Louise Bøttcher

Children with Spastic Cerebral Palsy, Their Cognitive Functioning, and Social Participation: A Review

White matter lesions are often seen in children with spastic cerebral palsy (CP). Evidence points to specific impairment of attentional, visuospatial, and executive functions; although both attention and executive functions are relatively unexplored in spastic CP. The few recent studies on language functions in mild or moderate CP point to well-functioning language. The presence of specific cognitive impairments may, in part, explain why children with spastic CP have a higher risk of learning disabilities and problems in peer relations. However, to understand the development of cognitive impairments, it is necessary to include how social participation feeds back on cognitive processes.

Attentional and executive impairments in children with spastic cerebral palsy

Aim  Children with cerebral palsy (CP) are reported to have learning and social problems. The aim of the present study was to examine whether children with CP have impairments in attention or executive function.

Disability as a risk factor? Development of psychopathology in children with disabilities

Empirical research has established that children with disabilities are more likely to develop psychopathology than children without disabilities. But too little is known about the association between disability and psychopathology. The aim of this article is to discuss developmental psychopathological models that conceptualise the connection between childhood disability and psychopathology. Empirical studies of psychopathology among children with a congenital hearing impairment and children with cerebral palsy will be reviewed, representing in-depth examples of association between disability and psychopathology. Both a congenital hearing impairment and cerebral palsy were found to be dominating risk factors for all types of psychopathology, but no relationship was identified between degree of disability and risk of psychopathology. The higher risk cannot be explained by biological impairments alone. To explain the contradictory findings, developmental models of disability and psychopathology are applied. Within a multi-factorial developmental psychopathological perspective and a dialectical model of disability (Vygotsky, 1993), it is suggested that disability can be understood as an incongruence between the individual development of the child and demands and expectations in the specific relations and institutions in which the child participates. This incongruence creates and strengthens negative factors for the child with disability and results in a higher risk of psychopathology.

Disability as a Dialectical Concept: Building on Vygotsky's Defectology

The legacy of defectology, Vygotsky’s theoretical work on children with disabilities, still offers a useful approach in disability research. Vygotsky understood disability as an incongruence between the individual’s psychological structure and the structure of cultural forms. The incongruence describes a dialectical relation between the person with a disability and the surrounding society. The aim of this study is to explore Vygotsky’s concept of incongruence. A case example is presented. Through video observation of a child with severe cerebral palsy (CP) and cognitive visual impairment, the incongruence is analysed in two settings: in school together with a teacher and at home together with his mother. Use of vision, arm movement and a Rolltalk (a computer for communication) were the categories selected for analysis. The results demonstrate how the impact of the boy’s cognitive visual impairment and CP differed depending on the interaction with the environment and on how his teacher and mother interacted with him. The dialectical dynamics of incongruence in each of the two settings created different levels of abilities/disabilities. It is argued that the dialectical psychological understanding of disability offers a useful approach to overcome dualistic understandings of the person with a disability and the surrounding society.

Systematic cognitive monitoring of children with cerebral palsy – the development of an assessment and follow-up protocol

ABSTRACTCerebral palsy (CP) is associated with cognitive impairments, learning difficulties and reduced social participation. Individual assessment is necessary for individually tailored interventions. This paper describes the development of a systematic follow-up programme of cognition, and the challenges of integrating it into the regular follow-up of children with CP. Initiated by the Nordic users‘ organisations, a group of psychologists proposed a protocol of follow-up of cognition in children with CP – the CP Cog. This protocol consists of neuropsychological instruments covering general cognitive functioning, visuospatial and executive functioning. The article presents a natural experiment describing development and implementation of the cognitive protocol in three Scandinavian countries. This introduction illustrates challenges associated with implementation, especially how the success of the protocol hinges on structural backup within the different countries. In conclusion the CP Cog assessment pro...

Beyond a Biomedical and Social Model of Disability: A Cultural-Historical Approach

Two opposing models of disability exist; the medical model and the social model. The medical model focuses on disability as the result of one or more physical defects of the individual body; while the social model focuses on how barriers in society construct disability by limiting the participation of particular groups of people. This chapter introduces a disability model based on Vygotsky’s cultural-historical theories. The model depicts how human development is formed through a dialectical process between biological maturation (the natural line of development) and participation in cultural forms (the cultural line of development). Under normal circumstances, for a typical child, the natural and the cultural line of child development support each other. However, this is not the case for a child with disabilities. The often problematic development of children with disabilities arises and develops from an incongruence between, on one hand, the biological development of the child and on the other, the structure of cultural practices (in institutions, families, etc.) in which the child is living. Furthermore, the chapter introduces to cultural-historical developmental theories and central concepts such as zone of proximal development, the child as social agent, the social situation of development, motives and demands.

An interview study of why parents conduct intensive ABA home training for their child with autism spectrum disorder. An analysis from the lens of the dialectical disability model

Abstract The number of parents undertaking an intensive home training programme of children with disabilities (e.g. Applied Behavioural Analysis) has increased. It reveals a paradox in current disability research and policies. On the one hand, policies in general are aimed at inclusion through movement of social barriers for participation, grounded in the social model of disability. On the other hand, intensive home training is based on the aim of rehabilitation through intensive training of individual cognitive and social skills, an approach grounded in a bio-medical model. Intensive home training programmes are supported by political legislation that enables parents to partake the training and hire the necessary helpers. How is this paradox viewed from the perspective of the parents? From the departure of the dialectical model of disability – and its central concepts of developmental incongruence, developmental time and social agency – two mothers practising home training with their children with autism disorder were interviewed about their motives for home training and subsequent experience with their child. Results showed that the motive to home training was to create a local congruence that allowed the child to thrive. Intensive home training also restored the mothers’ sense of agency vis-à-vis their child’s development. However, home training might not abolish the need for adaptations of the child’s social practices outside the family. It is discussed how societal support to home training risks to hinder higher order reorganisation of developmental opportunities that are necessary to actualise policy statements of inclusion.

Unfolding Time in the Cultural-Historical Model of Disability

To understand children with disability, and how they can be supported, is it important to understand the concept of developmental time. In most mainstream theories in developmental psychology, time is first and foremost understood as the chronological time of a child, ie, the child’s age measured in years and months. In the cultural-historical approach, interwoven levels of history and cultural development are included to understand development at an individual level. Developmental time at an individual level becomes related to cultural and historical time changes. The chapter introduces different levels of time and shows how developmental time is interwoven with the developmental incongruence between the child’s individual biological development and the cultural forms of developmental demands and support. The concepts developmental time windows and speed is further introduced to illustrate how timely support to a child with disability is crucial – and how biological development is linked to culture. The chapter also introduces to the history of disability and how different societal values have been of significance throughout historical time. Four examples are discussed in the travel through history – euthanasia and eugenics, institutionalization, early intensive treatment and inclusion. They all serve as examples of how changes in society alter cultural-historical practices for children with disabilities; and through this, the incongruence that forms the developmental conditions of young children with disabilities.

Mental Health and Children with Disabilities

Plenty of research has documented a higher prevalence of mental health problems in children with disabilities of all types, thus indicating a common underlining risk dynamic. Based on empirical findings, the chapter will begin by exploring the question of whether specific types of impairments are associated with certain types of developmental aberrations. The cultural-historical model of disability is used to analyse the processes involved. The first example will be attachment. Attachment has been studied in psychology as one important factor that may explain the development of both positive mental health and mental health problems. From the cultural-historical point of view, attachment is built and develops around parents and their infant/child as mutual social agents; and the congenital dispositions the child brings into the mutual system impacts on the development of the attachment system. Challenging behavior is another theme addressed – showing how behaviour is mediated by dialectical cultural and biological processes. Behaviour considered to be problematic (either for the child, for the environment or both) needs to be understood as the child’s social agency in answer to conflicts between the natural and the cultural line of development. In probing the possible meaning of a child’s problematic behaviour as intrinsic to the social situation of development, it is necessary to consider both the capacity of the child to understand the situational social demands, the child’s repertoire of social agency in relation to cultural demands and the availability of support within the specific setting.

The Toddler and Preschool Child with Disabilities: Becoming a Social Agent

Many important steps in the child’s development are demanded and supported from the age of two to the age of five. A central theme in the chapter is the impact of disability on the child’s exploration of the cultural meanings of objects and use of them through participation in ongoing activity settings. From the cultural-historical theoretical perspective, use of objects is an important developmental aspect of cognitive as well as social skills. A second theme is play as a social activity, which is a leading activity during the toddler and preschool period. Analyses of the impact of disability on object use and play activities is central to the theoretical unfolding of the developmental incongruence during the toddler/preschool years. During the toddler period, the child’s social agency is established as an important foundation for further development. What the child affords from the environment affects how he/she acts towards the environment. It is discussed how different impairments impact on the development of the toddler’s basic sense of agency and social identity – through peer interaction and the development of understanding of others minds. Often, it will be necessary to create supportive activity settings of the child’s early development of active social participation, in which the toddler with impairments is able to explore him- or herself as an agent who is uniquely contributing to social life. Focus has to be on how to support the child in exploring both physical and social properties of the world.