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How preschool teachers and children spend their time in preschool sets the stage for child engagement and learning. To describe characteristics of environments and activities and to compare child engagement in indoor and outdoor free play, systematic observations of children and teachers were performed in 78 Swedish preschool units. Results showed that indoor and outdoor free play were the main activity settings. Children interacted as much with other children as with teachers. The content focus was dominated by non-pretend play, construction, art and music, followed by pretend play and academic contents. Child engagement was significantly higher in free play indoors compared to outdoors. Teachers engaged in varied tasks, but their central task was managing. Teachers were typically in proximity to small groups of children, or by themselves, and mostly talked to or listened to a single child. Findings are discussed in relation to the preschool curriculum and future research needs.

Background and aims: Social interactions in preschool and a child's gender are, in cross-sectional studies, related to the child's overall levels of hyperactive behaviour and engagement in preschool activities. However, whether social interaction and gender can predict children's engagement and hyperactivity is not thoroughly investigated. This study aims to investigate the longitudinal influence of gender, child-to-child interaction, and teacher responsiveness on the association between trajectories of children's levels of core engagement and hyperactive behaviour. It was hypothesized that peer-to-child interaction and teacher responsiveness in preschool settings are related to positive change in engagement among children with hyperactive behaviour, especially for boys. Sample and methods: Swedish preschool staff completed questionnaires assessing the variables of interest for children aged 1-5 (N = 203). Data were collected on three occasions over a two-year period. Latent growth curve (LGC) models were used to explore whether teacher responsiveness, peer-to-child interaction, and gender predict trajectories of engagement and hyperactivity. Results: The results revealed that high levels of hyperactivity were associated with lower levels of engagement on the first occasion. Positive peer-to-child interactions and responsive teachers were significant predictors of an increased level of engagement and decreased level of hyperactive behaviour, especially for boys. Conclusions: The findings underscore the need to improve social interactions, especially peer-to-child interactions, to improve engagement in children with hyperactive behaviour, especially boys. Implications for practices and research are discussed.

Eye-gaze technology provides access to a computer through the control of eye movements, thus allowing students with severe motor and communication difficulties to communicate and participate in curriculum activities and leisure; however, few studies have investigated whether any challenges exist to its implementation. This study examines the feasibility for teachers, parents, and therapists of applying an eye-gaze technology intervention for students with severe motor and communication difficulties in everyday settings. A mixed-method design was applied, focusing on the acceptability, demands, implementation, and practicality of the technology applications. Data was collected from 16 participants who assisted five students using eye-gaze technology in a previous 6-month intervention. The intervention comprised (a) use of eye-gaze devices with individualized content; and (b) services including training in use, team meetings, and bi-monthly support on implementation problems. The results showed that the participants perceived the technology as appropriate to enhance interaction and understanding of the students' learning and communication messages. Portable and easy-to-adjust systems were crucial to apply eye-gaze technology in different contexts. Improving eye-gaze services was required to afford in-service education, follow-up services, and loaning programs for sustainable implementation. The facilitators and barriers could guide researchers and practitioners to enhance the implementation of eye-gaze technology. [ABSTRACT FROM AUTHOR]

Participation is a fundamental human right, and being able to communicate is an essential component of participation in various life situations, such as at school, with peers, and in the community. Augmentative and alternative communication (AAC) interventions aim to facilitate communication and social interaction, independence, and participation in all aspects of life. The purpose of this study was to summarize and map the AAC intervention outcomes for children with complex communication needs onto the Family of Participation-Related Constructs (fPRC) framework. The scoping review identified 270 studies for inclusion, and the data gathered was extracted and mapped onto the fPRC framework. The results indicate that although many studies have reported on participation-related constructs such as activity competence and context, there is still insufficient focus on attendance and involvement, sense of self, and environment constructs. Hence, future research in the field of AAC is needed on the various constructs of participation proposed by the fPRC framework. [ABSTRACT FROM AUTHOR]

Introduction: The increased focus among researchers and professionals on participation as an explicit intervention outcome has prompted a paradigm shift in both thought and practice. However, much research centers on altering participation outcomes in specific life situations and stages. This discussion paper considers "participation as a means" in pediatric rehabilitation and special education interventions, emphasizing its role in achieving lasting outcomes. Method: This paper uses a Venn diagram approach to consider relations between three core concepts--participation, intervention, and outcomes--and their intersection. The paper's central theme revolves around the intersection of these concepts, wherein participation serves as a means to achieve enduring participation outcomes within the realms of rehabilitation and special education. The discussion is supported by contemporary empirical work and from literature identified in two recent scoping reviews focusing on the intervention process. Results: Achieving enduring participation outcomes through participation in the intervention process necessitates creating a learning experience, with children and families actively participating in every step: identifying participation issues, seeking explanations, prioritizing intervention goals, selecting methods, implementing interventions, and evaluating the process and outcomes. Discussion: This structured approach supports professionals and researchers to foster the skills and capacity required for lasting participation outcomes for children with impairments. [ABSTRACT FROM AUTHOR]

To investigate strategies used by professionals in pediatric rehabilitation to engage children in every step of the intervention process, including assessment, goal setting, planning and implementation of the intervention, and results evaluation. A scoping literature review was conducted, and seven databases were searched, including CINAHL and MEDLINE, ProQuest Central, PsycINFO, Social Science Premium Collection, PubMed, and Web of Science. A citation search of included articles was completed. Predetermined criteria, quality standards, and PIO framework guided the selection process. Results were presented in relation to Self-Determination Theory (SDT) and the contextual model of therapeutic change. In total, 20 studies were included in the review. Pediatric professionals reported that therapeutic use of self and their own engagement in the intervention facilitated the establishment of a supportive relationship. Providing clear explanations about their role and therapy rationale developed positive expectations. By making the child feel successful within-session and outside-session activities, professionals enhanced child mastery. Professionals' strategies were abstractly described. Further research is needed to investigate strategies that are effective in the different steps of the intervention. More observational, longitudinal studies are required to capture fluctuations in in-session engagement. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate if the type of class setting is related to the utilisation of disability-related services and child welfare services outside school over time among children with mild intellectual disability (ID). A quantitative study with a longitudinal and comparative design was carried out including data from archival records concerning service utilisation among 405 children. Children in special classes were more likely than children integrated into regular classes to utilise disability-related services. Integrated children who changed school setting from regular classes to special classes were more likely to begin to utilise such services and to increase the number of services utilised, compared to children who remained integrated. Professionals in social services and schools may need to improve their collaboration around families of children with mild ID when assessing needs and providing services. Special attention may need to be devoted to children integrated into regular classes.

Autism spectrum disorder is associated with diverse social, educational, and occupational challenges. To date, no standardized, internationally accepted tools exist to assess autism spectrum disorder-related functioning. World Health Organization's International Classification of Functioning, Disability and Health can serve as foundation for developing such tools. This study aimed to identify a comprehensive, a common brief, and three age-appropriate brief autism spectrum disorder Core Sets. Four international preparatory studies yielded in total 164 second-level International Classification of Functioning, Disability and Health candidate categories. Based on this evidence, 20 international autism spectrum disorder experts applied an established iterative decision-making consensus process to select from the candidate categories the most relevant ones to constitute the autism spectrum disorder Core Sets. The consensus process generated 111 second-level International Classification of Functioning, Disability and Health categories in the Comprehensive Core Set for autism spectrum disorder--one body structure, 20 body functions, 59 activities and participation categories, and 31 environmental factors. The Common Brief Core Set comprised 60 categories, while the age-appropriate core sets included 73 categories in the preschool version (0- to 5-year-old children), 81 in the school-age version (6- to 16-year-old children and adolescents), and 79 in the older adolescent and adult version (?17-year-old individuals). The autism spectrum disorder Core Sets mark a milestone toward the standardized assessment of autism spectrum disorder-related functioning in educational, administrative, clinical, and research settings.

Objective: To investigate patterns of parenting stress and access to sufficient informal and formal support among parents of children with disabilities. To explore whether child cognitive level, conduct problems and the need of language interpretation in contacts between parents and professionals are associated with patterns of parenting stress and support. Method: Parents (N = 140) of children with disabilities in Sweden completed a questionnaire about parenting stress and support. Patterns of three variables--parenting stress and access to sufficient informal and formal support--were investigated using cluster analysis. The relationship of child cognitive level, level of conduct problems and of language interpretation needs between parents and professionals to cluster membership was explored using multinomial logistic regression. Results: Five different clusters of parenting stress and support emerged. Parents in cluster 1 had lower than sample mean ratings on all three variables. Cluster 2 had elevated parenting stress, cluster 3 had elevated insufficient informal support and cluster 4 had elevated insufficient formal support. Cluster 5 had elevated ratings on all three variables. Greater child cognitive difficulties increased the likelihood of parent membership in cluster 2 (elevated stress), cluster 3 (elevated insufficient informal support), or cluster 5 (elevated ratings on all variables). Child conduct problems increased the likelihood of membership in cluster 2 (elevated stress) or cluster 5 (elevated ratings on all variables). No relationship between language interpretation needs and cluster membership was found. Conclusions: Patterns of parenting stress and sufficiency of support, and their associations with child characteristics, vary substantially. However, families of children with conduct problems experiencing elevated parenting stress in combination with insufficient informal and formal support, may be particularly vulnerable. The results of the current study highlight the clinical importance of exploring and identifying individual parenting stressors and perceived levels of support, to be able to adapt services to better suit a variety of needs, and thus promote equitable care. [ABSTRACT FROM AUTHOR]

This is the fourth international preparatory study designed to develop International Classification of Functioning, Disability and Health (ICF, and Children and Youth version, ICF-CY) Core Sets for Autism Spectrum Disorder (ASD). Examine functioning of individuals diagnosed with ASD as documented by the ICF-CY in a variety of clinical settings. A cross-sectional study was conducted, involving 11 units from 10 countries. Clinical investigators assessed functioning of 122 individuals with ASD using the ICF-CY checklist. In total, 139 ICF-CY categories were identified: 64 activities and participation, 40 body functions and 35 environmental factors. The study results reinforce the heterogeneity of ASD, as evidenced by the many functional and contextual domains impacting on ASD from a clinical perspective.

This study describes the adaptation and validation of the American Institute for Research (AIR) Self-Determination Scale for use in Norwegian research and education. The study contributes to the field by enabling reliable assessment of self-determination of Norwegian students with intellectual disability. The operational equivalence of the construct of self-determination in American and Norwegian culture were examined. The article further describes the adaptations that were made to the scale to ensure its fitness for intended use. Psychometric reliability (Cronbach's a and test-retest reliability) was tested on 121 students, and the underlying structure of the scale was examined by means of principal component analysis. The adapted version of the questionnaire (AIR-S-NOR) shows respectable psychometric properties. Suggestions for how the AIR-S-NOR can be used in future research and educational practices are presented.

Background: Students with disability show an increasing incidence of school failure. Quality teaching and appropriate support may foster high self-efficacy, a predictive factor for successful school outcomes. Physical Education (PE) can provide students with a context in which self-efficacy and participation are promoted leading to improved academic achievement. The transition into secondary school can be challenging for many students with increased educational demands, developmental changes and individual social identification coinciding. A disability may add to the challenge of success. Methods: Three groups of students, aged 13 years and enrolled in Swedish mainstream schools were targeted (n = 439). Groups included students with (1) A diagnosed disability, (2) Low grades in PE (D-F), and (3) High grades (A-C) in PE. Questionnaires were collected and analyzed from 30/439 students with a diagnosed disability (physical, neuro-developmental and intellectual) from 26 classes, their classmates and their PE-teachers (n = 25). Relationships between student self-reports and PE-teachers' self-ratings were investigated. Also examined was the potential to which students' functional skills could predict elevated general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. Results were compared with the total sample and between the three target groups (n = 121). Results: For students with disabilities, better self-rated teaching skills were related to lower student perceived general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. The impact of classroom climate in PE was more obvious among students with disabilities. Perceived functional skills were associated with elevated general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. Better socio-cognitive functional skills had an overall positive effect on all outcomes. Students with disabilities reported results similar to the total sample, the D-F group scored lower and the A-C group higher than the total sample and the disability group. Elevated self-efficacy in PE is six times less probable in students with disabilities, compared to the A-C group. Conclusions: Our findings that better teacher planning and grading skills, are detrimental to students disadvantaged by disability is contradictive. Improving the establishment and communication of adapted learning standards at the transition to secondary school is a crucial and a predictive factor for promoting positive school experiences for students with disability. Students with disabilities need to be assured that the intended learning outcomes can be reached by doing activities differently than their typically functioning peers. Consideration of class composition is suggested as a means of promoting a positive learning climate, which would particularly benefit students with disabilities. Allocation of resources to support student socio-cognitive skills would improve experiences for the D-F group and likely promote a positive learning environment.

In 2022, an international conference was held focusing on 'participation'. We shared current evidence, identified knowledge gaps and worked together to understand what new knowledge and community and practice changes were needed. This brief communication is a summary of the conference delegates' discussions. We present the key assumptions we make about participation and propose what is needed to create change for societies, communities, families and individuals. While we have some robust evidence to support participation approaches, more is needed, and it is everyone's responsibility to build an inclusive society where participation for all is the reality. [ABSTRACT FROM AUTHOR]

Eye-gaze assistive technology offers children with severe motor and communication difficulties the opportunity to access and control a computer through eye movements. The aim of this study was to examine the impact of eye-gaze assistive technology intervention on participation in computer activities and technology usability among children with complex needs in Taiwan. This study involved a multiple baseline design across individuals. The participants were four children aged three to six years with severe motor and communication difficulties and low eye-control skills. The six-month intervention consisted of two collaborative team meetings and 12 individual supports to facilitate the use of eye-gaze assistive technology at home or in educational environments. Participation in computer activities (diversity, frequency, and duration) was repeatedly measured through a computer use diary. Other outcomes included assessments of goal achievements and parents/teachers' ratings on children's performance in computer activities. The young children increased the diversity of their computer activities and their frequency and duration of computer use from baseline to the intervention phase. The children attained six of eight predefined goals related to play, communication, and school learning. Parents and teachers perceived the children's changes in performance as meaningful. This study strengthens the evidence that eye-gaze assistive technology is useful in everyday contexts for children with complex needs in Taiwan. The findings add knowledge that children with weak eye-control skills increased participation in computer activities as a result of the eye-gaze assistive technology. Eye-gaze assistive technology (EGAT) as an access method to control a computer can provide opportunities for children with severe motor and communication difficulties to participate in computer activities. Children with severe motor and communication difficulties and low eye-control skills with sufficient practice can learn to use EGAT for communication and learning, with support from stakeholders and collaborative service. EGAT could be introduced for children with complex needs at early ages as a means of using computers for play, communication, and school learning, which could be helpful for later education and learning. Stakeholders in educational environments could include EGAT in educational computer systems so that pupils with severe motor and communication difficulties could interact with a computer, thereby enhancing their engagement and learning. [ABSTRACT FROM AUTHOR]

Child engagement has been defined as active participation in classroom routines, appropriate interactions with the environment and it also predicts academic achievement. Therefore, it is necessary to identify predictors of engagement over time. Moreover, cross-cultural data is needed to provide a global picture of the quality of Early Childhood Education and Care (ECEC) across countries. This study aims to describe the quality of Swedish preschool classrooms and its relationship with students' engagement over time. Data was collected from 165 preschool teachers in 55 preschool units in Sweden. Results show that all classroom-related variables (Emotional Support, Instructional Support and Classroom Organisation) have increased levels over time, while engagement remained stable. Three groups of preschool classroom units were identified with similar patterns of classroom quality over time (higher emotional support and lower instructional practice) and similar differences in level. Emotional Support was found to be the best predictor of student engagement over time.

The study purpose was to, with the help of ICF and the CPS model, describe and explain patterns of co-occurring problems with participation in everyday life activities, body functioning and environment for children who completed brain tumor treatment. Hospital, habilitation and school records for nine children (5–11 yrs.) diagnosed with brain tumor, were retrospectively reviewed for everyday problems after treatment completion. These problems were linked to ICF codes. Median code distribution within ICF constructs participation, body function, body structure, activity, and environment were calculated to generate typical (close to median) and atypical (distant from median) patterns of problems on individual and group levels. Two children were in-depth analyzed with collaborative problem-solving (CPS) model to identify participation problems and plausible explanations. In total, 4543 ICF linked codes revealed similarities and differences between individuals. The selected child-cases displayed educational challenges and peer-relational problems. The ICF codes related to activity, body function and environment revealed plausible explanations for the children's documented problems with participation in everyday life. The combination of ICF and CPS can provide a comprehensive view of the child's problems and guide development of participation in everyday life-focused interventions for children treated for brain tumors. Care should be guided by interventions and support directed at individual children and their everyday life. The International Classification of Functioning, Disability and Health (ICF) framework can support identification of the individual child's patterns of problems and how these affects the child's everyday life. It is recommended to start by identifying participation problems when using ICF to identify and describe problems in children's natural settings. The collaborative problem-solving model can guide healthcare, habilitation and school services when identifying and acting on typical and atypical problem patterns experienced by these children. [ABSTRACT FROM AUTHOR]

This study examined social interaction as a mediator between externalized behaviour difficulties and children's engagement in preschool. Data from 663 children (340 boys), aged 18-71 months, were collected at 81 Swedish preschool units in six municipalities to test a path model that included child, teacher, and child groups. The results indicated that behaviour difficulties and engagement may occur simultaneously. Hyperactivity had a direct negative influence on engagement, which was not the case with conduct problems. Teachers' responsiveness as well as positive interactions with peers had an indirect influence on the relationship between hyperactivity and engagement. Responsive staff and positive interactions within the child group seem to contribute to children's engagement despite hyperactivity. Children's engagement, as well as special support to stimulate engagement in preschool, is discussed.

Background: Children with profound intellectual and multiple disabilities (PIMD) demand intense family accommodations from birth and onwards. This study used an exploratory and qualitative study design to investigate stability and change in sustainability of daily routines and social networks of Swedish families of children with PIMD. Materials and Methods: Eight families participated over two years in eco-cultural family interviews and social networks interviews collected at home visits. Data were analyzed descriptively and by manifest contents analysis. Results: Results showed variations in sustainability of daily routines over time across families. The sustainability was linked to fathers' involvement, couples' connectedness and emotional support. Stability and change of social networks were characterized by low overlap between the child and family networks, the children's communicative dependency and low density of able communication partners. Conclusions: The results indicate that patterns of stability and change were linked both to family resources and child characteristics.

Background: Children with a mild intellectual disability (ID) and their families often require social services; however, because of the characteristics of the formal service system, these families may be at risk of not receiving necessary services. The aim of this study was to obtain knowledge regarding the types and number of services that families receive from social services because of the child's disability and because of social problems. Another aim was to acquire knowledge regarding the percentage of families receiving services and to evaluate the received services in relation to the child's gender, school setting and age. Method: Utilisation of social services among 84 children with a mild ID and their families in two municipalities in Sweden was examined using existing social services records. Results: Approximately one-third of the families received services because of the child's disability and one-fourth because of social problems. Children integrated into mainstream classes were significantly less likely to receive services from social services because of their disability than children in self-contained classes. The most commonly utilised services because of the child's disability were companion service, short period of supervision for schoolchildren and special transportation services. The services most utilised because of social problems were help from a personal contact, a contact family for the child's siblings and financial assistance for the child's parents. Conclusions: Social services must engage in outreach activities, especially in schools, so that families having a child with mild ID are recognised and receive necessary services.

This study shows that students, teachers, and parents in Swedish schools ascribe differing meanings and significance to students' participation in school in relation to academic achievement. Students see participation as mainly related to social interaction and not academic achievement, whilst teachers view students' participation as more closely related to activity and academic performance. Despite these differences, teachers and students are in close agreement regarding activities of a social nature. Teachers' and parents' ratings of parents' involvement in school demonstrate a higher agreement, but also correlate negatively with the academic achievement of the student. This is likely because communication is more frequent with parents of underachieving students than students demonstrating high academic performance. The partly inconsistent results in previous research regarding the relation between participation and academic achievement can here be explained by the choice of raters, as this connection only exists in ratings carried out by teachers.

The aim of this article is to explore whether 15 students with a high level of truancy have experienced social support at school. The analysis is based on systems theory with a focus on the social context at school. The study is based on data collected in an earlier school document study (Strand & Granlund, 2013) and on 2 earlier interview studies with the school staff (Strand & Cedersund, 2013) and the students themselves (Strand, 2012). Data triangulation was conducted using person-based content analysis. The students were divided in three groups of the school system. For "the winners," we found that engaged adults close to them made a positive difference that restored their relationship with school. "The unchallenged" and "the losers" of the school system had poor social relationships with the school staff, especially within the classroom. A dearth of relationships with classmates was observed for all 3 groups. There was a low level of agreement between the information taken from the school documents, what the school staff members said, and what the students themselves said for all of the groups. What the students perceived as support was not the same as the school had noted as provided and received support.

Introduction: Rather than focusing on the activities that the smartphone has been used for, the existing literature frequently focuses on the association between problematic use of smartphone independent of the content of use (self-reported) and depressive symptoms in youth. This study aims to explore patterns of smartphone usage and the association with depressive symptoms in nursing students. Methods: This cross-sectional study of nursing freshmen (n = 1, 716) was conducted between October and November 2018. Participants were recruited from three Chinese public medical universities using stratified cluster sampling. Self-rated frequency of 12 different smartphone activities over the preceding week was evaluated. Depressive symptoms were assessed by using the Patient Health Questionnaire-9 (PHQ-9). Results: Of the 1,716 students recruited, 1,424 (83.0%) were girls, and the mean [SD] age was 18.90 [1.39] years. Using principal component analysis (PCA), two typical usage patterns were indicated. The "entertainment pattern" factor included a high frequency of streaming images or videos, searching for information, chatting online, online shopping, downloading, reading online, checking social media sites, taking pictures or videos, and playing games. The "communication pattern" had a high frequency of emailing, texting, and calling. Using logistic regression models, the association between smartphone usage patterns and depressive symptoms was tested. The "communication pattern" was significantly associated with a 53% increase in the odds of moderate and above depressive symptoms (AOR = 1.529; 95% CI = 1.286-1.818; p < 0.001), controlling for a set of socio-demographic and smartphone use covariates. Discussion: This study provides insights into how the patterns of smartphone usage are associated with the severity of depressive symptoms in nursing students. It indicates that it may primarily be how we use our smartphones rather than how much we use them that poses a risk for depression. [ABSTRACT FROM AUTHOR]

Background: Human rights provide fundamental conditions for people to maintain dignity and self-determination and protect a nation's most vulnerable citizens. In South Africa, children with intellectual disability who experience socioeconomic disadvantage may be particularly vulnerable due to their cognitive impairments and inability to garner needed resources. Method: The perceptions of children with intellectual disability regarding their access to basic amenities in their home environments were examined to determine whether their positive human rights were met. Risk factors were examined in relation to these perceptions. Results: The results suggested that participants generally reported high degrees of access to basic resources. Logistic regressions suggested socioeconomic risk factors (e.g., income, education, household size, relationship status) were negatively related to children's reports of access to food and their own beds and positively related to having someone available to explain confusing concepts to them. Conclusions: The positive human rights of children living in high-risk environments should be monitored to ensure all South Africans have their rights met.

This paper is a retrospective descriptive content analysis of all identified school documents for 90 ninth-grade students with a history of truancy, collected from two Swedish compulsory schools. The study investigates individual, school, and psychosocial factors in the documents and three analyses are presented: (1) a general analysis of the documents, (2) a comparison of truant students with and without learning difficulties (LD), and (3) a comparison between students with LD who received no special educational support and those who did receive support. Predictors for truancy were credits in the fall of the eighth grade, difficulties in mathematics, and relationship problems. For 50% of the students, frequent truancy first became evident after the seventh grade. No connections were found between documented educational and social support, learning difficulties, and level of truancy.