Children's health and developmental delay : positive functioning in every-day life

The general aim of this thesis was to gain understanding of what patterns of child and environment characteristics that promote and sustain health and positive functioning of children with and without developmental delay or disabilities. The focus was on promotion of strengths and competencies rather than on prevention of risk factors, with an emphasis on children’s functioning in every-day life. Both cross-sectional and longitudinal studies were conducted on representative samples of children. In Study I, participation in school activities were used as an outcome of positive functioning of children with disabilities. The findings indicated that autonomy, locus of control, child-peer interaction, and availability of activities were most influential in relation to participation in a pattern of child and environment factors. No significant difference was found across groups in type and degree of disability. Study II was conducted to gain knowledge of how young children perceive health. The interviews revealed that children perceived health in a multidimensional perspective, well represented by the health dimensions of ICF. The children largely related consequences of health to engagement. In Study III, engagement was used as an outcome of children’s interaction with their natural environment. The focus was to describe how children with and without developmental delay, divided into homogenous groups according to a pattern of child-environment interaction factors, engaged in developmentally appropriate behavior in their preschool and home environment. Groups of children with different patterns showed similar outcomes of engagement. Children with developmental delay were represented across groups, implying that developmental delay was less of a factor by itself influencing level of engagement. Study IV was longitudinal and the aim was to identify pathways of children’s engagement over time of children with and without developmental delay. Child-peer interaction seemed to promote high level engagement, while developmental delay only showed to be influential of low level engagement over time if combined with behavior problems. Children without developmental delay or behavior problems were met with greater teacher responsiveness, and at the same time teacher responsiveness predicted stable patterns of high level engagement or change to higher level engagement over time. The general finding in this thesis supported a both a multidimensional perspective of health and positive functioning, in where developmental delay and disability is viewed as a function of child and environmental characteristics. The results are discussed in a systemic perspective, in where the role of the delay or disability, as of other factors related to health and positive functioning in the whole child-environment system is determined by a multitude of factors. The dynamic character of children’s development makes it difficult to predict children’s future functioning, from isolated factors such as disability or developmental delay. Thus, a disability or developmental delay only becomes a risk factor of health, when combined with other risk factors that decrease the functioning of children in their every-day life