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2014; 56: 346–54. 2. Rice ML. Language growth and genetics of specific language impairment. Int J Speech Lang Pathol 2013; 15: 223–33.

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The development of social strengths in children with cerebral palsy MARGARETA ADOLFSSON CHILD, School of Education and Communication and The Swedish Institute for Disability Research, J€onko¨ping University, J€onko¨ping, Sweden.

doi: 10.1111/dmcn.12354 This commentary is on the original article by Tan et al. on pages 370– 377 of this issue.

The study by Tan et al. is of interest because it shows that children′s development is not necessarily delayed because of disability, specifically cerebral palsy (CP).1 CP is one of the most common childhood-onset disabilities and a condition frequently researched. PubMed, for example, reports 13 885 hits for CP compared with conditions such as developmental delay (6079) and myelomeningocele (602). As CP causes activity limitations, which can lead to restrictions in socially or culturally influenced areas of life, the study by Tan et al. provides insights into the social strengths that children with CP have. The results, indicating that many of the children diagnosed with CP can develop to the same level of social participation as children without disability (even though it may take more time), should have a positive impact on the expectations of their caregivers and families. Hopefully adults might increase their efforts to teach children with disabilities to interact with peers instead of mostly communicating with adults.2 The construct of participation has various interpretations and the rating of participation is controversial. This study aimed to address ‘performance of social participation’, from the perspective of socialization including interrelationships, play and leisure time; coping rated with the Vineland Adaptive Behavior Scale; and social function rated with Pediatric Evaluation of Disability Inventory. In the International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY),3 participation is defined as ‘involvement in a life situation’. It includes two aspects: to attend activities, i.e. be there, and to experience engagement while being there.4 The 300 Developmental Medicine & Child Neurology 2014, 56: 297–301

ratings reported in this study reflect the abilities needed for social interactions, not necessarily how a child carries out the interactions in various life situations. The ratings are in accordance with how capacity is rated using the ICF-CY qualifiers, but does not reflect the children′s attendance or engagement. Therefore, the children′s performance of social participation is not fully established. The Tan et al. study has several implications for clinical practice. For example, doing and being with others, which are elements of social participation, facilitate learning and development and should be considered by the adults who are around children with disabilities.5,6 Child participation, as a determinant of well-being and life satisfaction, may also decrease mental health problems.7 In addition to the abilities needed for social interactions, social participation includes an experience of belonging and inter-subjective interaction that leads into acts of acknowledgment.8 Because adults provide ‘scaffolds’ for the experiences of children with disabilities, parents and teachers have the responsibility to encourage the children to start interacting with peers and to introduce them to potential friends. The results reported in this study in terms of the development of children’s abilities for interactions, should influence the adults’ attitudes to the children’s social roles in a positive way. When receiving support from adults, it is likely that the children’s understanding of and adaption to social demands improve. For children with CP, participation restrictions are most often associated with their physical impairments related to environmental barriers, such as reduced access to venues and events.9,10 However, negative social attitudes to disability may also constitute barriers to participation. As children with disabilities attend community activities less frequently than typically developing children,11 adults must make efforts to introduce the children to such activities in addition to introducing them to those peers sharing the activity. For persons with severe CP or persons with additional intellectual disability, the result of the study shows there is no specific age where development ceases. This should be

seen as a promising finding that should encourage parents and professionals to continue to stimulate social development across ages. In this study, developmental trajectories were stratified by level of gross motor functioning. For future research, the authors note the need for enhanced insight into the

additional determinants of social participation development, such as CP characteristics and contextual factors. Since manual abilities are important for diverse activities, communication included, should the developmental trajectories also be stratified by the children’s level of fine motor functioning?

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5. Guralnick MJ. Connections between mental health and

the Netherlands study. Dev Med Child Neurol 2014; 56:

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tal delays. Paper presented at the Regional ISEI confer-

2. Guralnick MJ, Connor RT, Neville B, Hammond MA.

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6. Heah T, Caste T, McGuire B, Law M. Successful par-

children with mild developmental delays: effectiveness of

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disabilities. Can J Occup Ther 2007; 74: 38–47.

2013. 9. Colver A. What are we trying to do for disabled children? Curr Paediatr 2006; 16: 501–5. 10. Imms C. Children with cerebral palsy participate: a review of the literature. Disabil Rehabil 2008; 30: 1867– 84. 11. Bedell G, Coster W, Law M, et al. Community partici-

7. Badley EM. Enhancing the conceptual clarity of the

pation, supports, and barriers of school-age children

3. World Health Organization. International Classification

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with and without disabilities. Arch Phys Med Rehabil

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2013; 94: 315–23.

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4. Granlund M, Arvidsson P, Niia A, et al. Differentiating

8. Melin E, Janson U. Social participation in caring, teach-

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ing, and peer exchange: case studies of inclusive



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