The results provide baseline information regarding typical levels of functional performance in children with Down syndrome at 5 years of age. However, the broad range of functional performance across children indicates a need for caution in generalizing the results to an individual child.

A certain level of development and independence seems to be required for a child with Down syndrome to be viewed as ready to enter elementary school, and perceptions of readiness for school may be culturally dependent. In addition to the well-described challenges in language and communication skills, being viewed as ready for school includes having stopped using diapers, a topic not previously mentioned as a factor in postponing elementary school entry for children with Down syndrome. Awareness of culturally influenced performance skills may give direction to parents and professionals in targeting areas in the preschool years that might help promote these children's readiness for school.

Purpose Reforms in the health-care system may impact how health-care professionals perceive and enact their roles. This study aims to examine the way in which occupational therapists experience and describe their roles in municipalities after the implementation of a health reform (the Coordination Act) in Norway. Design/methodology/approach This qualitative study was designed within the perspectives of social constructivism. Data was collected through focus group interviews with 10 community-working occupational therapists. A thematic framework analysis was used to examine the participants’ experiences. Findings The following four themes emerged: external factors that framed and shaped the occupational therapists’ roles in municipalities; the strengths and dilemmas of the generalist; the problematic generic position and the strengths; and dilemmas of the specialist. Originality/value The study suggests that occupational therapy practitioners should identify new opportunities and adapt to health reform changes. They also need to renegotiate their roles as the health reforms require more specialized competences. Greater emphasis must be placed on the core knowledge and competences of occupational therapists to strengthen their professional identity in the municipalities.

Background: Children and youth with disabilities participate less in leisure activities than their nondisabled peers. Increasing participation is a primary goal of rehabilitation interventions. However, valid measures that include the individual’s perspectives and facilitating and hindering factors for participation are lacking in the Norwegian setting. In this study, ActiveYou II, a self-report, web-based instrument under development, was tested to obtain item quality and applicability. Methods: Nine children with disabilities participated in cognitive interviews, testing a first set of ActiveYou II items. The verbal probe method for cognitive interviews was applied. Results: The children’s comprehension and responses through cognitive interviews improved the applicability and item quality of ActiveYou II. Item adjustments were made to the wording of the questions and response alternatives, and the number of response alternatives were decreased where appropriate. Conclusion: The use of cognitive interviews with children before performing further psychometric testing has been very useful in the development process of ActiveYou II. Adjustments of the questions and response alternatives were made accordingly.