Social relationships and friendships of children with developmental disabilities: implications for inclusive settings. A systematic review

Predictors of health-related quality of life (HRQoL) for caregivers of children with developmental disabilities in Saudi Arabia: An observational study

To examine predictors of health-related quality of life (HRQoL) for caregivers of children with developmental disabilities, a cross-sectional design was used. Participants were primary caregivers of children with developmental disabilities. Caregivers completed a demographic form about the child and the family, and the Arabic version of Patient-Reported Outcomes Measurement Information System-Profile 29 (PROMIS-29 v2.0). Descriptive statistics were used to report on demographic data, 1-sample Z tests to compare PROMIS domain scores with the general population, and multiple linear regression analyses to identify predictors of each domain. Participants were 111 primary caregivers, mostly mothers (65.8%). Caregivers reported higher levels of anxiety, depression, fatigue, sleep disturbance, and pain interference, and lower levels of physical function and social participation compared to the general population, P < .05. The regression models for predicting the HRQoL accounted for 12.3% of the variance in the physical function domain (P = .016), 13.9% in the anxiety domain (P = .009), 24.7% in the ability to engage in social activities and roles (P < .001), and 11.4% in the pain interference domain (P = .02). In these models, the severity of the child's disability and/or the child's age were common significant predictors. Specifically, child's age was the only significant predictor in 2 domains, the anxiety domain (β = -.29, P < .01) and ability to participate in social activities and roles domain (β = .42, P < .05). The severity of the child's disability was the only significant predictor in the physical function domain (β = -.52, P < .01). Both the severity of the child's disability and the child's age were significant predictors in the pain interference model (β = .40, P < .05), and (β = -.23, P < .05), respectively. However, the models did not significantly predict depression, fatigue, or sleep disturbance, P > .05. HRQoL is a complex construct and is influenced by multiple child and family factors. Implications of the study emphasize the importance of regular HRQoL screening for caregivers, the development of efficient referral systems for support services, and the exploration of respite care options.

Dual Identification: Trajectories to English Proficiency for English Learners with Autism Spectrum Disorder

BACKGROUND

There are an increasing number of English Learners (EL) served in schools, including children with Autism Spectrum Disorder (ASD). However, little is known about students who receive school-based services as EL and under autism eligibility.

PURPOSE & METHODS

The present study aimed to examine the sociodemographic characteristics, time to English Language Proficient status by survival analysis, and predictors of English fluency utilizing a logistic regression for dually identified EL and autism eligible students in a large urban school district during the 2011-2019 academic school years.

RESULTS

Overall, dually identified students (N = 849) educated in segregated settings (N = 372) became English proficient at lower rates and at older ages than students included in general education (N = 477).

CONCLUSION

Students placed in segregated special education classrooms were significantly less likely to achieve English Language Proficient classification. The present study begins to illustrate the time to English proficiency of dually identified students and the potential impact it has on their educational opportunities.

Perspectives of Adults without Disabilities on their Friendships with Individuals with Intellectual and Developmental Disabilities

Friendships contribute to positive social outcomes such as the promotion of prosocial behaviors and social well-being and can lead to an overall healthy quality of life. Despite the importance of friendships, little is known about how individuals without disabilities develop and maintain friendships with individuals with intellectual and developmental disabilities. Using a phenomenological research design, the current study explored the lived experiences of 17 adults without disabilities who discussed the development and maintenance of their friendship with an individual with intellectual and developmental disabilities. Semi-structured interviews were conducted and subsequently collaborative, open coding was used to identify codes and themes across participants. Three main themes emerged related to 1) factors that facilitated friendship development; 2) factors that contributed to friendship maintenance; and 3) impacts of the friendship for both individuals with and without intellectual and developmental disabilities. Implications of the results are discussed as well as future directions for research.

Intellectual Profiles of Clinic-Referred Preschoolers

Intellectual impairments in preschoolers have been widely studied. A regularity that emerges is that children's intellectual impairments have an important impact on later adjustments in life. However, few studies have looked at the intellectual profiles of young psychiatric outpatients. This study aimed to describe the intelligence profile of preschoolers referred to psychiatry for various cognitive and behavioral problems in terms of verbal, nonverbal, and full-scale IQ and to examine their association with diagnoses. Three hundred four clinical records from young children aged under 7 years and 3 months who consulted at an outpatient psychiatric clinic and who had one intellectual assessment with a Wechsler Preschool and Primary Scale of Intelligence were reviewed. Verbal IQ (VIQ), Nonverbal IQ (NVIQ), and Full-scale IQ (FSIQ) were extracted. Hierarchical cluster analysis using Ward's method was employed to organize data into groups. The children had, on average, a FSIQ of 81, which is significantly lower than that expected in the general population. Four clusters were identified by the hierarchical clusters analysis. Three were characterized by low, average, and high intellectual ability. The last cluster was characterized by a verbal deficit. Findings also revealed that children's diagnoses were not related to any specific cluster, except for children with an intellectual disability with, as expected, low abilities. Children referred to an intellectual assessment in an early childhood mental health clinic showed an altered intellectual development, more specifically in the verbal domain.

Better Health, Better Lives? 10-Years on From the World Health Organization's Declaration on the Health of Children With Intellectual Disabilities

It is now 10 years since the European Declaration on the Health of Children and Young People with Intellectual Disabilities and their Families: Better Health - Better Lives was adopted by the World Health Organization. Through discussions with key informants and an online literature review, we reflect on actions and progress made in line with this Declaration to improve the health and wellbeing of children with intellectual disabilities and their families. Despite finding positive examples of policy, legislation and practice in support of children with intellectual disabilities, there are clear gaps and areas for improvement. Countries must continue to take action, as supported by the World Health Organization and other such organisations, in order to support children with intellectual disabilities in realising their fundamental human rights.

Communication and Social Interaction Experiences of Youths With Congenital Motor Speech Disorders

PURPOSE

The purpose of this study was to explore the communication and social interaction experiences of adolescents with congenital motor speech disorders due to cerebral palsy or Down syndrome, with the aim of identifying clinical and research needs to support the development and implementation of speech-language interventions.

METHOD

Five male youths (ages 14-18 years) with congenital motor speech disorders and one of their parents participated in face-to-face, semistructured interviews designed to understand communication and social experiences in daily life. Interviews were audio-recorded and orthographically transcribed offline. Content was coded according to topic areas emerging in the data. Themes were developed to illustrate the most salient and representative aspects of participants' experiences according to the phenomenological tradition that recognizes that participants are experts in their "lived experience."

RESULTS

Participants described the youths' day-to-day communication experiences, including facilitators and barriers to successful social interactions. Thematic analysis revealed three main themes: (a) strong core relationships amidst sparse, superficial interactions in daily life; (b) the complicated picture of why; and (c) how speech-language pathologists can help.

CONCLUSIONS

Participants reported that the impact of congenital motor speech disorders on social interactions and experiences became more apparent in adolescence than in earlier childhood. Addressing communication challenges to meet the unique social demands of this period requires tailored interventions that target multiple contributing factors beyond speech impairment, such as social communication skills, negative communication partner attitudes, and participation opportunities. Shifting practice toward a life participation approach to communication intervention stands to substantially improve the long-term social outcomes of adolescents with motor speech disorders.

Solution-Focused Coaching for Friendship in Pediatric Rehabilitation: A Case Study of Goal Attainment, Client Engagement, and Coach Stances

AIMS

To examine goal attainment, engagement, and the stances used by coaches providing a solution-focused coaching intervention (SFC-peds) for young people with cerebral palsy pursuing friendship goals.

METHODS

The case study involved two clients with cerebral palsy (a young child and his mother, and a youth) and their service providers. An interpretive descriptive approach was used to analyze quantitative and qualitative data. Friendship goal attainment was assessed by the Canadian Occupational Performance Measure and goal attainment scaling, and client engagement was assessed using the Pediatric Rehabilitation Intervention Measure of Engagement-Service Provider version. Information from post-intervention client interviews was used to identify coach stances and relationships with client engagement.

RESULTS

Participants met their friendship goals and were considered to be highly engaged by their coaches. Four coach stances were identified: Respectful Inquiry, a Strengths Presupposition, Implementation Curiosity, and Inspiring Commitment. These stances, and aligned tactics, engaged clients on affective, cognitive, and behavioral levels, and impacted the client's stance toward their goal.

CONCLUSIONS

SFC-peds appears to be an effective and engaging approach for young people with disabilities working on friendship goals. The findings illustrate how the coach's stances and tactics engage clients, thus impacting the client's own stances toward change.

A Case Study of a Robot-Assisted Speech Therapy for Children with Language Disorders

The aim of this study was to explore the potential of using a social robot in speech therapy interventions in children. A descriptive and explorative case study design was implemented involving the intervention for language disorder in five children with different needs with an age ranging from 9 to 12 years. Children participated in sessions with a NAO-type robot in individual sessions. Qualitative methods were used to collect data on aspects of viability, usefulness, barriers and facilitators for the child as well as for the therapist in order to obtain an indication of the effects on learning and the achievement of goals. The main results pointed out the affordances and possibilities of the use of a NAO robot in achieving speech therapy and educational goals. A NAO can contribute towards eliciting motivation, readiness towards learning and improving attention span of the children. The results of the study showed the potential that NAO has in therapy and education for children with different disabilities. More research is needed to gain insight into how a NAO can be applied best in speech therapy to make a more inclusive education conclusions.

Exploring the Shared Meaning of Social Inclusion to Children with and without Disabilities

AIMS

Perspectives of children with and without disabilities on social inclusion are seldom sought in the childhood disability literature, impeding the ability to provide inclusive experiences for all children. This qualitative study explored meaningful aspects of social inclusion from the perspectives of children with and without disabilities in an inclusive recreation program.

METHODS

Drawing on the interpretive paradigm and subjectivity epistemology, this study adopted a generic qualitative methodological approach. Seventeen children with and without disabilities involved in the same inclusive recreation program participated in two semi-structured interviews. These interviews were analyzed using an inductive thematic analysis.

RESULTS

Three key themes emerged and were interpreted as dimensions of social inclusion: contextual, intrapersonal, and interpersonal. The contextual dimension included the freedom to choose activities and receiving equal attention from staff. The intrapersonal dimension was characterized by psychological safety and group fellowship. The interpersonal dimension included having positive authentic interactions and giving/receiving help.

CONCLUSIONS

These findings may influence future program development and implementation to promote inclusive experiences for all children.

Valuing e-inclusion: Social media and the social networks of adolescents with intellectual disability

BACKGROUND

Social media is a growing phenomenon, yet people with intellectual disability (ID) may not experience comparable access to this communication technology. Adolescents with ID may benefit from e-inclusion, especially as individuals with ID are at risk of having smaller social networks.

MATERIALS AND METHODS

The Social Network Guide was adapted to measure social media usage and used to examine the interpersonal relationships of adolescents with and without ID.

RESULTS

Adolescents with ID held smaller social networks with less developed informal relationships. However, friendship quality was comparable or superior to typically developing peers. Adolescents with ID interacted with a smaller percentage of contacts using social media. Social media use was predictive of the number of reported friendships and did not significantly predict critical comments.

CONCLUSIONS

Findings suggest that adolescents with ID have comparable access to social media but use these sites to interact with a smaller number of social contacts.

How do peers promote social inclusion of children with disabilities?A mixed-methods systematic review

Purpose: This mixed-methods systematic review synthesized findings from studies published between January 1, 2006 and July 31, 2018 on the social inclusion experiences of children with and without disabilities, as viewed from their own perspective, with a focus on how typically developing peers promote social inclusion.Method: Forty-five studies met the inclusion criteria. Data from included studies were synthesized by means of content analysis.Results: The findings detail the inner social inclusion experiences (e.g., feeling included, different) of children with disabilities and provide information regarding the influence of disability type (e.g., physical, social, affective) on typically developing peers' responses (e.g., acceptance vs. rejection), peers' explanations for social inclusion/exclusion, and peers' relationships with children with disabilities. Barriers to social inclusion, supports, as well as strategies used to promote social inclusion, as perceived by peers and children with disabilities, are also reported.Conclusion: The findings of this review provide evidence that despite society's efforts to promote social inclusion, children with disabilities continue to report feeling lonely and excluded, having limited contact socially outside of home, and encountering systemic barriers (e.g., bullying, discrimination). More research on the social inclusion experiences of children with disabilities beyond educational settings is needed, such as in the contexts of recreation and leisure, community, and employment.Implications for rehabilitationThe perspectives of children with and without disabilities need to be integrated in activities and programs aimed at promoting social inclusion.Teaching social inclusion strategies to children with and without disabilities is needed to help them deal with barriers.In addition to educational settings, rehabilitation clinicians need to promote social inclusion strategies in other contexts such as recreation and leisure, community, and employment contexts.

An Examination of Social Skills, Friendship Quality, and Loneliness for Adults with Williams Syndrome

Individuals with Williams Syndrome (WS) are hypersocial, overfriendly, and experience social skills deficits that may adversely impact their social outcomes. This study examined the relation between social skills, friendship quality, and feelings of loneliness for adults with WS as reported by 114 parent-adult with WS dyads. Results indicate that although most friends do not live close-by, adults with WS have good quality friendships and do not report high feelings of loneliness. Positive friendship qualities were found to partially mediate the relationship between social skills impairments and social feelings of loneliness. Findings indicate that although adults with WS experience social skills deficits and struggle to maintain friendships in their immediate community, they still report positive friendship qualities and low feelings of loneliness.

Participation of children with disabilities in school: A realist systematic review of psychosocial and environmental factors

Background

In order to make informed decisions about how best to support children and young people with disabilities, effective strategies that facilitate active and meaningful participation in school are required. Clinical factors, diagnosis or impairments somewhat helpful in determining what should be provided in interventions. However, clinical factors alone will not offer a clear view of how to support participation. It is helpful then to look at wider psychosocial and environmental factors. The aim of this review was to synthesise evidence of psychosocial and environmental factors associated with school participation of 4–12 year old children with disabilities to inform the development of participation-fostering interventions.

Methods

A systematic search and synthesis using realist methods was conducted of published research. Papers had to include consideration of psychosocial and/or environment factors for school participation of children with disabilities. The review was completed in accordance with the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Papers were identified via Boolean search of the electronic databases MEDLINE, CINAHL, PhycINFO and ERIC (January 2006-October 2018). Appraisal focussed on contributions in terms of whether the articles are appropriate for the review (relevance) and research quality (rigour). Data were analyzed using content and thematic analysis methods using a realist framework. A narrative synthesis of results was reported.

Results and implications

We identified 1828 papers in the initial search. Seventy two papers were included in the final synthesis. Synthesis of findings led to three overarching mechanisms representing psychosocial factors for children (1) identity (2) competence and (3) experience of mind and body. Environmental aspects (context) compromised five interrelated areas: (1) structures and organization, (2) peers, (3) adults, (4) space and (5) objects. Our synthesis provides insights on how professionals may organize efforts to improve children’s participation. Consideration of these findings will help to proactively deal with suboptimal participation outcomes. Development of theoretically determined assessments and interventions for management of school participation are now required.

Gender Differences in the Social Motivation and Friendship Experiences of Autistic and Non-autistic Adolescents

This mixed-methods study examined gender differences in the social motivation and friendship experiences of adolescent boys and girls with autism relative to those without autism, all educated within special education settings. Autistic girls showed similar social motivation and friendship quality to non-autistic girls, while autistic boys reported having both qualitatively different friendships and less motivation for social contact relative to boys without autism and to girls with and without autism. Semi-structured interviews with the adolescents corroborated these findings, with one exception: autistic girls reported high levels of relational aggression within their friendships, suggesting that girls on the autism spectrum in particular may struggle with identifying and dealing with conflict in their social lives.

Assessing the Social Skills and Problem Behaviors of Adolescents With Severe Disabilities Enrolled in General Education Classes

Although enhancing the social competence of students with severe disabilities has long remained a prominent focus of school-based intervention efforts, relatively little attention has focused on identifying the most critical social and behavioral needs of students during high school. We examined the social skills and problem behaviors of 137 adolescents with severe disabilities from the vantage point of both special educators and parents. We sought to identify areas of potential intervention need, explore factors associated with social skill and problem behavior ratings, and examine the extent to which teachers and parents converged in their assessments of these needs. Our findings indicate teachers and parents of high school students with severe disabilities rated social skills as considerably below average and problem behaviors as above average. In addition, lower social skills ratings were evident for students with greater support needs, lower levels of overall adaptive behavior, and a special education label of autism. We found moderate consistency in the degree to which teachers and parents aligned in their assessments of both social skills and problem behavior. We offer recommendations for assessment and intervention focused on strengthening the social competence of adolescents with severe disabilities within secondary school classrooms, as well as promising avenues for future research.

In their own words: the place of faith in the lives of young people with autism and intellectual disability

Abstract Although the prominence of spirituality and religious connections among the people of the United States is well documented, little is known about the place of faith in the lives of youth with developmental disabilities. In this qualitative interview study, we examined the perspectives of 20 young people with intellectual disability or autism on their faith, spiritual expressions, and disability. Participants identified key spiritual expressions and themes reflecting the importance of faith in their lives. They also shared perceptions of their disability in the context of their faith, highlighting affirmation and acceptance of their disability. We offer recommendations to families, faith communities, and service systems for supporting the spiritual formation, expression, and connections of young people with disabilities.

Social interactions of students with disabilities who use augmentative and alternative communication in inclusive classrooms

The purpose of this study was to explore the naturally occurring social interactions for students with disabilities who use augmentative and alternative communication (AAC) in general education classrooms. We observed 16 students who used AAC and received services under the categories of autism or intellectual disability. Participants primarily interacted with their support personnel and infrequently conversed with peers despite often being in close proximity. Few interaction episodes were initiated by students who used AAC, and initiations to peers and adults appeared to serve somewhat different functions. Students with disabilities relied more heavily on facial expressions and gestures than on the use of their AAC devices. Recommendations for promoting interaction opportunities among students are offered, and future research directions are suggested.

Social integration of people with intellectual disability: insights from a social psychological research programme

BACKGROUND

Social integration of people with intellectual disability (ID) moving into regular neighbourhoods tends to be studied and evaluated without detailed knowledge about the social psychological aspects of everyday interaction between neighbours with and without ID. The goal of the present paper is to show how the authors' social psychological research programme may contribute to this field of inquiry.

METHODS

The different ways in which societies respond to features and behaviours that may be perceived as deviant are theoretically analysed. Results of empirical studies are reported to clarify how social responses to people with ID are special in terms of perceptions, emotions and interaction desires of people with and without ID during a pre-contact and contact phase.

RESULTS

On the basis of the theoretical analysis, it is concluded that regular neighbouring in modern Western society often takes the form of benevolent tolerance, rather than stigmatisation and prejudice. However, empirical studies reveal that, prior to getting people with ID as new neighbours, prospective neighbours without ID experience a specific pattern of emotions that are associated with specific desires (e.g. with respect to information supply or a caring relationship). These anticipatory reactions are dependent on the expected size of the group moving in and on the severity of ID. Furthermore, while actually engaging in neighbouring, neighbours with and without ID appear to have experiences related to behaviour of residents, staff and features of housing facilities that are perceived as (in)congruent with regular neighbouring.

CONCLUSIONS

It is concluded that interpersonal relationships between neighbours with and without ID should not be simplified in terms of attitudes that would be primarily prejudiced/stigmatising versus entirely accepting. Rather, our studies paint a more complex picture of sometimes ambivalent thoughts, feelings and interaction needs that all should be taken into account to make social integration a success.

Developing a person-centred support service for families caring for children with severe learning disabilities in rural and urban areas

The article describes an innovative, person-centred service provided to families who had a child or teenager with severe learning (intellectual) disabilities. It was delivered in three areas within Northern Ireland: two urban and one rural. The service promoted the social inclusion of young people in volunteer-run community activities, based around a person-centred plan developed with the child's family. A three-year formative evaluation of the service was undertaken (2006-2008) via interviews and focus groups with parents (N = 48), young people (N = 19), volunteers (N = 7), community workers (N = 4) and referring social services staff (N = 14). The service was successfully implemented in all three areas. In particular, it helped parents to clarify their individual support needs and engaged their child in ordinary community activities. The distinctive features of the service and the changed ethos it represents are discussed.

Friendship Experiences among Children with Disabilities Who Attend Mainstream Australian Schools

Purpose. To explore the experiences of friendship for children with disabilities who attend mainstream Australian schools. Background. Being a friend is an important occupational role for all children. However, the literature suggests that physical inclusion of children with disabilities in mainstream schools does not necessarily develop social inclusion. Methods. Phenomenology was used to explore friendship experiences of 10 primary school children with disabilities. Findings. Five themes emerged from the data: (1) self-identity; (2) meaning of friendship; (3) classroom experiences; (4) playing together; (5) longing for friendship. These themes reflected the importance of friendship in the children's lives, the influence of the children's beliefs and values, and the impact of the attitudes and actions of educational staff and other students. Implications. Occupational therapists need to work collaboratively with educational staff, students, and their peers to create inclusive school settings that facilitate positive friendship experiences for children with disabilities.