This chapter examines the participation of young children with developmental disabilities and chronic medical conditions in extracurricular activities (ECAs), detailing both benefits and barriers. Despite legal mandates for equal participation, children with disabilities still engage in ECAs at lower rates than their peers, though recent trends show gradual improvement. The chapter synthesizes research on the broad range of ECAs—including sports, clubs, performing arts, and community activities—available in schools and communities, noting significant variability in participation linked to disability type, age, communication needs, and gender. Successful inclusion requires individualized planning, support, and adaptations, such as Individualized Health Plans, natural supports, and accessible environments. Practical strategies for maximizing participation include visual supports, partner/group activities, staff training, and fostering a culture valuing diversity. While highlighting the developmental, social, and health benefits of ECA involvement, the chapter emphasizes persistent challenges for children with extensive support needs and calls for further research and innovative approaches for equitable, meaningful access.