Abstract
Although in recent years the interest in studying the quality of life (QoL) of children with cerebral palsy (CP) has been growing, there are hardly any studies that have specifically evaluated QoL in people with both CP and intellectual disability (ID). Therefore, this study aims to (1) describe the individual QoL of children and adolescents with CP and ID, and (2) examine the influence of several individual and environmental variables on the QoL scores. The sample encompassed a total of 165 participants with CP and ID aged 4 to 21 years old who were receiving support from 42 Spanish organizations. The KidsLife Scale was used. Descriptive statistics were obtained and correlation and multiple regression analyses were performed. The highest values were obtained in physical well-being and rights, while the domains with the lowest scores were self-determination and social inclusion. Level of ID, percentage of disability, physical disability in the upper extremities and size of the organization were significant QoL predictors. This study provides useful information about strengths and needs of children and adolescents with CP and ID in the different domains of QoL and with insights into factors that may help to enhance their QoL.
Similar content being viewed by others
References
Arias, V. B., Gómez, L. E., Morán, M. L., Alcedo, M. A., Monsalve, A., & Fontanil, Y. (2018). Does quality of life differ for children with autism spectrum disorder and intellectual disability compared to children without autism? Journal of Autism and Developmental Disorders, 48(1), 123–136. https://doi.org/10.1007/s10803-017-3289-8
Arnaud, C., White-Koning, M., Michelsen, S. I., Parkes, J., Parkinson, K., Thyen, U., Beckung, E., Dickinson, H. O., Fauconnier, J., Marcelli, M., McManus, V., & Colver, A. (2008). Parent-reported quality of life of children with cerebral palsy in Europe. Pediatrics, 121(1), 54–64. https://doi.org/10.1542/peds.2007-0854
Aymerich, M., Berra, S., Guillamón, I., Herdman, M., Alonso, J., Ravens-Sieberer, U., & Rajmil, L. (2005). Desarrollo de la versión en español del kidscreen: Un cuestionario de calidad de vida para la población infantil y adolescente [Development of the Spanish version of the Kidscreen, a health-related quality of life instrument for children and adolescents]. Gaceta Sanitaria, 19(2), 93–102.
Bacherini, A., Igliozzi, R., Cagiano, R., Mancini, A., Tancredi, R., Muratori, F., & Balboni, G. (2021). Behavioral and emotional problems of toddlers with autism spectrum disorder: Effects of parents’ sociocultural level and individual factors. Research in Developmental Disabilities, 119, 104106. https://doi.org/10.1016/j.ridd.2021.104106
Badía, M., Orgaz, M. B., Gómez-Vela, M., Verdugo, M. A., Ullan, A. M., & Longo, E. (2016). Do environmental barriers affect the parent-reported quality of life of children and adolescents with cerebral palsy? Research in Developmental Disabilities, 49, 312–321. https://doi.org/10.1016/j.ridd.2015.12.011
Badía, M., Orgaz, M. B., Riquelme, I., & Gómez-Iruretagoyena, J. (2020). Domains of the cerebral Palsy Quality of Life Questionnaire (CP QOL) for children and adolescents: Spanish adaptation and psychometric properties. Journal of Developmental and Physical Disabilities, 1–19. https://doi.org/10.1007/s10882-020-09751-z
Badía, M., Rodríguez, P., Orgaz, M. B., & Blanco, J. M. (2013). Calidad De vida en Los pacientes con parálisis cerebral en proceso de envejecimiento [Quality of life in patients with cerebral palsy during aging process]. Rehabilitación, 47(4), 194–199. https://doi.org/10.1016/j.rh.2013.02.002
Balboni, G., Bacherini, A., Rebecchini, G., Cagiano, R., Mancini, A., Tancredi, R., Igliozzi, R., & Muratori, F. (2021). Individual and environmental factors affecting adaptive behavior of toddlers with autism spectrum disorder: Role of parents’ socio-cultural level. Journal of Autism and Developmental Disorders, 51, 3469–3482. https://doi.org/10.1007/s10803-020-04803-x
Balboni, G., Mumbardó-Adam, C., & Coscarelli, A. (2020). Influence of adaptive behavior on the quality of life of adults with intellectual and developmental disabilities. Journal of Applied Research in Intellectual Disabilities, 33(3), 584–594. https://doi.org/10.1111/jar.12702
Burke, K. M., Raley, S. K., Shogren, K. A., Hagiwara, M., Mumbardó-Adam, C., Uyanik, H., & Behrens, S. (2020). A meta-analysis of interventions to promote self-determination for students with disabilities. Remedial and Special Education, 41(3), 176–188. https://doi.org/10.1177/0741932518802274
Cardoso, A. M. R., de Medeiros, M. M. D., Gomes, L. N., Martins, M. L., Padilha, W. W. N., & Cavalcanti, A. L. (2018). Factors associated with health and oral health–related quality of life of children and adolescents with cerebral palsy. Special Care in Dentistry, 38(4), 216–226. https://doi.org/10.1111/scd.12301
Cicchetti, D. V., Koening, K., Klin, A., Volkmar, F. R., Paul, R., & Sparrow, S. (2011). From Bayes through marginal utility to effect sizes: A guide to understanding the clinical and statistical significance of the results of autism research findings. Journal of Autism and Developmental Disorders, 41, 168–174. https://doi.org/10.1007/s10803-010-1035-6
Colver, A., Rapp, M., Eisemann, N., Ehlinger, V., Thyen, U., Dickinson, H. O., Parkes, J., Parkinson, K., Nystrand, M., Fauconnier, J., Marcelli, M., Michelsen, S. I., & Arnaud, C. (2015). Self-reported quality of life of adolescents with cerebral palsy: A cross-sectional and longitudinal analysis. The Lancet, 385(9969), 705–716. https://doi.org/10.1016/S0140-6736(14)61229-0
Davis, E., Reddihough, D., Murphy, N., Epstein, A., Reid, S. M., Whitehouse, A., Williams, K., Leonard, H., & Downs, J. (2017). Exploring quality of life of children with cerebral palsy and intellectual disability: What are the important domains of life? Child: Care Health and Development, 43(6), 854–860. https://doi.org/10.1111/cch.12501
Dickinson, H. O., Parkinson, K. N., Ravens-Sieberer, U., Schirripa, G., Thyen, U., Arnaud, C., Beckung, E., Fauconnier, J., McManus, V., Michelsen, S. I., Parkes, J., & Colver, A. F. (2007). Self-reported quality of life of 8–12-year-old children with cerebral palsy: A cross-sectional European study. The Lancet, 369(9580), 2171–2178. https://doi.org/10.1016/S0140-6736(07)61013-7
Fernández, M., Verdugo, M. A., Gómez, L. E., Aguayo, V., & Arias, B. (2018). Core indicators to assess quality of life in population with brain injury. Social Indicators Research, 137, 813–828. https://doi.org/10.1007/s11205-017-1612-6
Giray, E., Şimşek, H. İ, Aydoğduoğlu, M., Kangal, A. Ç., Çelik, A., Kurt, C., & Saygı, E. K. (2018). Pain evaluation in a sample of Turkish children with cerebral palsy and its association with dependency level, verbal abilities, and the quality of life of patients and sociodemographic status, depression, and quality of life of their caregivers. Turkish Journal of Physical Medicine and Rehabilitation, 64(3), 222–229. https://doi.org/10.5606/tftrd.2018.1871
Glinac, A., Matović, L., & Delalić, A. (2016). Health related quality of life in children with cerebral palsy. Paediatria Croatica, 60(1), 1–7. https://doi.org/10.13112/PC.2016.1
Gómez, L. E., Alcedo, M. A., Arias, B., Fontanil, Y., Arias, V. B., Monsalve, M. A., & Verdugo, M. A. (2016). A new scale for the measurement of quality of life in children with intellectual disability. Research in Developmental Disabilities, 53–54, 399–410. https://doi.org/10.1016/j.ridd.2016.03.005
Gómez, L. E., Monsalve, A., Morán, L., Alcedo, M. A., Lombardi, M., & Schalock, R.L. (2020d). Measurable indicators of CRPD for people with intellectual and developmental disabilities within the framework of quality of life. International Journal of Environmental Research and Public Health, 17, e5123. https://doi.org/10.3390/ijerph17145123
Gómez, L. E., Morán, M. L., Alcedo, M., Arias, V. B., & Verdugo, M. A. (2020a). Addressing quality of life of children with autism spectrum disorder and intellectual disability. Intellectual and Developmental Disabilities, 58(5), 393–408. https://doi.org/10.1352/1934-9556-58.5.393
Gómez, L. E., Schalock, R. L., & Verdugo, M. A. (2020c). The role of moderators and mediators in implementing and evaluating intellectual and developmental disabilities-related policies and practices. Journal of Developmental and Physical Disabilities, 32, 375–393. https://doi.org/10.1007/s10882-019-09702-3
Gómez, L. E., Verdugo, M. A., Rodríguez, M., Morán, L., Arias, V. B., & Monsalve, A. (2020b). Adapting a measure of quality of life to children with Down syndrome for the development of evidence-based interventions. Psychosocial Intervention, 29, 39–48. https://doi.org/10.5093/pi2019a17
Gómez, L. E., Morán, L., Al-Halabí, S., Swerts, C., Verdugo, M. A., & Schalock, R. L. (2022). Quality of life and the International Convention on the rights of persons with disabilities: Consensus indicators for assessment. Psicothema, 34(2), 182–191. https://doi.org/10.7334/psicothema2021.574
Gómez, L. E., Peña, E., Alcedo, M. A., Monsalve, A., Fontanil, Y., Arias, B., & Verdugo, M. A. (2014). El Constructo De calidad de vida en niños y adolescentes con discapacidades múltiples y profundas: Propuesta para su evaluación [The construct of quality of life for children and adolescents with multiple and profound disabilities: A proposal for the assessment]. Siglo Cero, 45(1), 56–69.
Gómez, L. E., Morán, M. L., Navas, P., Verdugo, M. A., Schalock, R. L., Lombardi, M., Vicente, E., Guillén, V. M., Balboni, G., Swerts, C., Al-Halabí, S., Alcedo, M. A., Monsalve, A., & Brown, I. (2023). Using the quality of life framework to operationalize and assess CRPD Articles and Sustainable Development Goals. Journal of Policy and Practice in Intellectual Disabilities. https://doi.org/10.1111/jppi.12470. Advance on line publication
Gómez, L. E., Schalock, R. L., & Verdugo, M. A. (2021a). A new paradigm in the field of intellectual and developmental disabilities: Characteristics and evaluation. Psicothema, 33(1), 28–35. https://doi.org/10.7334/psicothema2020.385
Gómez, L. E., Schalock, R. L., & Verdugo, M. (2021b). A quality of life supports model: Six research-focused steps to evaluate the model and enhance research practices in the field of IDD. Research in Developmental Disabilities, 119, 104–112. https://doi.org/10.1016/j.ridd.2021.104112
González, E., Gómez, L. E., & Alcedo, M. A. (2016). Enfermedades raras y discapacidad intelectual: evaluación de la calidad de vida de niños y jóvenes [Rare diseases and intellectual disability: Assessment of quality of life of children and adolescents]. Siglo Cero, 47, 7–27. https://doi.org/10.14201/scero2016473727
Jeong, H. G., Chung, E., & Lee, B. H. (2018). A comparison of the ICF-CY and quality of life among cerebral palsy, down syndrome and typically develo** children. Journal of Rehabilitation Research, 22(1), 195–212. https://doi.org/10.16884/JRR.2018.22.1.195
Jovellar-Isiegas, P., Resa Collados, I., Jaén-Carrillo, D., Roche-Seruendo, L. E., & Cuesta García, C. (2020). Sensory Processing, functional performance and quality of life in unilateral cerebral palsy children: A cross-sectional study. International Journal of Environmental Research and Public Health, 17(19), 7116. https://doi.org/10.3390/ijerph17197116
Kołtuniuk, A., Rozensztrauch, A., Budzińska, P., & Rosińczuk, J. (2019). The quality of life of polish children with cerebral palsy and the impact of the disease on the family functioning. Journal of Pediatric Nursing, 47, e75–e82. https://doi.org/10.1016/j.pedn.2019.05.011
Leonard, H., Whitehouse, A., Jacoby, P., Benke, T., Demarest, S., Saldaris, J., Wong, K., Reddihough, D., Williams, K., & Downs, J. (2022). Quality of life beyond diagnosis in intellectual disability–latent profiling. Research in Developmental Disabilities, 129, 104322. https://doi.org/10.1016/j.ridd.2022.104322
Longo, E., Badia, M., Orgaz, M. B., & Gómez-Vela, M. (2017). Comparing parent and child reports of health-related quality of life and their relationship with leisure participation in children and adolescents with cerebral palsy. Research in Developmental Disabilities, 71, 214–222. https://doi.org/10.1016/j.ridd.2017.09.020
Longo, E., Badía, M., Orgaz, M. B., Verdugo, M. A., Arias, B., Gómez-Vela, M., González-Gil, F., & Ullán, A. M. (2012). Calidad De vida en niños y adolescentes con parálisis cerebral [Quality of life in children and adolescents with cerebral palsy]. Revista Brasileira em Promoção Da Saúde, 25(4), 426–434.
Maenner, M. J., Blumberg, S. J., Kogan, M. D., Christensen, D., Yeargin-Allsopp, M., & Schieve, L. A. (2016). Prevalence of cerebral palsy and intellectual disability among children identified in two US national surveys, 2011–2013. Annals of Epidemiology, 26(3), 222–226. https://doi.org/10.1016/j.annepidem.2016.01.001
Maestro-Gonzalez, A., Bilbao-Leon, M. C., Zuazua-Rico, D., Fernandez-Carreira, J. M., Baldonedo-Cernuda, R. F., & Mosteiro-Diaz, M. P. (2018). Quality of life as assessed by adults with cerebral palsy. PLoS ONE, 13(2), e0191960. https://doi.org/10.1371/journal.pone.0191960
Makris, T., Dorstyn, D., & Crettenden, A. (2021). Quality of life in children and adolescents with cerebral palsy: A systematic review with meta-analysis. Disability and Rehabilitation, 43(3), 299–308. https://doi.org/10.1080/09638288.2019.1623852
Menardo, E., Balboni, G., & Cubelli, R. (2017). Environmental factors and teenagers’ personalities: The role of personal and familial socio-cultural level. Behavioural Brain Research, 325(Pt. B), 181–187. https://doi.org/10.1016/j.bbr.2017.02.038
Michalska, A., Markowska, M., Śliwiński, Z., & Pogorzelska, J. A. (2018). Quality of life in children and young people with tetraplegic cerebral palsy. Medical Studies/Studia Medyczne, 34(2), 112–119. https://doi.org/10.5114/ms.2018.76871
Milićević, M. (2022). Functional and environmental predictors of health-related quality of life of school‐age children with cerebral palsy: A cross‐sectional study of caregiver perspectives. Child: Care Health and Development. https://doi.org/10.1111/cch.13007
Morán, L., Gómez, L. E., Balboni, G., Monsalve, A., Verdugo, M. A., & Rodríguez, M. (2022). Predictors of individual quality of life in young people with down syndrome. Rehabilitation Psychology, 67(2), 205–214. https://doi.org/10.1037/rep0000443
Morán, M. L., Gómez, L. E., & Alcedo, M. A. (2019a). Inclusión social y autodeterminación: Los retos en la calidad de vida de Los jóvenes con autismo y discapacidad intelectual [Social inclusion and self-determination: The challenges in the quality of life of youth with autism and intellectual disability]. Siglo Cero, 50(3), 29–46. https://doi.org/10.14201/scero20195032946
Morán, M. L., Gómez, L. E., Alcedo, M., & Pedrosa, I. (2019b). Gender differences in social inclusion of youth with autism and intellectual disability. Journal of Autism and Developmental Disorders, 49(7), 2980–2989. https://doi.org/10.1007/s10803-019-04030-z
Morán, M. L., Hagiwara, M., Raley, S. K., Alsaaed, A. H., Shogren, K. A., Qian, X., Gómez, L. E., & Alcedo, M. A. (2021). Self-determination of students with autism spectrum disorder: A systematic review. Journal of Developmental and Physical Disabilities, 33, 887–908. https://doi.org/10.1007/s10882-020-09779-1
Omura, J., Fuentes, M., & Bjornson, K. (2018). Participation in daily life: Influence on quality of life in ambulatory children with cerebral palsy. PM&R, 10(11), 1185–1191. https://doi.org/10.1016/j.pmrj.2018.05.010
Pérez-Ardanaz, B., Morales-Asencio, J. M., León-Campos, Á., Kaknani-Uttumchandani, S., López-Leiva, I., Garcia-Piñero, J. M., Martí-García, C., & García-Mayor, S. (2020). Quality of life and health services utilization for Spanish children with cerebral palsy. Journal of Pediatric Nursing, 53, 121–128. https://doi.org/10.1016/j.pedn.2020.03.001
Power, R., King, C., Muhit, M., Heanoy, E., Galea, C., Jones, C., Badawi, N., & Khandaker, G. (2018). Health-related quality of life of children and adolescents with cerebral palsy in low‐and middle‐income countries: A systematic review. Developmental Medicine & Child Neurology, 60(5), 469–479. https://doi.org/10.1111/dmcn.13681
Radsel, A., Osredkar, D., & Neubauer, D. (2017). Health-related quality of life in children and adolescents with cerebral palsy. Slovenian Journal of Public Health, 56(1), 1. https://doi.org/10.1515/sjph-2017-0001
Rapp, M., Eisemann, N., Arnaud, C., Ehlinger, V., Fauconnier, J., Marcelli, M., Michelseng, S. I., Nystrandh, M., Colveri, A., & Thyen, U. (2017). Predictors of parent-reported quality of life of adolescents with cerebral palsy: A longitudinal study. Research in Developmental Disabilities, 62, 259–270. https://doi.org/10.1016/j.ridd.2016.12.005
Reddihough, D., Leonard, H., Jacoby, P., Kim, R., Epstein, A., Murphy, N., Reid, S., Whitehouse, A., Williams, K., & Downs, J. (2021). Comorbidities and quality of life in children with intellectual disability. Child: Care Health and Development, 47(5), 654–666. https://doi.org/10.1111/cch.12873
Rezaei, A., Raji, P., Mousavi, S. T., Mahmoodian, M., & Baghestani, A. R. (2021). Study of environmental factors and quality of life in children with cerebral palsy based on international classification of functioning, disability and health. British Journal of Occupational Therapy, 85(2), 137–143. https://doi.org/10.1177/03080226211008724
Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M., Damiano, D., Dan, B., & Jacobsson, B. (2007). A report: The definition and classification of cerebral palsy. April 2006. Developmental Medicine and Child Neurology Supplement, 109, 8–14.
Schalock, R. L., & Verdugo, M. A. (2002). Quality of life for human service practitioners. American Association on Mental Retardation.
Sentenac, M., Rapp, M., Ehlinger, V., Colver, A., Thyen, U., & Arnaud, C. (2021). Disparity of child/parent-reported quality of life in cerebral palsy persists into adolescence. Developmental Medicine & Child Neurology, 63(1), 68–74. https://doi.org/10.1111/dmcn.14638
Shikako-Thomas, K., Dahan-Oliel, N., Shevell, M., Law, M., Birnbaum, R., Rosenbaum, P., Poulin, C., & Majnemer, A. (2012). Play and be happy? Leisure participation and quality of life in school-aged children with cerebral palsy. International Journal of Pediatrics. https://doi.org/10.1155/2012/387280. Article e387280.
Shogren, K. A., Wehmeyer, M. L., Lassmann, H., & Forber-Pratt, A. J. (2017). Supported decision making: A synthesis of the literature across intellectual disability, mental health, and aging. Education and Training in Autism and Developmental Disabilities, 52(2), 144–157.
Stone, M., Kash, S., Butler, T., Callahan, C., Verdugo, M. A., & y Gómez, L. E. (2020). Validation of English language adaptations of the KidsLife and San Martin scales for assessing quality of life with individuals on the autism spectrum receiving residential care. Journal of Developmental and Physical Disabilities. https://doi.org/10.1007/s10882-019-09686-0
Swerts, C., Gómez, L. E., de Maeyer, J., Goedele, D. N., & Vandersplasschen, W. (2022). Development of the Quality of Life in Youth Services Scale (QOLYSS): Content-related validity evidence based on adolescents’ and expert reviewers’ perspectives. Applied Research in Quality of Life, 17, 593–612. https://doi.org/10.1007/s11482-021-09921-x
Swerts, C., Lombardi, M., Gómez, L. E., Debeer, D., De Maeyer, J., & Vanderplasschen, W. (2023). A tool for assessing the quality of life of adolescents in youth care: Psychometric properties of the QOLYSS. Psychosocial Intervention, 32(1), 21–31. https://doi.org/10.5093/pi2022a17
Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). ìPearson.
United Nations. (2006). Convention on the Rights of Persons with Disabilities. Retrieved November 20, 2023. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities/convention-on-the-rights-of-persons-with-disabilities-2.html
Unver, B., & Erdem, E. U. (2019). Effects of intellectual disability on gross motor function and health related quality of life in cerebral palsy. Clinical and Experimental Health Sciences, 9(2), 138–142. https://doi.org/10.33808/clinexphealthsci.516098
Verdugo, M. A., Fernández, M., Gómez, L. E., Amor, A. M., & Aza, A. (2019). Predictive factors of quality of life in acquired brain injury. International Journal of Clinical and Health Psychology, 19(3), 189–197. https://doi.org/10.1016/j.ijchp.2019.06.004
Verdugo, M. A., Schalock, R. L., & Gómez, L. E. (2021). The quality of Life supports model: Twenty-five years of parallel paths have come together. Siglo Cero, 53(3), 9–28. https://doi.org/10.14201/scero2021523928
Verdugo, M. A., Schalock, R. L., & Gómez, L. E. (2023). The quality of life supports model as a major component in applying the quality of life paradigm. Journal of Policy and Practice in Intellectual Disabilities. https://doi.org/10.1111/jppi.12468. Advance on line publication.
White-Koning, M., Grandjean, H., Colver, A., & Arnaud, C. (2008). Parent and professional reports of the quality of life of children with cerebral palsy and associated intellectual impairment. Developmental Medicine & Child Neurology, 50(8), 618–624. https://doi.org/10.1111/j.1469-8749.2008.03026.x
WHOQOL Group. (1995). The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Social Science and Medicine, 41(10), 1403–1409.
Williams, K., Jacoby, P., Whitehouse, A., Kim, R., Epstein, A., Murphy, N., Reid, S., Leonard, H., Reddihough, D., & Downs, J. (2021). Functioning, participation, and quality of life in children with intellectual disability: An observational study. Developmental Medicine & Child Neurology, 63(1), 89–96. https://doi.org/10.1111/dmcn.14657
Acknowledgements
We thank the organizations, people with cerebral palsy, professionals, and families for their involvement and participation in this research.
Funding
This work was supported by the Spanish Ministry of Economic and Competitiveness (PSI2012-33139), the Spanish Ministry of Science, Innovation and Universities (MCIU); the State Research Agency (AEI) and The European Regional Development Fund (FEDER), with the Research Grant PID2019-105737RB-I00/AEI/10.13039/501100011033.
Author information
Authors and Affiliations
Contributions
MLM, LEG and GB conceptualized the study and developed the methodology. MLM, GB and AB conducted the formal analysis. LEG and AM contributed to the funding acquisition and were responsible for project administration. LEG and MLM conducted the investigation process performing the measurement. LEG supervised the research activity. MLM and LEG wrote the original draft. All authors participated in the interpretation of data and helped to write the manuscript. All authors reviewed and approved the final manuscript.
Corresponding authors
Ethics declarations
Ethical Approval
Ethics procedures have been followed and APA ethical standards and the standards governing research involving human participants in force in Spain have been met. Ethical approval was obtained from the University of Oviedo to conduct this study.
Informed Consent
Informed consent was obtained from all individual participants included in the study or their legal guardians in a written form.
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Morán, M.L., Gómez, L.E., Balboni, G. et al. Quality of Life in Children and Adolescents with Cerebral Palsy and Intellectual Disability: Predictors and Personal Outcomes. Child Ind Res 17, 123–143 (2024). https://doi.org/10.1007/s12187-023-10079-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12187-023-10079-1