Beyond Silence: A Scoping Review of Provided Support for Grieving Children With Intellectual Disabilities or Autism Spectrum Disorder.

Children with intellectual disabilities (ID) or autism spectrum disorder (ASD) are considered unable to grieve or understand the concept of death and might not receive grief support after the death of a beloved person; hence, they are at risk of developing complicated grief. This scoping review identified existing grief support for children with ID or ASD. Searching seven databases yielded 514 records; six studies met the predefined inclusion criteria. The six studies identified grief support, including discussions, participation in death rituals, family support, stories, and professional interventions. The support could be organized into three levels, micro, meso, and exo, overlooking the macro level completely, indicating that grief support for these children tends to be irregular and inconsistent.

The association between self-reported psychosomatic complaints and bullying victimisation and disability among adolescents in Finland and Sweden.

AIM: To analyse the associations between bullying victimisation, disability, and self-reported psychosomatic complaints in adolescents, and to investigate the role of support from parents and teachers in such associations. METHODS: The study was based on Finnish and Swedish data from two waves (2013/2014 and 2017/2018) of the Health Behaviour in School-aged Children survey (n=16,057). Descriptive statistics were produced for four groups of adolescents: (a) bullied with disabilities; (b) not bullied with disabilities; (c) bullied without disabilities; and (d) not bullied without disabilities (reference group). Two multilevel multinomial logistic regression models were performed for the Finnish and Swedish samples separately. The first model analysed associations between psychosomatic complaints and bullying victimisation, controlling for a range of confounders. The second model analysed associations between psychosomatic complaints and social support from parents and teachers. RESULTS: Across both countries, bullied adolescents with disabilities were more likely to self-report psychosomatic complaints than the reference group, even after adjusting for other potential confounders. Teacher support was identified as a potential protective factor as the odds ratio for psychosomatic complaints decreased when including teacher support as a factor in the model. The association with parent support showed mixed findings in Finland and Sweden. CONCLUSIONS: Disability in combination with bullying victimisation generated the highest levels of self-reported psychosomatic complaints compared to adolescents that were not bullied nor had disabilities. High teacher support may be a protective factor against psychosomatic complaints for bullied and/or disabled adolescents.

Chronic health conditions and school experience in school-aged children in 19 European countries.

This study investigates chronic conditions (CC) prevalence among children in mainstream schools, their school experience and life satisfaction in Europe. Data were collected from the 2017/2018 HBSC survey, a cross-national study using self-reported questionnaires administered in classrooms. Nationally representative samples of children aged 11, 13, and 15 years in mainstream schools from 19 European countries (n = 104,812) were used. School experience was assessed using four variables: low school satisfaction, schoolwork pressure, low teacher support, and peer-victimization, which were related to life satisfaction. Latent class analysis (LCA) was conducted to identify patterns of school experience among students with CC. The prevalence of CC varied from 8.4 (Armenia) to 28.2% (Finland). Children with CC (n = 17,514) rated their school experience and life satisfaction lower than children without CC. LCA identified three school experience patterns: "negative on all items" (37%), "negative on all items, except school pressure" (40%) and "overall positive" (23%). The distribution of subgroups varied across countries-in countries with a higher proportion of children with CC in mainstream schools, children reported more negative school experiences. Compared to the "overall positive" group, low life satisfaction was highest for students classified as "negative on all items" (relative risk (RR) = 2.9; 95% CI 2.2-3.8) with a lesser effect for "negative on all items, except school pressure" (RR) = 1.8; 95% CI 1.4-2.4). These findings provide cross-national data documenting the diversity in inclusive educational practices regarding school placement and school experiences, and suggest that efforts are still needed to allow a fully inclusive environment.

Parental distress rating at the child's age of 15 years predicts probable mental diagnosis: a three-year follow-up.

BACKGROUND: Mental health in adolescence is an increasing global public health concern. Over half of all mental disorders debut by 14 years of age and remain largely untreated up to adulthood, underlining the significance of early detection. The study aimed to investigate whether parental distress rating at the child's age of 15 predicts a probable mental diagnosis in a three-year follow-up. METHODS: All data was derived from the Finnish Family Competence (FFC) Study. The analysis focused on whether parental CBCL (Child Behavior Checklist) rating (n = 441) at the child's age of 15 years predicted the outcome of the child's standardised DAWBA (Development and Well-Being Assessment) interview at offspring's 18 years. RESULTS: Multivariable analysis showed that a one-unit increase in the total CBCL scores increased the relative risk of a DAWBA-based diagnosis by 3% (RR [95% CI] 1.03 [1.02-1.04], p < 0.001). CONCLUSIONS: Parental CBCL rating in a community sample at the adolescent's age of 15 contributes to early identification of adolescents potentially at risk and thus benefitting from early interventions.

The Role of Disability in the Relationship Between Mental Health and Bullying: A Focused, Systematic Review of Longitudinal Studies.

Having both a disability and being bullied increases the risk of later mental health issues. Children with disabilities are at greater risk of being bullied and therefore at greater risk of adverse mental health outcomes. We conducted a limited systematic review of longitudinal studies focusing on the role of disability in relation to bullying and mental health problems. Twelve studies with an initial measure of mental health or disorder, measured no later than 10 years of age, were found. Ten of these twelve studies suggested that having a disability before victimisation increased the impact of mental health problems measured after bullying experiences. The conclusion is that children with a disability, such as behavioural problems, have an increased risk of later mental health problems through bullying victimization. Children with two risk factors had significantly worse mental health outcomes. These additional mental health problems may be alleviated through reduced bullying victimisation.

Cyberbullying and traditional bullying among Nordic adolescents and their impact on life satisfaction.

Aims: The aim of this study was to investigate the prevalence of cybervictimization in the six Nordic countries and to assess its overlap with traditional bullying. A further aim was to examine potential associations between life satisfaction, on the one hand, and traditional bullying and cyberbullying on the other. Methods: Analyses were based on data from the 2013/2014 Health Behaviour in School-aged Children study. It included 32,210 boys and girls, aged 11, 13, and 15, living in the six Nordic countries. Results: The prevalence of cyberbullying by both pictures and by messages was around 2% in all the Nordic countries except Greenland. There it was considerably higher. The prevalence of being bullied in a traditional manner varied widely by country. For boys, this type of bullying was most frequent in the youngest age group and then decreased steadily in the older age groups. Girls were on average more likely to be cyberbullied. Cyberbullying was more common among 13- and 15-year-olds than 11-year-olds. Higher family affluence was unrelated to the risk of cyberbullying. However, it was related to traditional bullying and combined forms of bullying. Compared with intact families, cybervictimization was commoner among single-parent families and stepfamilies. Adjusting for age, gender, family affluence, and family structure, those subjected to cyberbullying had lower life satisfaction than those who were not bullied. Conclusions: We found relatively little overlap between cyberbullying and traditional bullying, indicating that the two may be separate phenomena stemming from different mechanisms, at least in the Nordic context.

Physical Activity Among Adolescents With Long-Term Illnesses or Disabilities in 15 European Countries.

Physical activity (PA) is an important health-promoting behavior from which adolescents with long-term illnesses or disabilities (LTID) can benefit. It is important to monitor differences across countries in adherence with PA recommendations for health. The aim of this study was to compare PA levels among 15 European countries after disaggregating data by disability. Data from pupils (mean age = 13.6 years, SD = 1.64) participating in the 2013/2014 Health Behavior in School-aged Children study were analyzed to compare adolescents without LTID, with LTID, and with LTID that affects their participation (affected LTID). Logistic regression models adjusted for age and family affluence, stratified by gender and country group with PA recommendations for health as the outcome variable. With the data pooled, 15% (n = 9,372) of adolescents reported having LTID and 4% (n = 2,566) having affected LTID. Overall, fewer boys with LTID met PA recommendations for health than boys without LTID, although it was not statistically significant either at the national levels or for girls.

Trends in multiple recurrent health complaints in 15-year-olds in 35 countries in Europe, North America and Israel from 1994 to 2010.

BACKGROUND: Health complaints are a good indicator of an individual's psychosocial health and well-being. Studies have shown that children and adolescents report health complaints which can cause significant individual burden. METHODS: Using data from the international Health Behaviour in School-aged Children study, this article describes trends in multiple recurrent health complaints (MHC) in 35 countries among N = 237 136 fifteen-year-olds from 1994 to 2010. MHC was defined as the presence of two or more health complaints at least once a week. Logistic regression analysis was performed to evaluate trends across the five survey cycles for each country. RESULTS: Lowest prevalence throughout the period 1994-2010 was 16.9% in 1998 in Austria and highest in 2006 in Israel (54.7%). Overall, six different trend patterns could be identified: No linear or quadratic trend (9 countries), linear decrease (7 countries), linear increase (5 countries), U-shape (4 countries), inverted U-shape (6 countries) and unstable (4 countries). CONCLUSION: Trend analyses are valuable in providing hints about developments in populations as well as for benchmarking and evaluation purposes. The high variation in health complaints between the countries requires further investigation, but may also reflect the subjective nature of health complaints.

Trends in health complaints from 2002 to 2010 in 34 countries and their association with health behaviours and social context factors at individual and macro-level.

BACKGROUND: This article describes trends and stability over time in health complaints in adolescents from 2002 to 2010 and investigates associations between health complaints, behavioural and social contextual factors at individual level and economic factors at macro-level. METHODS: Comprising N = 510 876 11-, 13- and 15-year-old children and adolescents in Europe, North America and Israel, data came from three survey cycles of the international Health Behaviour in School-aged Children (HBSC) study. Age- and gender-adjusted trends in health complaints were examined in each country by means of linear regression. By using the country as the random effects variable, we tested to what extent individual and contextual variables were associated with health complaints. RESULTS: Significant associations are stronger for individual level determinants (e.g. being bullied, smoking) than for determinants at macro-level (e.g. GDP, Gini), as can be seen by the small effect sizes (less than 5% for different trends). Health complaints are fairly stable over time in most countries, and no clear international trend in health complaints can be observed between 2002 and 2010. The most prominent stable determinants were being female, being bullied, school pressure and smoking. CONCLUSION: Factors associated with health complaints are more related to the proximal environment than to distal macro-level factors. This points towards intensifying targeted interventions, (e.g. for bullying) and also targeting specific risk groups. The comparably small effect size at country-level indicates that country-level factors have an impact on health and should not be ignored.

Psychosocial working conditions: an analysis of emotional symptoms and conduct problems amongst adolescent students.

This study explored how psychosocial features of the schoolwork environment are associated with students' mental health. Data was drawn from 3699 ninth grade (15 year-old) Swedish students participating in the Health Behaviour in School-Aged Children survey. Using Structural Equation Modelling, perceived school demands, decision control and social support from teachers, classmates and parents were examined in relation to students' emotional and conduct problems. Higher demands were associated with greater emotional symptoms and conduct problems. Although weaker social support predicted emotional symptoms and conduct problems, the relative influence of teachers, classmates and parents differed. Teacher support was more closely associated with conduct problems, particularly for girls, while classmate support was more strongly related to emotional symptoms. The findings indicate that while excessive school pressure is associated with poorer mental health, social support can assist in optimising adolescents' emotional health and adaptive behaviour, as well as shaping perceptions of demands.

The association between adolescents' self-esteem and perceived mental well-being in Sweden in four years of follow-up.

BACKGROUND: The situation concerning adolescent mental health is a global public health concern, and the concept includes the ability to cope with problems of everyday life. A person's approach and attitude towards themselves, i.e., their self-esteem, affects mental health. The study aimed to appraise and deepen the scientific understanding of adolescents' self-reported self-esteem at age 12-13 from a resource perspective and test its ability to predict subsequent perceived mental well-being at age 17. METHODS: Data from the Longitudinal Research on Development in Adolescence (LoRDIA) prospective follow-up study of adolescents aged 12-13, and 17 (n = 654) were analysed using ANCOVA. The outcome variable, perceived mental well-being (MWB), covers the aspects of mental well-being inspired by the "Mental Health Continuum," representing positive mental health. Covariates were self-esteem (SE) and reported initially perceived MWB at age 12-13. Other independent explanatory variables were gender, the family's economy, and the mother's educational level. RESULTS: Self-esteem appeared relatively stable from 12-13 to 17 years (M = 20.7 SD = 5.8 vs. M = 20.5 SD = 1.7). There was a significant but inverted U - shaped association between SE at age 12-13 and perceived MWB at age 17 [F (1, 646) = 19.02, ß-0.057; CI -0.08--0.03, Eta = 0.03, p = .000]. Intermediate but not strong SE predicted significantly good MWB. When conducting the ANCOVA for boys and girls separately, only the mother's educational level was significantly positively associated with perceived MWB of girls. CONCLUSIONS: Good self-esteem in early adolescence increases the likelihood of an unchanged favourable development of self-esteem and the probability of good perceived mental well-being. SE explained 18 per cent of the variation of MWB, and even more among girls. However, normal SE rather than high SE at 12 and 13 years is predictive of later mental well-being. Girls reported low self-esteem more often. Therefore, supporting self-esteem early in life can promote mental well-being in adolescence.

The utility of the International Classification of Functioning construct as a statistical tool - operationalizing mental health as an indicator of adolescent participation.

BACKGROUND: The ICF provides a common scientific language for the study of health and functioning. Adolescent mental health, operationalized as engagement in life situations, is one aspect of functioning. Engagement as mental health has a bi-directional relation with environmental factors. AIM: To test the statistical utility of the International Classification of Functioning (ICF) classification in coding adolescent mental health and mental health problems. METHODS: Using data measuring mental health in a representative Swedish sample of 12-13-year-olds linking responses to the classification codes. The internal structure of the classification system constructs was tested using factor analysis. RESULTS: A factorial solution could be found for most chapters indicating that the ICF framework and coding system could be used; however, the variance explained was quite low. Linking worked better at code-level, rather than chapter level. Items measuring risk behavior or risk factors are loaded in separate constructs. CONCLUSIONS: When coding items for statistical purposes, code-level rather than chapter level is to be preferred. Also, participation in risk behavior loads in separate factors indicating that these behaviors are separate from other types of participation.Implications for rehabilitationConsidering some challenges with varying level of detail in the ICF-CY's chapters, the framework can be used to identify the content of mental health questionnaires to be used in rehabilitation.To provide more detailed information in rehabilitation addressing mental health, a code-level solution is more appropriate than a chapter level solution.Despite the use of same ICF-CY codes, negative participation, i.e., risk behavior, measures a different dimension than positive participation, is especially relevant in rehabilitation addressing mental health.

Trajectories of participation, mental health, and mental health problems in adolescents with self-reported neurodevelopmental disorders.

PURPOSE: Having a neurodevelopmental disorder (NDD) increases the risk of mental health problems and lower participation. We investigated the trajectories of mental health problems and participation in adolescents with NDD and compared these with trajectories for peers without NDD. In addition, the relationship between participation, mental health (well-being), and mental health problems were investigated. MATERIALS AND METHODS: Data from a Swedish longitudinal survey study (LoRDIA) was used and adolescents with and without self-reported NDD were followed from 12/13 to 17 years, in three waves. Mental health problems were measured using the Strength and Difficulties Questionnaire, and well-being was measured with the Mental Health Continuum short form. RESULTS: Adolescents with NDD experience more mental health problems than adolescents without NDD. Hyperactivity, a key feature of NDD, remains stable, while emotional problems and psychosomatic complaints, increase over time for girls, independent of NDD. Participation is stable over time but is more related to well-being than to NDD or mental health problems. CONCLUSIONS: Gender is an important factor with girls exhibiting more problems. Mental health explains more of the variation in participation than mental health problems and NDD. Probably participation intervention can enhance mental health which may protect from mental health problems.Implications for rehabilitationMental health, i.e., emotional-, social-, and psychological well-being is more strongly related to participation and to reduced levels of mental health problems than having an NDD or not, thus assessing mental health separately from measuring NDD is important.Interventions focusing on participation may lead to higher mental health and having high mental health (flourishing) may facilitate participation.Girls with self-reported NDD seem to have a higher burden of mental health problems, especially if they also are languishing, i.e., having low mental health, therefore a strong focus on this group is needed both in research and clinical practice.Half of all adolescents are flourishing, independently of NDD or not, even if they are experiencing some symptoms of mental health problems, adolescents with NDD who are also languishing, have much higher ratings of mental health problems.

Teenagers' mental health problems predict probable mental diagnosis 3 years later among girls, but what about the boys?

BACKGROUND: The prevalence of mental disorders is increasing, and there seems to be a gender difference in prevalence, with girls reporting more mental health problems than boys, especially regarding internalizing problems. Most mental disorders debut early but often remain untreated into adulthood. Early detection of mental disorders is essential for successful treatment, which is not always happening. The study aimed to estimate to what extent teenagers' self-reports predict probable mental diagnosis as they enter adulthood, particularly regarding gender differences. METHODS: Self-reported mental health problems, Youth Self-Report (YSR) at 15 years (range 3-110, n = 504) from the ongoing Finnish family competence study (FFC) using modified multivariable Poisson regression analysis for prediction of DAWBA (Development and Wellbeing Assessment) interview outcomes 3 years later. RESULTS: One unit's increase in YSR was estimated to correspond to an increase in the relative risk of a probable DAWBA-based diagnosis by 3.3% [RR (95% CI) 1.03 (1.03-1.04), p < 0.001]. In gender-specific analysis, the findings applied, particularly to girls. CONCLUSIONS: Youth Self-Report (YSR) scores at pubertal age predicted the risk of a probable mental diagnosis at the onset of adulthood, particularly in girls. Further research is needed to explain the lower sensitivity of YSR among boys.

Gender Differences in Bullying Reflect Societal Gender Inequality: A Multilevel Study With Adolescents in 46 Countries.

PURPOSE: Social patterns in bullying show consistent gender differences in adolescent perpetration and victimization with large cross-national variations. Previous research shows associations between societal gender inequality and gender differences in some violent behaviors in adolescents. Therefore, there is a need to go beyond individual associations and use a more social ecological perspective when examining gender differences in bullying behaviors. The aim of the present study was twofold: (1) to explore cross-national gender differences in bullying behaviors and (2) to examine whether national-level gender inequality relates to gender differences in adolescent bullying behaviors. METHODS: Traditional bullying and cyberbullying were measured in 11-year-olds to 15-year-olds in the 2017/18 Health Behaviour in School-aged Children study (n = 200,423). We linked individual data to national gender inequality (Gender Inequality Index, 2018) in 46 countries and tested their association using mixed-effects (multilevel) logistic regression models. RESULTS: Large cross-national variations were observed in gender differences in bullying. Boys had higher odds of perpetrating both traditional and cyberbullying and victimization by traditional bullying than girls. Greater gender inequality at country level was associated with heightened gender differences in traditional bullying. In contrast, lower gender inequality was associated with larger gender differences for cyber victimization. DISCUSSION: Societal gender inequality relates to adolescents' involvement in bullying and gendered patterns in bullying. Public health policy should target societal factors that have an impact on young people's behavior.

Bullying, Mental Health, and the Moderating Role of Supportive Adults: A Cross-National Analysis of Adolescents in 45 Countries.

Objectives: Relationships with supportive adults during adolescence may be a protective factor that lowers the risks associated with bullying. The current study aimed to examine the moderating role of supportive adults in the associations between bullying involvement (in-person and cyber) and mental health problems (psychological symptoms and low life satisfaction). Methods: Data from 45 countries and regions taking part in the 2017/18 Health Behaviour in School-Aged Children study (N = 230,757) were used. Multivariable Poisson regression models were used to estimate relative risks of bullying on mental health. Effect estimates were compared across the number of supportive adults to examine a possible cumulative protective effect of relationships with supportive adults. Results: Bullying involvement was consistently associated with poor mental health across the 45 countries. Risk of mental health problems associated with bullying involvement was greatest among students reporting relationships with multiple supportive adults. This was true for all indicators of bullying involvement. Conclusion: Bullying remains a prevalent and harmful experience for youth worldwide. Merely having supportive adults is not sufficient in protecting youth from experiencing the mental health risks associated with bullying.

Student Self-Efficacy and Aptitude to Participate in Relation to Perceived Functioning and Achievement in Students in Secondary School With and Without Disabilities.

School-based Physical Education (PE) is important, especially to students with disabilities whose participation in physical activities out of school is limited. The development over time of participation-related constructs in relation to students' perceived functioning and achievement is explored. Students in mainstream inclusive secondary school self-rated their PE-specific self-efficacy, general school self-efficacy, aptitude to participate in PE, and perceived physical and socio-cognitive functional skills at two timepoints, year 7 and year 9. Results were compared between three groups of students with: disabilities (n = 28), high grades (n = 47), or low grades (n = 30) in PE. Over time, perceived physical skills of students with disabilities became strongly associated with self-efficacy and aptitude to participate. Perceived socio-cognitive skills in the study sample improved and had a positive effect on PE-specific self-efficacy. Efforts should be made to limit the accelerated negative impact of perceived restricted functioning of students with disabilities. Grading criteria need to be developed to comply with standards adapted to fit abilities of students with disabilities. Meaningful learning experiences appear to be created when participation is promoted and capacity beliefs (PE-specific self-efficacy) are boosted. Allocating resources to support the development of students' socio-cognitive skills seem to have potential for overall positive school outcome.

Short-term longitudinal participation trajectories related to domestic life and peer relations for adolescents with and without self-reported neurodevelopmental impairments.

BACKGROUND: With maturity and development, complexity in demands and roles change. As participation is often restricted in children with disabilities, this process might be delayed in adolescents. Investigating profiles of participation for adolescents with and without neurodevelopmental impairments could provide an understanding of which factors relate to high level of participation. The aim is to investigate trajectories of participation in everyday activities across clusters based on self-rated participation patterns in frequency of participation and perceived importance of activities related to domestic life and peer-related activities for adolescents with and without self-reported neurodevelopmental impairments. METHODS AND PROCEDURES: A prospective person-based cohort study design. OUTCOMES AND RESULTS: Five typical trajectories were identified. Trajectories between clusters with high perceived involvement in peer relations were associated with sibling support and family communication. Self-reported neurodevelopmental impairments did not predict participation profiles at certain time points, nor movements between clusters when measuring self-reported attendance and importance in domestic life and in peer-related activities. CONCLUSION AND IMPLICATIONS: Perceived sibling support and family communication are important for predicting typical trajectories across clusters in frequency of attendance and the perceived importance of domestic life and peer relations. Type of impairment was less important in predicting typical trajectories.

Trends in multiple health complaints in Polish adolescents in light of data from 30 European countries and Canada (2002-2018).

BACKGROUND: Adolescence is a sensitive period accompanied by rapid developmental changes that can result in health complaints. The aim of the study was to describe the trend of subjective health complaints (HBSC-SCL) of Polish adolescents compared to their peers from 30 other countries and to rank all countries based on a proposed standardised measure. MATERIAL AND METHODS: Data from the Health Behaviour in School-Aged Children (HBSC) study collected from 2002 to 2018 were used. The overall number of respondents from 30 countries in the combined sample from five quadrennial rounds was 773,356, including 49.2% boys and 50.8% girls. The HBSC-SCL is a non-clinical measure consisting of eight health complaints, usually analysed in two dimensions of psychological and somatic symptoms. Linear regression analysis was applied to assess the significance of trends of the total index and two subindices in the combined sample and individual countries. RESULTS: A significant increasing trend for the eight-item index appeared in Poland only in 13- and 15-year-olds, while only among 15-year-olds in the combined sample from 30 countries. Standardised country rank varied between -1.85 and 2.48 (worst). The countries that achieved extreme negative values (>=1) are France, Hungary, Italy, and Sweden, and the rank for Italy is considerably higher than for other countries. In Poland, the standardised rank for psychological symptoms exceeded the threshold of +1 in 2018. CONCLUSIONS: The HBSC-SCL index could be useful for monitoring change in adolescent mental health. The proposed method of ranking may allow a broader view of the differences and similarities between countries and help to identify those performing unfavourably against cross-country patterns.

Definitions and Operationalization of Mental Health Problems, Wellbeing and Participation Constructs in Children with NDD: Distinctions and Clarifications.

Children with impairments are known to experience more restricted participation than other children. It also appears that low levels of participation are related to a higher prevalence of mental health problems in children with neurodevelopmental disorders (NDD). The purpose of this conceptual paper is to describe and define the constructs mental health problems, mental health, and participation to ensure that future research investigating participation as a means to mental health in children and adolescents with NDD is founded on conceptual clarity. We first discuss the difference between two aspects of mental health problems, namely mental disorder and mental illness. This discussion serves to highlight three areas of conceptual difficulty and their consequences for understanding the mental health of children with NDD that we then consider in the article: (1) how to define mental health problems, (2) how to define and assess mental health problems and mental health, i.e., wellbeing as separate constructs, and (3) how to describe the relationship between participation and wellbeing. We then discuss the implications of our propositions for measurement and the use of participation interventions as a means to enhance mental health (defined as wellbeing). Conclusions: Mental disorders include both diagnoses related to impairments in the developmental period, i.e., NDD and diagnoses related to mental illness. These two types of mental disorders must be separated. Children with NDD, just like other people, may exhibit aspects of both mental health problems and wellbeing simultaneously. Measures of wellbeing defined as a continuum from flourishing to languishing for children with NDD need to be designed and evaluated. Wellbeing can lead to further participation and act to protect from mental health problems.