For automated documentation systems to be meaningful in pediatric rehabilitation, they must accurately capture and summarize information about a child's or youth's involvement in daily life activities. We present attention-ASP, aneuro-symbolic framework that combines Transformer attention with Answer Set Programming (ASP) to capture involvement-level information from interview-based text. By encoding domain-specific vocabularies as ASP programs, our model guides attention heads to focus on contextual cues such as place, time, activity, object, and people. Results show that symbolic reasoning over attention improves alignment with expert assessments, offering a promising direction for advancing clinical documentation tools in pediatric rehabilitation.

BACKGROUND: Sexual and gender minority youth aged 12-18, whose sexual orientation, gender identity, or gender expression diverges from societal norms, encounter higher rates of bullying, violence, and depressive symptoms than their peers.

METHODS: Guided by the Minority Stress Model and Keyes' definition of well-being, this cross-sectional study investigates differences between sexual and gender minority youth and their peers in well-being (emotional, psychological, social), perceived school environment, and exposure to bullying and violence (sexual, physical, psychological). Furthermore, it explores the relationship between these factors and psychological distress and school attendance among sexual and gender minority youth. Secondary data analysis was conducted using the Youth Public Health Survey in Jönköping County, Sweden. Pooled multivariable linear and logistic regression analyses were performed to assess group differences (n = 5020) and identify predictors of psychological distress and school attendance among sexual and gender minority youth (n = 456).

RESULTS: Sexual and gender minority youth reported significantly lower levels of well-being, peace at school, alongside higher rates of bullying, violence, school stress, psychological distress, and increased odds of missed school compared to their peers. Among sexual and gender minority youth emotional and psychological wellbeing and teacher support were significant protective factors, while increased disability frequency, school stress, and exposure to sexual violence were significant risk factors across psychological distress and school attendance outcomes.

CONCLUSION: Swedish sexual and gender minority youth experience mental health and school-related disparities, underscoring the need for targeted, school-based interventions.

IMPLICATIONS TO PRACTICE: Pediatric and school-based nurses play a crucial role in these efforts.

Aim: To gain a comprehensive understanding of participation, particularly the construct ‘involvement’, in daily life activities from the perspective of children and young people with childhood-onset disabilities.

Method: We conducted a scoping review of literature from PubMed, CINAHL, and PsycINFO. We included articles if they examined the experiences of involvement in activities from the perspective of children and young people with childhood-onset disabilities, used qualitative methods, and were published in peer-reviewed journals after 2001. Data (e.g. age, narratives on involvement) from included studies were extracted, mapped, and thematically synthesized.

Results: Of 5241 articles, 30 met the inclusion criteria. We identified six concepts representing the experience of involvement in activities from the perspective of children and young people with childhood-onset disabilities. One concept reflected a continuum of inner dedication or investment in activities, ranging from non-involvement to involvement overload, which can be understood as the in-the-moment experience of involvement, representing the core of the involvement experience. Five additional ideas captured how children and young people process, interpret, and reflect on their experiences of involvement.

Interpretation: Results can inform paediatric rehabilitation measures and interventions focused on involvement. Future research should explore children and young people's involvement in undesirable activities and whether the concepts of involvement vary by context (e.g. country, activity setting) and personal factors (e.g. age, type of disability). 

Poor mental health (problems and well-being) among children, particularly those with disabilities, represents a significant individual and public health burden, with multifactorial origins including family environment and participation limitations. Family climate also impacts participation, suggesting the three structures may be interlinked. Furthermore, children with disabilities face additional obstacles increasing their vulnerability to poor mental health, such as limitations to participation. Therefore, the present study aimed to (1) investigate whether participation mediated the relationship between family climate and mental health and (2) whether possible relationships differed by disabilities. The Swedish Statistics (SCB) register on the conditions of life for children (barnULF) was utilised. This interview-based registry study employs a repeated cross-sectional design, where children are recruited yearly and invited to participate in the study. The present study used data from 2013-2019, resulting in 3676 children aged 10-18, of whom 510 reported some type of disability. Structural Equation Models (SEMs) mediation analyses were conducted to assess the possible mediating role of participation between family climate and mental health (well-being and problems separately), including models with and without covariates (age and gender). Multigroup analyses were conducted to assess whether children with and without disability differed. Results showed that participation significantly mediated the relationship between family climate and mental well-being but not mental health problems, amongst all children. Models including covariates indicated mediating models for both well-being and problems, but only amongst children without disabilities. However, model fits were poor. Implications of the study direct preventative strategies to focus on family climate as a route to improve mental well-being and highlight the importance of earlier strategies amongst children with disabilities and in particular girls.

This paper addresses a conceptual and formal limitation in the International Classification of Functioning, Disability and Health (ICF), where activity and participation are treated as a unified construct, creating ambiguity in rehabilitation contexts. We propose an ontology keeping the ICF structure but formally separating these concepts, enabling more precise participation assessment. A case-based query analysis demonstrates how the unified ICF model may yield false positives in participation documentation, while the refined ontology supports nuanced evaluation. Implementation details and future evaluation are discussed.

Purpose

To understand the current practices and future needs of practitioners involved in identifying low wellbeing and/or mental health problems in 10-24-year-olds with complex communication needs.

Methods

This mixed methods study (cross-sectional survey and follow-up focus groups) included participants who may be involved in identifying mental health concerns in young people with complex communication needs. Analyses included descriptive statistics (quantitative data) and interpretive description methods (qualitative data). These data were then synthesised before interpretation.

Results

Survey participants (n = 112 from 17 occupational backgrounds) mostly used "interaction with the person" to identify both low wellbeing and mental health problems. The least used method was "formal tool". An interpreted description of focus group data (n = 19 participants) produced a six-part Practitioners' Story. The Story described practitioners' current practice (facilitating and inhibiting), feelings towards the present situation, and ideas for improving identification of mental health concerns in this population.

Conclusions

There was little consistency in how mental health concerns were evaluated in young people with complex communication needs, but informal methods were most common. Workforce education, access to relevant resources, and service settings which promote a collaborative approach to assessment should be prioritised to better address the mental health needs of this currently underserved population.

Purposes: To investigate item-level agreement between children with neurodevelopmental disorders (NDD) and their primary caregivers regarding perceived participation attendance and involvement, and identify differences in their selections of the important activities to children.

Materials and methods: The participants included 143 children with NDD aged 6 to 12 years and their primary caregivers (n = 130). Each completed the Picture My Participation (PmP) separately. Weighted Kappa coefficients and absolute agreement/disagreement were calculated to assess agreement between child-primary caregiver dyads in attendance and involvement ratings. Frequencies of items selected as one of the three most important activities were analyzed.

Results: Slight to moderate agreement was found between children and primary caregivers in perceived attendance (kappa = 0.10 - 0.47, p < 0.05) and involvement (kappa = 0.12 - 0.48, p < 0.05) at the item level. Children more frequently identified social activities, caregiving for others or animals, personal care, and school learning as important compared to their primary caregivers.

Conclusions: The relatively low agreement between children with NDD and their primary caregivers highlights the importance of including children's perspectives in collaborative goal-setting. Clinicians should tailor tools and strategies to address children's and caregivers' differences in perceived participation and important activities to facilitate the co-construction of participation goals.

Mental health is “a state of wellbeing” as per the World Health Organisation. People with disabilities generally experience poorer wellbeing than those without disabilities. Instruments which assess wellbeing or its three core components (emotional, psychological, social) may be less accessible or appropriate for people with complex communication needs (CCN). This study aimed to identify and describe instruments used to measure wellbeing in people with CCN. A systematic review following PRISMA guidelines was conducted. Six databases were searched to identify studies where wellbeing was measured in people with CCN. Two reviewers extracted data to describe the studies, participants, instrument(s) used, and adaptations applied. Instrument items were then mapped to indicators of mental health. Twenty-six studies were included. Participants’ receptive language ranged normal to profoundly impaired and they used a variety of expressive communication methods. Twenty-two different instruments were identified; ten of which were quality-of-life measures. Adaptations were made to instruments in eight studies, mostly to administration procedures. Item mapping revealed that while some wellbeing indicators were represented within the included instruments, coverage was insufficient to consider any instrument a “measure of wellbeing” for this population. Some instruments had features which made them more appropriate for people with CCN: ensuring communication access; recognising the relative importance of wellbeing indicators to an individual; collecting information from multiple sources when using proxy-report; and acknowledging environmental factors. Research is required to develop or adapt an instrument for valid and reliable measurement of wellbeing in people with CCN, ensuring the instrument addresses their communication access needs.

Purpose

This knowledge synthesis aimed to 1) Map the extent and nature of the literature on capacity building in the field of rehabilitation for transition-age youth with disabilities (12-30 years old) and 2) Describe how capacity building is conceptualized and identify principles and key ingredients underpinning this concept.

Materials and Methods

A scoping review using JBI methodology was employed. A search of six databases resulted in 2169 English documents; 34 were retained. Two reviewers charted and analyzed the data, supported by the third reviewer. Inductive content analysis was used to identify principles and key ingredients.

Results

Seven documents provided explicit definitions of capacity or capacity building. Content analysis revealed four principles describing capacity building as: 1) individualized approach with real-world application 2) fostering a preferred future 3) youth taking ownership for change and 4) an ongoing process. Six key ingredients detail how to build capacity: 1) individualized and flexible approach in natural context 2) shared responsibility 3) use of accessible information and resources 4) cultivate strengths 5) opportunities for full participation and 6) facilitate reflection on experiences.

Conclusion

Clinicians and researchers can draw upon identified capacity building principles and ingredients to support meaningful real-world outcomes for transition-age youth.

PURPOSE: To compare the participation ratings between children with special educational needs and their primary caregivers and investigate the activities children desire to change and their participation-based goals.

METHODS: Twenty children with special educational needs aged 8 to 12 years were interviewed using the Functioning Scale of the Disability Evaluation System-Child to measure participation frequency and independence and select desire-to-change activities. The International Classification of Functioning, Disabilities, and Health-based Collaborative Problem Solving was used to form participation-based goals.

RESULTS: Children reported participation differently from their primary caregivers. Nineteen children identified desire-to-change activities mostly related to the home and community settings and indicated a desire to change participation frequency. Children's participation-based goals reflected their desires to do their preferred activities more often.

CONCLUSIONS: Children with special educational needs had unique perspectives different from those of their caregivers, and they could identify desired activities and set participation goals with semi-structured methods.