To review the longitudinal trajectories – and the factors influencing their development – of mental health problems in children with neurodevelopmental disabilities. Systematic review methods were employed. Searches of six databases used keywords and MeSH terms related to children with neurodevelopmental disabilities, mental health problems, and longitudinal research. After the removal of duplicates, reviewers independently screened records for inclusion, extracted data (outcomes and influencing factors), and evaluated the risk of bias. Findings were tabulated and synthesized using graphs and a narrative. Searches identified 94,662 unique records, from which 49 publications were included. The median publication year was 2015. Children with attention deficit hyperactivity disorder were the most commonly included population in retrieved studies. In almost 50% of studies, trajectories of mental health problems changed by < 10% between the first and last time point. Despite multiple studies reporting longitudinal trajectories of mental health problems, greater conceptual clarity and consideration of the measures included in research is needed, along with the inclusion of a more diverse range of populations of children with neurodevelopmental disabilities.

Background: FUNDES-Child-SE is a proxy rating questionnaire for measuring participation and independence in children with disabilities in a Swedish context. It includes the components of frequency of attendance, engagement and independence. The original, Taiwanese FUNDES-Child 7.0, has previously been found to have a four-factor structure for frequency of participation and a two-factor structure for independence. The aim of this study was to test the factor structure in FUNDES-Child-SE. The factor structure is an important part of construct validity.

Methods: Caregivers of 163 children with disabilities aged 6–18 years participated in this cross-sectional study. Exploratory factor analysis was used to find the factor structure for Engagement. Confirmatory factor analysis was used to test the factor structure for all three components.

Results: The proposed factor structure for frequency of participation (daily living participation frequency, mobility participation frequency, learning participation frequency and community participation frequency) and independence (daily living independence and social participation independence) fit with data from FUNDES-Child-SE after excluding three to five items and adding two to five covariances of residuals. In the engagement component, two factors, named engagement in informal activities and engagement in formal activities, were found. After excluding one item and adding 10 covariances of residuals, the factor structure had an acceptable fit to data.

Conclusions: Differences in components' factor structure indicate that attendance and engagement are separate aspects of participation. Before using numeric scores from FUNDES-Child-SE in clinical settings, responsiveness and interpretability should be evaluated.

Research Findings: This study examined the engagement of 494 preschool children in Sweden (M = 53.44 months, SD = 10.64) using both teacher questionnaires to measure global engagement (trait) and observations to measure momentary engagement (state). Using a person-oriented approach with cluster analysis, we identified five distinct profiles of global and momentary engagement, with four of them showing discrepancies between global and observed engagement levels. We found that age, hyperactivity, and second language learner (SLL) status were related to a specific engagement profile. Specifically, children high in hyperactivity tended to be in clusters with higher momentary engagement than global engagement, whereas second language learners were overrepresented in clusters with lower momentary engagement.

Practice or Policy: The findings suggest that global and observed measures of engagement capture different aspects of children’s engagement and should not be used interchangeably. Children with low engagement ratings on both measures of engagement are more likely to have an extreme score on the global engagement measure, indicating that difficulties they experience will be more noticeable in their global engagement. On the other hand, displays of high levels of momentary engagement could signal children’s inherent potential, prompting tailored encouragement and support within Early Childhood Education and Care (ECEC) settings and promoting their overall engagement levels.

BACKGROUND: Children with disabilities have an increased risk of mental health problems. Patterns of mental health problems and well-being may vary. AIMS: To identify patterns of mental health problems and well-being in children with disabilities in Sweden, and investigate the influence of parental background (migration, education), and child cognitive level. METHOD: In this cross-sectional study, cluster analysis was used to analyse parents' ratings of conduct problems, emotional symptoms, and prosocial behaviour on the Strengths and Difficulties Questionnaire (SDQ) in children with disabilities (n = 136). The influence of parental background (migration, education) and child cognitive level on cluster membership was explored through multinomial logistic regression. RESULTS: Five clusters of mental health patterns emerged. Three clusters had mean ratings near or past clinical cut-off for one each of the SDQ-subscales. One cluster had difficulties on all three subscales. Greater child cognitive difficulties increased the likelihood of low prosocial behaviour (OR 2.501, p < .001) and of difficulties on all three subscales (OR 2.155, p = .006). Parental background did not influence cluster membership. CONCLUSION: Children with disabilities display varying mental health patterns. Awareness of the complexity of mental health patterns among children with disabilities is important. Screening and support for emotional symptoms and prosocial behaviour deficits should be considered for children with conduct problems. 

Background

Different barriers may hinder children with developmental disabilities (DD) from having a voice in research and clinical interventions concerning fundamentally subjective phenomena, such as participation. It is not well-investigated if video communication tools have the potential to reduce these barriers.

Aim

This study investigated the feasibility of administering a self-rating instrument measuring participation, Picture My Participation (PmP), via a video communication tool (Zoom), to children with DD.

Materials and methods

PmP was administered to 17 children with DD (mean age 13 years). The pictorial representations of activities and response options in PmP were displayed in a shared PowerPoint presentation, enabling nonverbal responses with the annotate function in Zoom. Child and interviewer perceptions of the interview were measured through questionnaires developed for the purpose.

Results

All the children completed the interview. Most PmP questions were answered, and no adverse events were registered. Technical issues could generally be solved. No special training or expensive equipment was needed for the interviews.

Conclusion

Interviewer-guided self-ratings of participation and related constructs through video communication may be a feasible procedure to use with children with DD from age 11. SignificanceOffering video communication may increase children's chances to contribute subjective experiences in research and clinical practice.

Background

Children in need of special support (INS) often display delays in time-processing ability (TPA) affecting everyday functioning. Typically developing (TD) children are not yet mature to use the information of a clock.

Aim

To investigate the feasibility of an intervention program, MyTime, to facilitate TPA and everyday functioning in pre-school children, including the subjective experiences of pre-school staff and the children.

Materials and Methods

The intervention sample consisted of 20 children: 4 INS and 16 TD. Intervention was given daily in 8 weeks with MyTime in the pre-school environment. Data collection procedures were evaluated and children were assessed for TPA pre- and post intervention. Everyday functioning were assessed by teachers, parents and children. Experiences of the intervention were assessed by a group interview with teachers and a Talking Mats© evaluation with children.

Results

MyTime worked well in pre-school and indicated an increase in the children's TPA and everyday functioning. The program was perceived simple to use by teachers and children highlighted the importance to understand the duration of time.

Conclusion

The program MyTime was found to be feasible in the pre-school environment. Significance: The assessment and program design can be used to investigate intervention effectiveness in a randomised study.

The participation of all children in preschool activities is the main outcome of inclusive Early Childhood Education and Care (ECEC). The current study used the Child Observation in Preschool (COP) to explore the observed participation patterns in the free play of a sample of 3-5-year-old Swedish preschool children (N = 453), and to examine the characteristics of the resulting clusters in terms of child and preschool unit characteristics. Based on a series of hierarchical and K-means cluster analyses, we identified eight distinct and meaningful clusters that could be ranked from very high to very low observed participation. Four of the clusters indicated average-to-very high observed participation. Two clusters indicated low-to-very low observed participation. The cluster displaying low observed participation had high proximity to a small group including teachers. On average, children in this cluster came from preschool units with significantly more second language learners. The cluster displaying a very low observed participation had low proximity to a small group including teachers. On average, children in this cluster were significantly more often second language learners, and the children came from units with a significantly higher number of resource staff. No significant differences appeared in the number of children with special educational needs across the clusters, although tendencies emerged. The results imply that the children in this sample had a varied degree of observed participation. Two clusters of children appeared to have difficulties in participating in free play activities where second language learners and children from preschool units with more second language learners were more common. Preschool teachers need to identify children who participate less in preschool activities and who might benefit from more teacher proximity. Teachers also need to reflect on how their proximity impacts the participation of children differently and on the type of support they provide when being close to the children.

Children with impairments are known to experience more restricted participation than other children. It also appears that low levels of participation are related to a higher prevalence of mental health problems in children with neurodevelopmental disorders (NDD). The purpose of this conceptual paper is to describe and define the constructs mental health problems, mental health, and participation to ensure that future research investigating participation as a means to mental health in children and adolescents with NDD is founded on conceptual clarity. We first discuss the difference between two aspects of mental health problems, namely mental disorder and mental illness. This discussion serves to highlight three areas of conceptual difficulty and their consequences for understanding the mental health of children with NDD that we then consider in the article: (1) how to define mental health problems, (2) how to define and assess mental health problems and mental health, i.e., wellbeing as separate constructs, and (3) how to describe the relationship between participation and wellbeing. We then discuss the implications of our propositions for measurement and the use of participation interventions as a means to enhance mental health (defined as wellbeing). Conclusions: Mental disorders include both diagnoses related to impairments in the developmental period, i.e., NDD and diagnoses related to mental illness. These two types of mental disorders must be separated. Children with NDD, just like other people, may exhibit aspects of both mental health problems and wellbeing simultaneously. Measures of wellbeing defined as a continuum from flourishing to languishing for children with NDD need to be designed and evaluated. Wellbeing can lead to further participation and act to protect from mental health problems.

Preschool staffs' responsiveness affects children's behaviour, their difficulties, and engagement in the preschool context, but children's behaviour and characteristics also affect staff responsiveness. Early second language learners (L2-learners) have been shown to have more problems with behaviour and emotions and lower engagement in preschool. Being engaged in preschool activities predicts future academic performance, attitude towards school and well-being in the short and long term, and can be promoted by the preschool staff. Knowledge of which factors support engagement in preschool for L2-learners can help prevent, in the early years, negative pathways based on low engagement and problems with behaviour and emotions. This cross-sectional study used data from a longitudinal study to investigate the relationship between child engagement and staff responsiveness as well as how child age, child problems with behaviour and emotions, child group size, and the child:staff ratio impact child engagement and staff responsiveness. The study also investigated whether these relations differ between L2-learners and children learning Swedish as their first language (L1-learners). Preschool staff (N = 611) reported through questionnaires on engagement, age, problems with behaviour and emotions and emotional symptoms of 832 children aged 13-71 months, as well as on staffing and staff responsiveness. With a path analysis extended by multi-group analysis, we found two models suggesting that age, problems with behaviour and emotions and preschool staff responsiveness influence child engagement, irrespective of background. The study also found that child engagement significantly influenced staff responsiveness. The multi-group analysis only weakly supported the hypothesis that the child's age affects staff responsiveness more strongly for L2-learners. The results indicate that individual children and child groups themselves can affect the responsiveness of their staff, and that children with low engagement risk being neglected. L2-learners are at increased risk since they tend to display lower engagement and more behaviour problems in preschool in general. If not attended to early, the lower engagement already apparent among L2-learners in preschool can create stable patterns of low engagement and problems with behaviour and emotions that extend beyond the preschool years and having negative effects on the children's later well-being and school performance.

Preschool children's engagement/social interaction skills can be seen as aspects of positive functioning, and also act as protective aspects of functioning. On the other hand, hyperactivity/conduct problems are risk aspects that negatively affect children's everyday functioning. Few studies have investigated such orchestrated effects on mental health in young children over time. The aims of the study are first, to identify homogeneous groups of children having similar pathways in mental health between three time points. Second, to examine how children move between time points in relation to risk and protective factors. Alongitudinal study over 3 years, including 197 Swedish preschool children was used. Questionnaire data collected from preschool teachers. Statistical analysis using person-oriented methods with repeated cluster analyses. Children high in engagement/social skills and low in conduct problems continue to function well. Children with low engagement/social skills exhibiting both hyperactivity and conduct problems continue to have problems. Children with mixed patterns of protective factors and risk factors showed mixed outcomes. The stability of children's pathways was quite high if they exhibited many positive protective factors but also if they exhibited many risk factors. Children exhibiting a mixed pattern of protective and risk factors moved between clusters in a less predictable way. That stability in mental health was related to the simultaneous occurrence of either many protective factors or many risk factors supports the notion of orchestrated effects. The results indicate that early interventions need to have a dual focus, including both interventions aimed at enhancing child engagement and interventions focused on decreasing behavior problems.