CHAPTER 3 80 (1993). The theme ‘Dream’ especially highlights these expression differences. While the dreams of school-aged children focused more on fantasy and objects/materials, adolescent children expressed wishes about their appearance and future plans. These differences fit with Erikson’s fifth stage—identity versus role confusion—in which adolescents search for a sense of self and personal identity and begin to look at the future. In the theme ‘I want to meet up with others whenever I want to’, there was a shift from being able to choose to self-govern. Besides the consistency with the theory of Erikson (1993), this shift is also in line with Eriksson and Granlund (2004), who describe the same alteration and mention that the SDT is recognisable in all age groups. Specifying the differences between the age groups would require a larger sample. However, the results of this study provide a good overview of the 6-18-year-old age group in this heterogeneous sample of children with a mitochondrial disorder. The heterogeneity of developmental disabilities in our population required flexible and tailor-made interview techniques. Techniques were adapted based on the child’s cognitive development (Piaget 1964), communication abilities and preferences. Whereas play and hand-puppets were used with a 6-year-old child with lower developmental abilities (global low functioning), auto-driven photo elicitation was used with a 6-year-old child with higher developmental abilities (global moderate functioning). The results appear trustworthy, because feedback from parents resulted in the addition of only two activities in total to all interviews. As mentioned, an in-depth description of the methods used is presented in Steultjens et al. (submitted). They analyse the utilised interview techniques for the nine interviewed children and conclude that the tailor-made interview techniques successfully gain the child perspective for the children included in the current study. The standard semi-structured interview would not have led to this success, nor was one technique applicable to all children. Therefore, to be able to give children with developmental disabilities and restricted communication a voice, and thus to include their perspective in research, tailor-made interview techniques are necessary. A limitation of this study could be that only seven children participated. Still, several procedures were performed to enhance the quality and trustworthiness of this research. Attention was paid to the standards for reporting qualitative research (O’Brien et al. 2014) and criteria to strengthen rigour (Kitto et al. 2008). The interview method was piloted and further developed with health care professionals, parents and children before being used in this research. The utilised interview techniques enhanced the ability to capture the children’s perspectives, a factor that was more important than having a larger sample. The decision-algorithm of the interview techniques could bemore systematic. However, because this was the first qualitative
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