha) typically range from .76 to .88 for the overarching domains, with test-retest reliability intraclass correlation coefficients (ICCs) ranging from .62 to .84 across two- to four-week intervals. Construct, convergent, and discriminant validities are firmly supported through systematic associations with functional motor classification, environmental affordances, self-determination metrics, and perceived quality of life. As an essential clinical and research assessment, the PAC bridges the gap between functional capacity and autonomous agency, operationalizing child-driven preferences within family-centered pediatric rehabilitation and educational planning.

2. Keywords

Preferences for Activities of Children, PAC, Children’s Assessment of Participation and Enjoyment, CAPE, pediatric participation, activity preferences, childhood disability, pediatric occupational therapy, psychometrics, self-determination, International Classification of Functioning Disability and Health

3. Authors

The Preferences for Activities of Children (PAC) was authored by an interdisciplinary team of clinical researchers in childhood disability and rehabilitation science:

• Gillian King, Ph.D. — Senior Scientist at Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, and Professor in the Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada.
• Mary Law, Ph.D., OT Reg. (Ont.) — Professor Emerita, School of Rehabilitation Science, and Co-Founder of CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.
• Susanne King, M.Sc. — Research Associate and Investigator, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.
• Patricia Hurley, M.Sc. — Research Coordinator and Evaluator, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.
• Steven Hanna, Ph.D. — Associate Professor, Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.
• Nancy Kertoy, Ph.D., S-LP(C) — Professor Emerita, School of Communication Sciences and Disorders, Western University, London, Ontario, Canada.
• Arlene Rosenbaum, B.A. — Research Associate, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada.

The Dutch adaptation and psychometric cross-cultural validation were completed by Mieke K. Bult, Ph.D., Marian J. Jongmans, Ph.D., Paul B. M. Verschuren, Ph.D., and Minne G. Lindeman, Ph.D. (2010), in collaboration with University Medical Center Utrecht and Utrecht University, the Netherlands.

4. Purpose

The central aim of the Preferences for Activities of Children (PAC) is to systematically and authentically capture a child’s personal interest in, and volition toward, everyday activities outside of mandatory educational curricula. Historically, pediatric functional evaluation concentrated predominantly on body structures, motor deficits, and standardized performance capacity. Such evaluations routinely relied upon proxy reports from parents, physicians, or educators, largely neglecting the subjective preferences and emerging autonomy of the children themselves. The PAC was specifically created to counterbalance this limitation by establishing a direct, self-report medium through which children aged 6 through 21, spanning diverse neurodevelopmental and physical profiles (such as cerebral palsy, autism spectrum conditions, acquired brain injuries, and physical motor delays), can express what they genuinely desire to do.

In clinical practice, particularly within pediatric occupational therapy, physical therapy, and speech-language pathology, the PAC serves as an essential tool for client-centered, family-guided goal setting. Therapeutic interventions often fail to achieve long-term lifestyle integration if goals reflect only what parents or clinicians believe the child ought to do, rather than activities the child fundamentally wants to pursue. By administering the PAC in tandem with the Children’s Assessment of Participation and Enjoyment (CAPE), clinicians contrast a child’s actual participation patterns (diversity, intensity, enjoyment, social context, and physical environment) against their latent preference profiles. Discrepancies between high preference and low actual participation highlight target areas where environmental barriers, physical inaccessible spaces, or societal attitudes restrict the child’s involvement, directing clinicians toward targeted environmental adaptations, assistive technologies, or community integration initiatives.

In research contexts, the PAC enables the empirical exploration of developmental trajectories in leisure interests, gender differences in leisure choice, and the impact of intervention protocols on widening a child’s horizons. It provides a standardized outcome measure for pediatric clinical trials investigating whether interventions increase not only physical competence, but also foster enriched, self-determined leisure repertoires. By decoupling preference from actual execution, researchers can isolate whether lower engagement levels in children with physical limitations stem from a genuine disinterest in those activities or from extrinsic physical and systemic barriers.

5. Psychological Construct

The psychological construct evaluated by the PAC is activity preference, rooted in intrinsic motivation, interest formation, and self-determination. Activity preference represents an individual’s affective predisposition, valence, and choice tendency toward engaging in specific occupations. The PAC segments this overarching construct into five distinct activity domains and two higher-order organizational levels:

Activity Domains

• Recreational Activities: Encompasses informal, play-oriented, and entertaining sedentary or light-action pursuits typically executed for instant amusement, relaxation, or solitary leisure. Examples include hanging out, watching television or videos, playing computer games, listening to music, doing crafts, and playing with toys. This dimension measures informal leisure interest that requires low structural demand.
• Active Physical Activities: Characterized by bodily movement, cardiorespiratory exertion, physical agility, and outdoor sports. Items evaluate interest in swimming, bicycling, team sports, martial arts, water sports, and non-competitive playground games. This subscale provides critical insight into a child’s desire for gross-motor engagement and physical recreation.
• Social Activities: Pertains to interpersonal interactions, communication, peer bonding, and collective events. It comprises pursuits such as going to parties, visiting friends or family, talking on the phone, entertaining guests, and spending time with peers. This domain assesses the child’s drive for social connectedness, relational development, and community affiliation.
• Skill-Based Activities: Involves rule-governed, systematic endeavors requiring deliberate practice, instruction, disciplined mastery, and progressive skill acquisition. Activities include taking music or art lessons, learning a foreign language or instrument, dancing, singing, and practicing specific sports techniques. This reflects achievement motivation and the willingness to invest structured effort into personal competence.
• Self-Improvement Activities: Reflects civic, intellectual, personal, and domestic responsibility tasks aimed at personal growth, prosocial contribution, and life skills. Items include reading, doing homework, volunteer work, gardening, pet care, doing chores, and participating in religious or community clubs. This domain reflects orientation toward developmental maturation, routine maintenance, and community socialization.

Higher-Order Activity Domains

• Informal Activities: Activities characterized by self-initiation, low structure, minimal adult direction, and flexible scheduling. These draw primarily from the Recreational, Active Physical (unorganized), and Social domains, capturing spontaneous, unprogrammed childhood occupation.
• Formal Activities: Activities organized by structured guidelines, formal coaching or oversight, specific schedules, and organized group enrollments (e.g., team sports, specialized lessons, youth organizations). This index quantifies preference for organized social and educational institutions.

6. Theoretical Framework

The conceptual architecture of the PAC is primarily informed by the World Health Organization’s International Classification of Functioning, Disability and Health (ICF), specifically its emphasis on the “Activities and Participation” component as distinct from “Body Functions and Structures”. Within the ICF model, participation is defined as involvement in a life situation, representing the ultimate societal outcome of health and rehabilitation. However, King, Law, and colleagues posited that participation cannot be understood purely as an objective tally of performance; it is fundamentally mediated by psychological factors including autonomous preference, perceived enjoyment, self-efficacy, and environmental congruence.

The PAC is anchored within Self-Determination Theory (SDT), formulated by Edward L. Deci and Richard M. Ryan. SDT asserts that human beings have innate psychological needs for autonomy (feeling in control of one’s choices), competence (feeling effective in interacting with the environment), and relatedness (feeling connected to others). The PAC directly honors the need for autonomy by providing a standardized, structured vehicle for children to articulate their autonomous interests independent of adult interpretation. When children participate in activities congruent with their internal preferences, they experience higher psychological well-being, intrinsic motivation, and identity cohesion.

Furthermore, the instrument incorporates tenets of the Person-Environment-Occupation (PEO) Model developed by Law and colleagues (1996). The PEO model conceptualizes occupational performance as the dynamic, transactional outcome of the interaction between the Person (their intrinsic preferences, skills, and desires), the Environment (physical, social, and cultural contexts), and the Occupation (the tasks and activities of daily life). The PAC isolates the “Person” component’s affective aspirations, enabling clinicians and researchers to observe whether the “Environment” effectively facilitates or restricts occupational engagement. Discrepancies between preferred activities and actual participation highlight environmental mismatches, framing therapeutic interventions around modifying environments rather than simply remediating personal impairments.

7. Validity

Extensive psychometric investigations have affirmed the multi-faceted validity of the PAC across both typically developing cohorts and pediatric clinical populations:

Construct and Discriminant Validity

Construct validity was established during initial norming studies across Canada involving over 400 children with physical disabilities and typically developing controls. Results demonstrated that the PAC effectively differentiates between varied developmental and demographic subsets. For instance, age-related trends emerged predictably: older youth displayed higher preferences for social and self-improvement activities (e.g., hanging out, talking on the phone, working for pay) and lower preferences for pretend or imaginative play compared to younger cohorts ($p < .001$). Gender differences aligned with empirical literature, showing higher active physical preference scores among boys and higher preferences for crafts, reading, and social activities among girls.

Discriminant validity was further proven by evaluating the relationship between functional impairment levels (such as the Gross Motor Function Classification System [GMFCS] in cerebral palsy) and PAC preference scores. Crucially, research by King et al. (2006) and Bult et al. (2010) demonstrated that while actual physical activity participation intensity (measured by CAPE) declined steeply in children with higher motor impairment (GMFCS levels IV and V), their preferences for active physical pursuits remained comparatively high. This critical divergence confirmed that the PAC assesses authentic preference rather than merely mirroring physical performance limitations, confirming construct independence.

Convergent and Concurrent Validity

Convergent validity has been documented by correlating PAC preference ratings with companion measures of self-perception, life satisfaction, and leisure interests. Strong positive correlations ($r = .45$ to $.68$) exist between PAC domain scores and corresponding activity enjoyment ratings on the CAPE. Furthermore, research examining self-concept demonstrates that children who express well-defined activity preferences on the PAC score significantly higher on scales measuring perceived athletic competence, social acceptance, and global self-worth on Harter’s Self-Perception Profile for Children.

8. Reliability

The PAC demonstrates robust internal consistency and temporal stability across international psychometric investigations:

Internal Consistency

In the original validation studies conducted by King et al. (2004), Cronbach’s alpha coefficients were calculated across both domain-specific and overarching scores. For the overarching domains, internal consistency was high:

• Overall Preference: $\alpha = .86$ to $.89$
• Formal Activities: $\alpha = .78$ to $.82$
• Informal Activities: $\alpha = .83$ to $.87$

For the five specific activity domains, alpha coefficients reflected solid internal consistency, considering the intentional heterogeneity of everyday leisure pursuits:

• Recreational Activities: $\alpha = .74$ to $.80$
• Active Physical Activities: $\alpha = .76$ to $.83$
• Social Activities: $\alpha = .72$ to $.79$
• Skill-Based Activities: $\alpha = .75$ to $.81$
• Self-Improvement Activities: $\alpha = .71$ to $.78$

Test-Retest Reliability

Temporal stability of the PAC was evaluated over intervals ranging from two to four weeks. Intraclass correlation coefficients (ICCs) demonstrate acceptable to excellent reproducibility across repeated administrations. Overall preference demonstrated an ICC of $.81$ ($95%\text{ CI } [.72, .88]$). Domain-level ICCs ranged from $.64$ for Recreational pursuits (which naturally fluctuate with immediate trends and seasonal factors) to $.82$ for Active Physical activities. In the Dutch cross-cultural adaptation by Bult et al. (2010), test-retest reliability across 67 children yielded ICCs between $.67$ and $.84$, confirming robust cross-linguistic and longitudinal consistency.

9. Factor Analysis

The structural composition of the PAC was established using comprehensive exploratory factor analyses (EFA) during its initial development, followed by confirmatory factor analyses (CFA) across diverse validation cohorts.

Exploratory Factor Analysis (EFA)

During initial scale development, principal component analysis with varimax and oblimin rotations was conducted on preference data gathered from over 400 children. Items loaded strongly onto five primary latent constructs matching everyday functional categories. Factor loadings for individual items onto their designated domains consistently met or exceeded the standard psychometric threshold of $.40$, with most core items demonstrating loadings between $.48$ and $.76$:

• Active Physical: High loadings observed for swimming ($.71$), bicycling ($.68$), team sports ($.65$), and water sports ($.62$).
• Social: Marked loadings for going to a party ($.72$), visiting with friends ($.67$), and entertaining guests ($.59$).
• Skill-Based: High loadings for taking lessons ($.74$), playing an instrument ($.69$), and practicing a sport or skill ($.63$).
• Self-Improvement: Loadings dominated by reading ($.64$), doing homework ($.58$), doing chores ($.56$), and volunteer work ($.52$).
• Recreational: Characterized by computer/video games ($.66$), listening to music ($.61$), and hanging out ($.55$).

Confirmatory Factor Analysis (CFA)

Subsequent CFA evaluations examined whether the five-factor model and the hierarchical two-factor model (Formal vs. Informal) demonstrated superior fit compared to unidimensional models. Goodness-of-fit indices confirmed acceptable model fit across cohorts: Comparative Fit Index ($ ext{CFI}$) values typically ranged from$.91$ to $.94$, the Tucker-Lewis Index ($ ext{TLI}$) exceeded$.90$, and the Root Mean Square Error of Approximation ($ ext{RMSEA}$) fell within the acceptable threshold of$.048$ to $.062$ ($ ext{SRMR} < .065$). These analytical results affirm that activity preference is multidimensional, supporting the calculation of separate domain subscale scores alongside the global composite score.

10. Instrument / Measurement Tool

The PAC is a highly structured, child-accessible preference inventory designed to be administered independently or via supported interview:

• Target Population: Children and youth aged 6 to 21 years with or without physical, intellectual, or developmental disabilities.
• Administration Format: Standardized visual card-sort procedure or structured illustrated booklet. Each of the 55 activities is presented on an individual visual card depicting the activity along with clear descriptive text.
• Item Count: 55 discrete everyday activity items.
• Administration Time: Approximately 15 to 30 minutes, depending on the child’s communication profile, cognitive capacity, and motor independence.
• Authentic Response Scale: 3-point scale:
  • 1 = I would not like to do at all (represented visually by a frowning face card)
  • 2 = I would sort of like to do (represented visually by a neutral/straight face card)
  • 3 = I would really like to do (represented visually by a smiling face card)
• Scoring Structure & Rules:
  • Overall Preference Score: The sum of all item ratings divided by the total number of items completed (range: 1.00 to 3.00).
  • Activity Domain Scores: Calculated as average preference ratings for each of the five subscales: Recreational (12 items), Active Physical (13 items), Social (10 items), Skill-Based (10 items), and Self-Improvement (10 items).
  • Overarching Dimension Scores: Average preference ratings for Formal activities (15 items) and Informal activities (40 items).
  • Higher numerical scores uniformly denote stronger intrinsic preference and desire to participate in that activity or domain.

11. Permissions & Fee and Test Year

The Preferences for Activities of Children (PAC) was officially published in 2004 by CanChild Centre for Childhood Disability Research, McMaster University, alongside the CAPE. The Dutch version was validated and published in 2010 by Mieke K. Bult and colleagues.

The manual, visual sorting cards, and record forms are commercially distributed and copyrighted by Pearson Clinical (formerly Harcourt Assessment / PsychCorp). The complete assessment kit (inclusive of the manual, CAPE/PAC record forms, and illustrated activity cards) is available for purchase for clinical, educational, and institutional diagnostic use. Academic and non-commercial clinical researchers can request licensing, research administration permissions, or digital utilization permissions through Pearson Clinical Assessments’ intellectual property and rights division or through the CanChild Centre for Childhood Disability Research. Standard student research discounts and permissions for non-funded academic investigations are routinely evaluated upon formal inquiry.

12. References

The following peer-reviewed publications and clinical manuals substantiate the theoretical, psychometric, and practical foundation of the PAC:

• Bult, M. K., Verschuren, O., Jongmans, M. J., Lindeman, E., & Ketelaar, M. (2010). What influences participation in leisure activities of children and youth with physical disabilities? A systematic review. Research in Developmental Disabilities, 32(5), 1521–1529. https://doi.org/10.1016/j.ridd.2011.01.045
• Bult, M. K., Verschuren, O., Lindeman, E., Jongmans, M. J., Westers, P., & Ketelaar, M. (2010). Pediatric participation: Cross-cultural adaptation, validity, and reliability of the Dutch Children’s Assessment of Participation and Enjoyment and Preferences for Activities of Children. Disability and Rehabilitation, 32(11), 868–875. https://doi.org/10.3109/09638280903349547
• Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268. https://doi.org/10.1207/S15327965PLI1104_01
• King, G., Law, M., King, S., Hurley, P., Hanna, S., Kertoy, N., & Rosenbaum, A. (2004). Children’s Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC). San Antonio, TX: Harcourt Assessment, Inc.
• King, G., Law, M., King, S., Hurley, P., Hanna, S., Kertoy, N., & Rosenbaum, A. (2007). Measuring children’s participation in recreation and leisure activities: Construct validation of the CAPE and PAC. Child: Care, Health and Development, 33(1), 28–39. https://doi.org/10.1111/j.1365-2214.2006.00613.x
• King, G. A., Law, M., Hurley, P., Petrenchik, T., & Schwellnus, H. (2010). A developmental comparison of the out-of-school recreation and leisure activity participation of boys and girls with and without physical disabilities. International Journal of Disability, Development and Education, 57(1), 77–107. https://doi.org/10.1080/10349120903537988
• Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The Person-Environment-Occupation Model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63(1), 9–23. https://doi.org/10.1177/000841749606300103
• World Health Organization. (2007). International Classification of Functioning, Disability and Health: Children & Youth Version: ICF-CY. World Health Organization. https://apps.who.int/iris/handle/10665/43737

13. Items of the Scale