Lena Almqvist

The International Classification of Functioning, Disability and Health and the version for children and youth as a tool in child habilitation/early childhood intervention – feasibility and usefulness as a common language and frame of reference for practice

Early childhood intervention and habilitation services for children with disabilities operate on an interdisciplinary basis. It requires a common language between professionals, and a shared framework for intervention goals and intervention implementation. The International Classification of Functioning, Disability and Health (ICF) and the version for children and youth (ICF-CY) may serve as this common framework and language. This overview of studies implemented by our research group is based on three research questions: Do the ICF-CY conceptual model have a valid content and is it logically coherent when investigated empirically? Is the ICF-CY classification useful for documenting child characteristics in services? What difficulties and benefits are related to using ICF-CY model as a basis for intervention when it is implemented in services? A series of studies, undertaken by the CHILD researchers are analysed. The analysis is based on data sets from published studies or master theses. Results and conclusion show that the ICF-CY has a useful content and is logically coherent on model level. Professionals find it useful for documenting childrens body functions and activities. Guidelines for separating activity and participation are needed. ICF-CY is a complex classification, implementing it in services is a long-term project.

‘I can play!’ Young children's perceptions of health

Health is today viewed as a multi-dimensional concept partly conceptualized independent from not being ill. The aim of this study was to gain knowledge of how young children perceive health. Interviews were conducted with 68 children (4–5 years), within their pre-school setting, with the help of a semi-structured interview guide. A multi-dimensional perspective represented by the health dimensions of the International Classification of Functioning, Disability and Health (ICF) was used in a manifest deductive content analysis. The childrens statements were categorized and placed under one of the four health dimensions, body, activity, participation and environment. A latent content analysis was applied to identify underlying themes in the manifest categories. The results revealed that young children perceive health as a multi-dimensional construct, largely related to being engaged, i.e. to be able to perform wanted activities and participate in a supportive every-day context. This implies that improvements of child engagement should be emphasized in health promotion and to a greater extent be the central focus of health interventions for young children.

Different agendas? The views of different occupational groups on special needs education

The purpose of the present paper is to investigate how different occupational groups explain why children have problems in school, how they believe schools should help these children and the role they believe that special educational needs coordinators (SENCOs) should have in such work. A questionnaire was distributed to all teaching and support staff in a Swedish municipality (N=1297). As a result, 938 persons (72.5%) answered the questionnaire. The answers given by (a) preschool teachers (b) teacher assistants (c) SENCOs (d) special teachers (e) class teachers and (f) subject teachers were compared. Several interesting patterns emerged from the data indicating that the occupational groups to a large extent have different ideas concerning how the school should work with children in need of special support. The SENCOs were, for example, the only group that believed that they should be involved in school development. The outcome of the study is discussed in relation to the notion of inclusive education.

An international comparison of patterns of participation in leisure activities for children with and without disabilities in Sweden, Norway and the Netherlands

Purpose: To investigate whether there are differences in participation in leisure activities between children with and without disabilities in Sweden, Norway and the Netherlands and how much personal and environmental factors explain leisure performance. Methods: In a cross-sectional analytic design, the Childrens Assessment of Participation and Enjoyment, CAPE, was performed with 278 children with disabilities and 599 children without disabilities aged 6–17 years. A one-way between-groups ANOVA explored the differences in participation between the countries. Hierarchical multiple regression analysis assessed if age, gender, educational level, living area and country of residence explained the variance in participation. Results: Scandinavian children with disabilities participated in more activities with higher frequency compared to Dutch children. The strongest predictor was country of residence. For children without disabilities, differences existed in informal activities, the strongest predictor was gender. Conclusion: Differences in school- and support systems between the countries seem to influence patterns of participation, affecting children with disabilities most.

Children’s voices – Differentiating a child perspective from a child’s perspective

Abstract Objective: The aim of this paper was to discuss differences between having a child perspective and taking the child’s perspective based on the problem being investigated. Methods: Conceptual paper based on narrative review. Results: The child’s perspective in research concerning children that need additional support are important. The difference between having a child perspective and taking the child’s perspective in conjunction with the need to know children’s opinions has been discussed in the literature. From an ideological perspective the difference between the two perspectives seems self-evident, but the perspectives might be better seen as different ends on a continuum solely from an adult’s view of children to solely the perspective of children themselves. Depending on the research question, the design of the study may benefit from taking either perspective. In this article, we discuss the difference between the perspectives based on the problem being investigated, children’s capacity to express opinions, environmental adaptations and the degree of interpretation needed to understand children’s opinions. Conclusion: The examples provided indicate that children’s opinions can be regarded in most research, although to different degrees.

Cultural validity of the Children's Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC).

Abstract Objective: The aim was to evaluate whether the activity items of the Childrens Assessment of Participation and Enjoyment/Preferences for Activities of Children (CAPE/PAC) were relevant for Swedish children. Subjects: A total of 337 typically developed children aged 6–17 years old. Methods: The CAPE/PAC was translated into Swedish in accordance with accepted translation procedures. By means of 14 group interviews with children with and without disabilities aged 6–15 years old and parents, available leisure activities were listed. These were matched to the items in the CAPE/PAC. Sixteen new potential activities were added and tested on 337 typical developed children from different regions of Sweden. A cutoff level of activities performed by >10% was set to identify relevant activities. Differences between the original and a proposed Swedish version were analysed using paired-samples t-tests of standardized mean scores. Results: Three new activity items were included, for 10 items new activity examples were added, and three not relevant items were excluded. In the Swedish version the outcome of standardized mean diversity score was significantly higher compared with the outcome of the original version. Conclusions:When using instruments in new contexts, it is not enough simply to translate; validation of the item relevance to the new context is essential.

Physical-activity coaching and health status in rheumatoid arthritis: A person-oriented approach

Purpose. No interventions to promote physical activity can succeed for all participants. Insights into the specific characteristics of those who do succeed are needed. One aim was to investigate whether a selection of correlates of general health perception creates cluster typologies in individuals with rheumatoid arthritis (RA). Another was to evaluate whether magnitude of change in health status differs between clusters after a 1-year coaching intervention targeting health-enhancing physical activity. Method. Two hundred and twenty-eight patients (74% women, mean age 56 years, disease duration 1 year) with RA, from 10 rheumatology clinics in Sweden, participated. The patients were assigned at random to intervention or control. The intervention group underwent 1 year of coaching to adopt health-enhancing physical activity (moderately intensive, 30 min/day, > 4 days/week). The cluster analysis included five correlates of general health perception: disease activity; pain; timed standing; activity limitation; and self-reported physical activity. The primary outcome of the coaching intervention was self-reported health status. Results. One-hundred and forty-six patients were eligible for inclusion in the cluster analysis. The eight clusters identified both at baseline and post interventions were operationalized according to the number of cluster variables affected: less (LE) affected or more (MO) affected, respectively. Clusters with LE affected variables had significantly better general health perception at baseline than those with MO affected variables. Further, coached individuals in MO affected clusters significantly improved self-reported health status compared both to those coached in LE affected clusters and to those in MO affected clusters in the control group. Conclusion. This person-based approach contributed more than did the results in a previous randomized controlled trial to the understanding of which patients benefit most from the present physical-activity coaching intervention. The intervention may thus be most beneficial for individuals more severely affected by their disease at baseline.

Differences in patterns of participation in leisure activities in Swedish children with and without disabilities

Abstract Purpose: To compare participation in leisure activities between Swedish children with and without disabilities and to examine whether age, gender, presence of disabilities, and mother’s educational level influence participation. Method: A Swedish version of the Children’s Assessment of Participation and Enjoyment was used to study the diversity, intensity, and enjoyment of participation in leisure activities of children aged 6 to 17 years. Fifty-five of the children had disabilities and 337 of the children did not have disabilities. A multiple regression analysis was conducted to explore the impact of age, gender, mother’s level of education, and disability on the diversity, intensity, and enjoyment of leisure activities. A t-test for independent samples was used to compare the diversity and intensity of participation between children with and without disabilities. Results: The multiple regression analysis explained 4–36% of the variance of diversity, intensity, and enjoyment. Children with disabilities participated with higher diversity, but with less intensity, than children without disabilities. Younger children had higher levels of enjoyment. Conclusions: Children with disabilities participated in several different activities, but the presence of a disability was associated with lower intensity of participation. The low explanatory value of the investigated variables indicates that the combined effect of several variables needs to be taken into consideration when designing participation interventions. Implications for Rehabilitation Children with disabilities participated in a high number of activities but with a low intensity compared to children without disabilities. Analysis of the children’s personal and environmental barriers and facilitators is critical to providing the therapist with ideas about which strategies should be implemented to increase participation. Assessment and intervention may need to focus on methods for supporting the children’s autonomy and on creating goals for intervention that focus on activities that are determined by the child based on their interests and desires. Age and gender influenced the variance in the diversity and enjoyment outcome and the presence of disability was associated with the intensity outcome. Age, gender, parental educational level, and disability only explain a small proportion of the variance in leisure participation patterns. Thus, client-centred and individually tailored interventions are needed that are based on the individuals unique situation.

Is it possible to get away from disability-based classifications in education? An empirical investigation of the Swedish system

Disability classifications is given a minor role in the Swedish national policy on special needs in schools. In the present study questionnaires are used to investigate the actual importance of medical diagnosis in obtaining special support as well as attitudes towards such practices. The study involves different levels of the educational system as well as different occupational groups within compulsory schooling and preschool. The results show that: 1) disability-based categories are seen as less needed in practice by chief education officers than by principals; 2) disability-based classifications have stronger support among school staff than in the guiding documents and among principals and chief education officers; 3) a disability-based approach has stronger support at the compulsory school level than at the preschool level; 4) the group most in favour of disability-based classifications is teachers and those most against are chief education officers, principals and SENCOs.

Computer-based assistive technology device for use by children with physical disabilities: a cross-sectional study.

Objective: To investigate the prevalence of children with physical disabilities who used a computer-based ATD, and to examine characteristics differences in children and youths who do or do not use computer-based ATDs, as well as, investigate differences that might influence the satisfaction of those two groups of children and youths when computers are being used for in-school and outside school activities.Method: A cross-sectional survey about computer-based activities in and outside school (n = 287) and group comparisons.Results: The prevalence of using computer-based ATDs was about 44 % (n = 127) of the children in this sample. These children were less satisfied with their computer use in education and outside school activities than the children who did not use an ATD.Conclusion: Improved coordination of the usage of computer-based ATDs in school and in the home, including service and support, could increase the opportunities for children with physical disabilities who use computer-based ATDs to perform the computer activities they want, need and are expected to do in school and outside school. Implications for Rehabilitation The prevalence of using a computer-based ATD in school was 44%, that is, it was common for children and youths with physical disabilities to use ATDs. Improved coordination of the usage of computer-based ATDs in school and in the home, including service and support, could increase the opportunities for children with physical disabilities who use computer-based ATDs to perform the computer activities they want, need and are expected to do in school and outside school. Children with physical disabilities who used a computer-based ATD were dissatisfied with the service provided for their ATDs. It important to use existing assessments to a high degree to augment the children’s and youth’s satisfaction with their access to and their use of computer-based ATDs for participation in ICT-activities in everyday activities. Further research is certainly needed to validate the use of any eventual existing instruments or to identify the needs with the aim to developing new ones for children and youths with disabilities where there is a deficiency.