Children with neurodevelopmental disorders and disabilities (NDD/D) have higher healthcare service utilization than those without. Based on provincial population-based linked administrative health data, a sizeable number of children are living with NDD/D. Given the high use of psychostimulants, specialized services for children with both NDD/D and psychiatric conditions may be the most needed services for children with NDD/D.

This paper demonstrates and discusses the use of think aloud protocols (TAPs) as an approach for examining and confirming sources of differential item functioning (DIF). The TAPs are used to investigate to what extent surface characteristics of the items that are identified by expert reviews as sources of DIF are supported by empirical evidence from examinee thinking processes in the English and French versions of a Canadian national assessment. In this research, the TAPs confirmed sources of DIF identified by expert reviews for 10 out of 20 DIF items. The moderate agreement between TAPs and expert reviews indicates that evidence from expert reviews cannot be considered sufficient in deciding whether DIF items are biased and such judgments need to include evidence from examinee thinking processes.

Other Child, parent, and social context factors are associated with parenting behaviors but these associations vary by the child's health group. Parenting behaviors differ for children with NDDs with and without EBPs. These findings offer important implications for practice and research and point to the importance of considering multiple contexts of influence, as well as their interactions, in understanding differences in parenting behaviors.

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Parenting children with multiple health conditions can be associated with less positive, less consistent and more ineffective parenting behaviours. Understanding the factors that are associated with the challenges of caring for these children may require additional research attention.