GENERAL DISCUSSION 227 9 voice their opinion and were easy to influence. However, it has been shown that children are not more suggestible than adults10. In addition, children from a young age are very trustworthy in telling their experiences, as long as they are questioned in the right way11, 12. Thus, uncovering the child’s perspective can be complex, laborious and requires creativity but is most certainly worthwhile8, 13-18. Therefore, health professionals must take the responsibility for uncovering the child’s perspective and skill themselves in communication with children in a creative, but evidence based, way. Based on the experiences during this thesis, I encourage to take three aspects that can enhance communication into account: 1) interviewer skills, 2) augmentative and alternative communication (AAC), and 3) parental influence. The interviewer, in a research or care setting, should have knowledge of children’s communication levels and should be skilled in verbal & non-verbal communication, bonding with the child, have a sense for timing and flexibility, and should be able to set a collaborative and interested atmosphere. The use of augmentative and alternative communication (AAC) can help children communicate more successfully and includes the use of any method, strategy or resource 19 as formal assistive devices (e.g. speech generating devices), communication tools (e.g. picto-cards), conventional semiotic communication (e.g. handwriting), unaided resources (e.g. gestures), and commonplace objects (e.g. smartphones)20. As parents can be either supportive or unsupportive for uncovering the perspective of the child, the interviewer should think before and during the conversation how to cope with unsupportive actions. The more experienced the interviewer is in his skills or has used unconventional AAC methods, like a hand-puppet, the more likely the communication will result in uncovering the child’s perspective, which is necessary for child-centred care21-24. Most professionals, taught to use rigorous and standardized methods, might benefit from skilling themselves in various communication methods and taking the time and effort to uncover the child’s perspective. It should also be mentioned that training is not only important for professionals, but especially for students who will become future professionals. It is known that effective communication in healthcare is necessary to achieve a high quality of care25. In addition, it is necessary to be able to incorporate the child’s perspective in shared decision making, and therefore child-centred care25-27. Therefore, in the training of at least allied health care professionals, there should also be a focus on the effect of communication and the future professional’s contribution to it. In my view, there are two important conditions to reach this goal; real live experience and learning from that experience, which fit with teaching in higher education28, 29, concepts of deep and sustainable learning30-32 and high impact learning that lasts33. To elaborate on the real live experience; in the education of professionals there is still a lot of role-play instead of ‘real live’ (in practice) experience. It is
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