Measuring Mental Health in Children with Disabilities : The use of the two continua model

Abstract: Mental health has traditionally been described as the absence of mental problems, being those second ones equated to impairments, overlapping disability with mental illness. This unfounded conviction is being replaced by a positive mental health approach that recognizes them as distinct constructs. The two continua model is the first model to prove with empirical support that the presence of mental problems does not entail a lacking positive mental health. In the midst of this transformation disabled children’s voices are being acknowledged as an often-ignored presence as the United Nation’s Convention of People with Disability pushes for their recognition.  This systematic review aims to explore which instruments are being used to measure the mental health of children with disabilities, and to assess how do they compare to the Mental health Continuum Scale (MHC-SF) which emerges as the operationalization of positive mental health in the Two continuum model. Five databases were explored, eight articles were chosen from which nine questionnaires were analysed and quality assessed with the Cosmin Checklist. From those, two instruments focused on mental problems (SDQ and ChYMH), two Surveys from which items were taken and adapted to measure flourishing (NSCH 2016/2011-2012 and L&H-YP 2011), three instruments targeting quality of life on children with a disability (Kidslife, CPQoL-Teens and Kidscreen), a newly developed subjective mental health questionnaire for children with intellectual disability (WellSEQ) and the MHC-SF itself.  Results show the emotional wellbeing dimension to be the most widely used, but positive functioning is misrepresented often measured as external factors. There is a tendence towards the traditional deficit-based formulation of items, despite that, there are good quality instruments that cater to children with disabilities with self-report measures (CPQoL-Teens, WellSEQ and Kidscreen) although severe ID co-mobilities are excluded. The use of digital resources in the administration poses a promising path to allow large scale surveys in children with cognitive and motor impairments, even more so being that the School is the common place of administration without acknowledging that children with chronic health conditions present higher rates of absenteeism.