Child-centred Framing Through Design Research: A Framework For Analysing Children’s ‘Dream Wheelchair’ Designs to Elicit Meaning and Elevate Their Voice

Abstract

This paper considers the possibilities of analysing children’s own designs to contribute to the design of inclusive paediatric mobility interventions. The aim of this paper is threefold: (1) to develop a framework for child-centred design analysis, (2) to analyse children’s designs to explore both quantitative and qualitative insights and (3) to explore how children’s voice could be elevated through design research.

A Child-centred Design Analysis Framework is developed in an interdisciplinary manner, comprising four dimensions including Child, Content, Context and Format. It is used as a vehicle to analyse and code 130 ‘Dream Wheelchair’ designs by children.

The children’s ‘Dream Wheelchair’ designs reference a range of features and priorities, which are gathered into themes through the framework, providing insights into children’s individual and collective mobility narratives, values and requirements. Themes are explored through a qualitative interdisciplinary lens to understand the nature of children’s lived experiences.

The framework promotes child-centred framing through extracting meaning from children’s own designs. It is suggested that child-centred framing and a rights-respecting approach to assistive technology design research can lead to more appropriate design outcomes and improved user experiences for children with disabilities.

Full text

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Child-centred Framing Through Design Research: A
Framework for Analysing Children’s ‘Dream Wheelchair’
Designs to Elicit Meaning and Elevate Their Voice
Cara Shaw, Francesca Bernardi and Farnaz Nickpour.
ABSTRACT
Purpose: This paper considers the possibilities of analysing children’s own designs to
contribute to the design of inclusive paediatric mobility interventions. The aim of this
paper is threefold: (1) to develop a framework for child-centred design analysis, (2) to
analyse children’s designs to explore both quantitative and qualitative insights and (3) to
explore how children’s voice could be elevated through design research.
Methods: A Child-centred Design Analysis Framework is developed in an
interdisciplinary manner, comprising four dimensions including Child, Content, Context
and Format. It is used as a vehicle to analyse and code 130 ‘Dream Wheelchair’ designs
by children.
Results: The children’s ‘Dream Wheelchair’ designs reference a range of features and
priorities, which are gathered into themes through the framework, providing insights into
children’s individual and collective mobility narratives, values and requirements. Themes
are explored through a qualitative interdisciplinary lens to understand the nature of
children’s lived experiences.
Conclusions: The framework promotes child-centred framing through extracting
meaning from children’s own designs. It is suggested that child-centred framing and a
rights-respecting approach to assistive technology design research can lead to more
appropriate design outcomes and improved user experiences for children with disabilities.
Keywords: child-centred; paediatric mobility; inclusive design; voice; children’s rights;
framing; interdisciplinary.

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1. INTRODUCTION
Child-centred Design Research
Child-centred Design is a design approach which places children and their rights at the
core of a design process to elevate their voice [1, 2], psychologically and physically
empower them [3] and uncover their unmet requirements and desires [4]. During
childhood, the ‘things’ [5] around us shape the way we experience and perceive the world
[6], influencing our development and fundamentally shaping our whole lives [7].
Designers thus have a great responsibility to carefully consider the way in which they
approach ‘framing’ when designing with or for children. Framing [8], also known as
‘frame creation' [9] or ‘problem-framing’ [10], is the process of understanding which
point of view to approach a design from, to ensure the right problem or opportunity is
being addressed before focusing on a solution. To achieve child-centred framing, design
research or designerly investigations [11] must be undertaken as a sensemaking activity
in the early stages of a design process to elicit children’s voice and gain child-centred
insights. Children are social actors who have a right to be recognised as experts in their
lived experience, and thus design researchers have a duty to pay attention to and
represent children and their perceptions in and through design research [12]. Druin [13]
and Abbott [14] advocate for involving children in design research as a necessary way to
achieve more appropriate and satisfactory child-centred design outcomes with better
usability and improved user experiences.
This paper presents a case study in the domain of inclusive paediatric mobility
(IPM) design, to explore how involving the voice of young wheelchair users in design
research can help designers better understand, frame and meet children’s requirements

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wishes and dreams. The consequence of designing IPM designs without adopting a child-
centred approach has historically resulted in issues with the functionality, usability and
desirability of designs, as discussed in detail in section 2.1. The designerly collaboration
described in this case study brings together a range of stakeholders to interpret child-
centred insights and elevate children’s voice from a breadth of disciplinary and
professional perspectives to collectively inform the framing of IPM design with the
ultimate aim of improving children’s overall satisfaction with design outcomes. The
following sections introduce interrelated principles, mindsets, practices and techniques
[15] for child-centred design research, which facilitate children’s rights and ensure design
decisions are informed and steered based on children's voice and points of view [2].
1.1. Principles and Mindsets for Child-centred Design Research
Children’s views, knowledge and desires are meaningful, contextual and representative of
the individual and collective experiences of a community with cultural and sociological
value and human worth [12]. Research with children encourages participation that is
inclusive, meaningful and respectful of children’s views in spite of developmental
assumptions that pervade children’s day-to-day [16,17]. Yet, such assumptions can
continue to impose methodological restrictions tied to age, communication milestones
and researchers’ preferences and beliefs, obstructing the active participation and fair
representation of children, their viewpoints and cultures [18,19,12]. Approaches such as
Co-design, Participatory Design, User-centred Design, Human-centred design and
Inclusive Design have well established principles around promoting designerly
collaborations and engaging with lived experience experts in research in order to support

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sensemaking and framing [8]. However, simply engaging with children is not the same as
child-centred design, of which there is limited literature beyond the contexts of designing
for play [2,4].
1.2. Practices and Techniques for Child-centred Design Research
Children’s imagination and natural curiosity can be elicited through involvement in
practices such as design fiction, co-design, speculative design and critical design [20] to
gain insights into their thinking, wishes and imagined futurescapes, which designers can
amplify in their design decisions [21]. Methodologies designed specifically for research
with children can reduce the hierarchical divide that is inevitably present in adult-child
interactions [22]. The scope of such methodologies is to reach a type of dialogic
symmetry that is rooted in balancing researchers’ ability to observe and extrapolate
meaning and children’s capacity to express ideas, opinions and stories that they value,
privilege and convey to appraise their status quo. Engaging in such an ethical and
practical endeavour calls for the recognition of children’s preferred forms of
communication, an appreciation of their innate and diverse capabilities, as well as their
choice of priorities which may be different to the adult designer’s own [23]. Hence,
approaches to children's participation in design research include conventional design
research methods such as interviews, observations and creative workshops, in addition to
more specialised methods such as role play or creative activities [24,25,26,2]. However,
conventional design research methods that involve questioning and directing children are
often less productive than promoting children’s creative autonomy through arts-based
methodologies such as drawing [27,28].

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Arts-based methodologies extend the hegemonic language and tools of
conventional design research to validate self-expression and meaningfully engage with
unscripted ideas, leading to explorations of children’s voice that could otherwise remain
hidden [29]. Visual, tactile and aesthetic communication plays a central role in engaging
with authenticity and minimising the directional impulse that can prevail in research with
children with disabilities [28]. Furthermore, if well planned and executed, such
methodologies could allow wider and more inclusive participation with larger scale input
from children nationally or internationally by facilitating their input without requiring
face-to-face interaction with a researcher [30,31] (as demonstrated by the following case
study). When navigating the landscape of child-centred practices and techniques, it is
important that designers acknowledge the long-established social imaginaries around the
power structures and hierarchies which exist between adults and children [3]. Such
hierarchies often lead to children being considered solely as end-users; by overlooking
the insightful expertise and views that children possess related to their own experiences,
designers could miss out on opportunities to capture or create newly embodied forms of
child-centred knowledge [4].
1.3. Eliciting Meaning and Elevating Children's Voice
Dimensions of Voice
Throughout the design process it is designers who decide whose voice they engage with
and include (to what extent, on what topics) to orchestrate whose experiences and
perceptions are given weight and echoed in the design outcome. The word ‘voice’ is used
metaphorically in this paper to signify opinions and expressions encapsulated by all

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modes of communication with explicit inclusion of non-verbal mediums [32]. Article 12
of the United Nations Convention on the Rights of the Child (CRC) [33] states that
children have the right for their voice to be given apt power in all matters affecting them.
Furthermore, Article 13 of the CRC [33] states that children have the right to “impart
information and ideas of all kinds, regardless of frontiers, either orally, in writing or in
print, in the form of art, or through any other media of the child's choice.” As explored in
section 1.3, there exists a substantial body of literature focused on engaging with children
to capture their voice through such modes of communication [25,27,29,32]. This paper
focuses on the stages which follow engagement with children, specifically how meaning
can be elicited from such qualitative data in a child-centred manner, and then considers
how children’s voice [34] can be amplified, strengthened and elevated through the way in
which design research is conducted. Tools and processes for eliciting children’s
multifaceted voice through an arts-based methodology are lacking and there is currently
no theoretically informed framework or best practice guidelines on how to analyse
children's art or designs in a holistic and rigorous way in order to inform the design
process. Capturing and curating different elements of children's voice through their own
designs and for design purposes is one major pathway for child-centred design that
requires further theoretical, methodological and empirical investigation.
Child-centred Designerly Collaborations
The merging of different disciplines is an integral and valuable aspect of child-centred
work, in order to draw on the various elements of child-centred expertise offered by
different disciplines. Childhood is multifaceted, heterogeneous and complex; differing

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preferences exist across disciplines around how best to elicit and elevate children’s voice,
accompanied by a range of professional and theoretical starting points and methodologies
[35,36]. With regards to the nature of disciplinary collaboration, typologies tend to define
the terms monodisciplinary as ‘isolated’, multidisciplinary as ‘additive’, interdisciplinary
as ‘interactive’ and transdisciplinary as ‘holistic’ [37]. Both interdisciplinary and
transdisciplinary approaches facilitate the questioning and merging of different
disciplinary perspectives, new levels of discourse and blending of knowledge, all of
which can provide a more rigorous and exhaustive approach to child-centred design
research. In turn, this ensures children’s voices are deeply considered without the
distinctions of disciplinary bias, and with reduced chance of misinterpretation. The
specialist knowledge and experience of experts from disciplines with a strong child-
centred focus can provide a focal point for researchers from other disciplines to ensure
the elevation of children’s voice remains a central motivation driving their work.
2. RESEARCH AIMS
Having reviewed existing practices around the inclusion of children’s voice in research
and design, this study focuses on child-centred framing within the specific context of
Inclusive Paediatric Mobility (IPM) design. The following three Research Questions
(RQ) and corresponding research aims were used to guide this study:
RQ1. How could children’s own designs be analysed to elicit meaning and explore
different elements of their voice?
Aim - Develop a child-centred framework for analysing children’s ‘Dream Wheelchair’
designs through an interdisciplinary lens.

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RQ2. What specifically can be learnt through children’s designs about their individual
and collective voice to inform child-centred IPM design?
Aim - Analyse the content and context of children’s designs to elicit both quantitative and
qualitative meanings and child-centred insights.
RQ3. How could children’s voice be elevated through design research?
Aim - Reflect on insights from this study and discuss considerations for how child-
centred design research could better elevate children’s voice.
3. DESIGNING FOR INCLUSIVE PAEDIATRIC MOBILITY
3.1. What is Inclusive Paediatric Mobility?
This paper specifically focuses on eliciting children’s voice to help frame the design of
Inclusive Paediatric Mobility (IPM) interventions, including assistive technology and
rehabilitation devices such as walking aids, exoskeletons and wheelchairs. IPM design
refers to the application of an Inclusive Design approach to create mobility interventions
for children with disabilities, with the fundamental goal of optimising the experience of
childhood. Inclusive Design is a well-established approach which considers the diversity
of people’s physical and psychosocial abilities, paying attention to the voice and lived
experiences of people with disabilities to reduce generalisation on user stereotypes and
design outcomes that cater for them [38].
The multidisciplinary nature of IPM requires various stakeholders’ voices to be
captured and considered in an IPM design process. Despite children being capable of
formulating their own opinions and views, their voice has historically been overlooked or
superficially engaged with by IPM designers [11]. Such apprehension to invest in

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meaningful engagement with children may have arisen from seemingly challenging
assumptions relating to children’s limited communication skills [39], abilities to verbalise
complex thoughts [13], or designers’ lack of methods for eliciting meaning from “messy,
multi-layered and non-normative character” [40]. As a consequence, children’s voice has
typically been diluted in the IPM design agenda, resulting in issues around the
functionality, usability and desirability of interventions, which can lead to poor outcomes
for the children using them [41]. To further explore and evidence such insights, an
illustrative mapping review was conducted to interrogate the past fifty years of designerly
contributions to the field of IPM [11]. This uncovered key gaps and opportunities around
five interrelated designerly ways including Designerly Investigations; Processes;
Contributions; Collaborations; and Contexts. The review evidenced the need for each of
these designerly ways to transition in order to achieve more appropriate IPM design
outcomes. One key priority identified was the optimisation of a child-centred design
approach with specific attention to designerly investigations and collaborations. This
study aims to advance this research thread by directly exploring a child-centred approach
to IPM design.
3.2. The Imperative Transition Towards Child-centred IPM
To address the aforementioned issues and ensure the future of IPM is built upon a
holistically considered and inclusive foundation, clarity around how designers interpret
and elevate children’s voice needs to be improved. Involving children throughout the
design and development of such health-related interventions has significant benefits [42].
Meaningfully and effectively incorporating children’s voice into the framing of IPM

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design could improve functionality, usability and desirability of interventions; uncover
currently unacknowledged, unstated and unmet narratives, requirements and challenges
around children’s mobility; and help imagine critical and speculative IPM futurescapes
[1,3,4,43]. To channel such benefits into the field of IPM design, children need to have
their perspectives and experiences valued and attributed the same worth as other
stakeholders who have the authority to influence design decisions. By collating children’s
thoughts, wishes and imagined futurescapes around childhood mobility, child-centred
design opportunities can be identified. These can inform the direction and dimensions of
future IPM design interventions whilst uncovering the value of including children’s voice
in the IPM design process.
The urgency to involve children in the design of IPM interventions stems from the
understanding that unless IPM interventions respond to the views and requirements of
children, their experience of childhood will be less than optimal and their right to achieve
the “fullest possible social integration and individual development” may not be fulfilled
[33]. Simply downsizing adult mobility designs to fit children has historically resulted in
various issues around the functionality, desirability and feasibility of IPM interventions
such as wheelchairs [41]. Whilst some of the technical and objective requirements in IPM
design can be addressed through engineering and clinical analyses, subjective
requirements necessitate input from children. With this in mind, it becomes imperative to
include the voice of children at all relevant stages of the IPM design process, beyond later
problem-solving stages and with particular attention to initial framing stages; rather than
rushing to solve a problem which has been framed by the designer’s or other
stakeholder’s own experiences and perception of the world, the principles of Design

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Justice [44] call for designers to ensure their design objectives have been framed with or
by those the design outcome is intended to be used by.
By establishing a more rigorous child-centred framing process, with specific
attention to capturing children’s voice, the existing issues with IPM design can be
reframed or even redefined to ultimately improve interventions and reinvent the material-
discursive landscape of IPM design. To achieve this, children’s thoughts, wishes and
imagined futurescapes around childhood mobility need to be captured in order to identify
child-centred design opportunities in the field. A mapping review of IPM design from
1970-2020 by O’Sullivan and Nickpour [11] highlights a major gap in both theory and
practice around child-centred IPM framing. This multi-layered gap and subsequent
opportunity could be best explained on three levels. Firstly, child-centred IPM design
approaches are limited and scattered [41]. Secondly, when attempted, these approaches
are mainly focused on problem-solving (engaging children with how to solve the
problem) rather than engaging children in framing the problem in the first place [8].
Thirdly, within child-centred framing in design, the focus has been on capturing specific
mobility requirements in terms of functionality, usability and desirability, rather than
capturing high level child-centred narratives of mobility, its meaning and its value.
Furthermore, there is currently no theoretically informed framework or best practice
guidelines on how to analyse children's own designs or art-based expressions in a holistic
and rigorous way. Capturing and curating different elements of children's voice through
their designs, for design purposes, is one major pathway to child-centred design that
requires further theoretical, methodological and empirical investigation. Such theoretical
and empirical knowledge could help inform the direction and dimensions of future IPM

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design interventions and uncover further value of including children’s voice in the IPM
design process.
4. METHODOLOGY
The first part of this section details how a dataset of children’s designs was assembled,
and the relevance of the embodied information to the aims of this research. The second
part of this section addresses research question 1 by detailing the development of a Child-
centred Design Analysis Framework, and outlining the methods used to identify and
synthesise child-centred insights from various disciplinary and stakeholder perspectives.
4.1. Secondary Data Collection, Context and Significance
The focus of this study is on eliciting meaning from children’s voice (as qualitative data)
rather than physically engaging children in design research. Thus, a qualitative secondary
dataset was selected for interrogation and analysis, consisting of IPM designs by 130
children, responding to a design brief set out as “Design your Dream Wheelchair” [45].
The selected secondary dataset was collected by an unaffiliated organisation through a
national design competition for young wheelchair users from across the United Kingdom.
The competition aimed to be inclusive and broad-reaching by promoting flexible entry
format options for entrants to either visualise, describe, or have assistance expressing
their designs. To enter the competition, participants (or their teacher/guardian) either
posted or emailed their design to the organiser. The competition saw ‘Dream Wheelchair’
designs submitted by 130 children aged between four to seventeen years, thus forming
the largest and most recent qualitative dataset of IPM designs by children, to align with

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the research aims set out in this paper. The authors of this paper are responsible for
conducting analysis on the dataset but have no connection or involvement with the
organisers of the competition, and have no relation to any of the competition entrants.
After preliminarily looking through the designs it was decided that the full dataset would
be included and represented in the analysis since, despite being a relatively large sample
size, the diversity and depth of content meant that information redundancy and data
saturation would be unlikely [46].
The dataset consisted of a range of formats; of the 130 designs, the most prevalent
medium of expression was visual communication, which included drawings, mixed
media and photo-collage, presented in both ‘visual-only’ and ‘visual and written’
formats. Prior to analysis, these were verbally described and then transcribed, stating the
purpose or appearance of all elements which could be objectively identified (e.g. colours
and patterns, design features, setting of design). 61% of children chose to accompany
their visual expression with a written description or annotations (either typed or
handwritten), whilst 36% produced a ‘visual-only’ entry. 3% of designs were expressed
in a ‘written only’ format. All written data, including annotations, were transcribed prior
to analysis. Nine of the designs were created with explicit assistance from an adult, and
three were created with acknowledged assistance from another child. Figure 1 quantifies
the data formats of children’s ‘Dream Wheelchair’ designs.

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Figure 1. Qualitative Data Formats of Children’s ‘Dream Wheelchair’ Designs
4.2. Developing the Child-centred Design Analysis Framework
Recognising the complex nature of inviting and including children’s design input, an
interdisciplinary collaboration was established to bring together three researchers with
distinct backgrounds covering the IPM design in industry, Children’s rights and
disability, and Inclusive Design in academia. The researchers shared core values and
interests around inclusive child-centred research, which was instrumental in enhancing
the experience, quality and rigour offered by interweaving different lenses throughout the
research process. There are two distinct ways to approach the analysis of children’s
drawings: one focusing on interpretation and another focusing on content [47]. Whilst
various methods exist to facilitate these approaches [47,30], there are no tools or
frameworks which facilitate analysis of designs by children with equal attention given to
qualitative and quantitative findings in an interdisciplinary manner. To ensure all aspects
of the children’s designs could be systematically analysed on multiple levels, an
interdisciplinary theoretical framework was devised to provide structure in the analysis
process [48], particularly as different values and priorities emerged from the diverse
disciplinary perspectives of the team of researchers. After becoming familiar with the

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dataset, a selection of existing frameworks and theories (outlined in Table 1) were
identified as key points of reference across disciplines, and synthesised keeping ‘theories
separate but integrated’ [48] to create the underpinnings of a holistic intersecting
framework suitable for this purpose.
Table 1. References used to construct the Child-centred Design Analysis Framework
REFERENCE
ROLE IN THE NEW FRAMEWORK
The conceptual ‘Three Facets of
Language and Art framework’ [49].
Used as the spine of the framework to
divide the analysis into segments based on
the ‘Content’, ‘Context’ and ‘Format’ of
designs.
‘Categories for Reasons A Possession
Is Valued’ [50].
Used in the ‘Content’ segment to capture
expressions of value to the child.
‘Hierarchy of User Experience’
categories [51].
Used in the ‘Content’ segment to capture
key dimensions relating to user experience.
‘CMF’, Form, and Metaphors - basic
design language considerations in
Industrial Design [52].
Used in the ‘Content’ segment to capture
references to design language.
The ‘AEIOU’ tool - to structure
qualitative observations around
activities, environments, interactions,
objects, and users [53].
Adapted and used in the ‘Context’ segment
to capture relevant contextual references.
PESTLE analysis tool – to analyse
external factors that may impact or
influence a design [54].
Used in the ‘Context’ segment to capture
external influences to the design or child.
Child’s communication medium [30].
Used in the ‘Format’ segment to record the
medium used to convey their design.

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4.3. Refining the Child-centred Design Analysis Framework
To improve coding reliability and ensure the framework and resulting analysis insights
were not biased by the researcher's disciplinary perspectives, the perceptions of a range of
IPM stakeholders were captured through hosting a two-part workshop with each of them,
using a thematic analysis approach [46] to elaborate on and refine the design analysis
framework. The participants included two Occupational Therapists, two Designers, one
Childhood Researcher, two parents of young wheelchair users. The researchers used their
personal networks to recruit participants from each stakeholder group, based on who they
believed were the best representatives in terms of experience and interests.
Workshop Design
Each workshop lasted approximately 60 minutes, hosted via video call, with the use of a
digital interactive whiteboard to brainstorm, document and record the session. During the
first half of the workshop, each stakeholder was asked to review a sample of 14 designs
(over 10% of the dataset), making notes or ‘codes’ to describe topics in the designs,
before identifying themes, patterns and categories. Seven of the 14 designs were
randomly selected from those by children aged 4-12 years, and the other seven were
randomly selected from those by children aged 13-17 years. A sample size of more than
14 designs would not have allowed enough time for workshop participants to review the
designs in the desired detail, whilst less than 14 would have limited exploration of the
diversity of topics and themes contained across the designs [46].
The second half of the workshop consisted of a theme-mapping activity to review
and refine the stakeholder’s identified themes and establish connections between them to

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adapt and refine the framework by expanding or adding nodes and subnodes to it. Words,
phrases and examples of visuals were assigned to central nodes or subnodes so that
references to these in the data could be coded by the lead researcher correspondingly. At
times, the stakeholders' disciplinary differences in languages and terminology resulted in
multiple interpretations of words, requiring blending and integrating to inform a common
understanding. For example, the word ‘comfort’ used in one of the design descriptions
was interpreted by a designer to mean ‘cosy’ in a pleasurable sense, by a parent to mean
‘alleviation’ in a pain or anxiety management sense, and by an Occupational Therapist to
mean ‘postural support’ in a more functional sense. In this case, the multiple
interpretations of the word ‘comfort’ were blended into a ‘Wellbeing’ node on the
framework, with subnodes referring to ‘physical comfort’ and ‘psychological comfort’, to
capture expressions from all interpretations and to enhance thoroughness and rigour in
the analysis.
4.4. Conducting the Child-centred ‘Dream Wheelchair’ Design Analysis
The workshop stimulated in-depth discussion around the children’s designs which helped
elicit meaning and qualitative insights from the wider dataset. Refinements to the
framework resulting from the workshop included the addition of new nodes, alterations to
the order of nodes and subnodes, language or terminology adjustments, and
rearrangement of the visual structure of the framework. The refined child-centred design
analysis framework (Figure 2) was then translated into a coding structure using NVivo
software, to code and analyse topics expressed through the dataset. After 14 of the
designs had been coded by the lead researcher, two other researchers reviewed the coded

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designs to verify the accuracy of the coding. The lead researcher then continued with a
content analysis approach to code all 130 of the children’s ‘Dream Wheelchair’ designs
to quantify insights.
Figure 2. Child-centred Design Analysis Framework
5. RESULTS FROM ANALYSING ‘DREAM WHEELCHAIR’ DESIGNS
This section responds to research question 2 by uncovering quantitative findings around
children’s individual and collective voice. Having analysed and coded the ‘Dream
Wheelchair’ designs, Figures 3, 4 and 5 present the results by quantifying references to topics

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from within three spinal segments of the analysis framework, addressing the Child, Content
and Context, respectively. An in-depth review of trending topics from this analysis has been
conducted in parallel to summarise key insights and further details about the analysis results,
as a supplement to this section of the paper [55].
5.1. ‘Child’ Analysis Results
Based on the available data, age was the only variable provided with all of the designs,
and also appeared to be the most notable cause for variations across the expressed topics.
Age has thus been used to divide the results for comparative analysis through each
segment of the framework, by splitting the results into designs by 4-12 year olds (n=70),
and designs by 13-17 year olds (n=60), to expose topics which vary between the two age
groups. Figure 3 quantifies information about the children and their approach to the
design task, elicited through analysing their ‘Dream Wheelchair’ designs.
Figure 3. ‘Dream Wheelchair’ Design Analysis Results – Child

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5.2. ‘Content’ Analysis Results
The most referenced topic uncovered by the analysis was ‘Utilitarian’ aspects of their
designs, mentioned by 82% of all children. This encompassed a broad range of more
specific sublevel topics, which were also captured largely within the user experience
section of the framework. The next most referenced topic was Colour, with overall 52%
of children annotating or describing certain colours as a noteworthy feature of their
design. Other highly trending topics included Technology (Functionality), Controls
(Usability), Safety or Security (Meaning), Food or Drink (Convenience), Physical
Comfort (Wellbeing), Storage or Hidden Compartment (Convenience), Weather
protection (Functionality) and Speed or Power (Functionality). Figure 4 quantifies
findings from the content of children’s ‘Dream Wheelchair’ designs.

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Figure 4. ‘Dream Wheelchair’ Design Analysis Results – Content

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5.3. ‘Context’ Analysis Results
The Context segment of the framework revealed that children’s interactions with the
people, objects and places around them are of great importance and influence in their
‘Dream Wheelchair’ designs. The most referenced topic in this segment, mentioned by
36% of children, was ‘Relationship’, encompassing human and non-human companions
with whom the designer/user interacts. Designs commonly relate to participating in
activities with others, functions which make their wheelchair serve others as well as the
principal user/designer, with explicit references to the ways they interact with or relate to
others. Figure 5 quantifies findings relating to the context of children’s ‘Dream
Wheelchair’ designs.
Figure 5. ‘Dream Wheelchair’ Design Analysis Results – Context

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6. CHILD-CENTRED INSIGHTS AND CONSIDERATIONS
Grounded by the analysis results and wider relevant literature, the following discussion addresses
research questions 2 and 3 by highlighting important insights and considerations relating to
child-centred design research, whilst also acknowledging the distinct disciplinary and
intersecting viewpoints within the research team. Section 6.1 specifically focuses on qualitative
insights and meaning elicited from children's voice (RQ2) which could inform child-centred IPM
design, whilst section 6.2 focuses on considerations for elevating children’s voice through design
research (RQ3).
6.1. Insights and Meaning Elicited from Children's Voice
Incremental Versus Radical Innovation
The level of innovation present in children’s designs varies significantly. Incremental
innovations seem to result from a focus on improving experience and desirability, are
seemingly informed by lived experience, and appear to have been approached with a
realist mindset. In contrast, the more radical innovations focus on re-imagining what the
entire wheelchair concept entails and enables, drawing on fantasy and fictional worlds to
redefine what is possible. Such designs appear to have been approached with an
abundance of imagination and an ‘escapist mindset’, featuring marvellous superpowers
and magical features, with less consideration given to reality. The majority of children
from both age groups seem to have approached this design task with the former realist
mindset, by accepting and adhering to social imaginaries of what a wheelchair is, and
focusing solely on incremental improvements to existing wheelchair designs.

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Technologically-enabled or ‘Techno-ableist’?
Many of the children’s designs were saturated with tech-heavy features to facilitate
inclusion and access to the world around them, granting autonomy and abilities equal or
superior to able-bodied peers. A dominant underlying narrative reflected in these design
choices, placed technologies as the solution to addressing disability, implying that
disabilities can be improved with these features. This could be interpreted as a form of
internalised ableism, or ‘Technoableism’ as Shew [56] explains, “dreams of passing, of
‘normalcy’, and ideas about inspiration and overcoming, frame many of the disability
community’s internal conversations about disability technologies''. Conversely, a
significant portion of the adult disability community advocate for accessible
infrastructure and policies over individual design solutions, with the mindset that
attention given to specific product fixes or ‘Disability Dongles’ [57] is attention diverted
from standardising the incorporation of accessibility into environments. The high
proportion of children across both age groups who dream of wheelchairs which can climb
steps, fly or hover, and have various magical powers, reflects a chasm between children
and adults’ thinking, which could signify their level of awareness around disability
models or constraints of reality (such as affordability and accessibility), or it could simply
reflect their sources of inspiration.
Spectrum of Requirements and Desires
Many of the children’s designs represent a desire for their ‘Dream Wheelchair’ to provide
or facilitate the most basic of needs, indicating that their existing wheelchairs may not.
This is highlighted by arranging the topics they expressed to fit within the five tiers

25
depicted in Maslow’s ‘Hierarchy of Needs’ theory [58]. Reoccurring examples of unmet
‘Basic Needs’ (Figure 6) included access to warmth, food and drink, and physical
comfort to prevent or manage pain. ‘Safety or security’ features were included in 38% of
the designs, ranging from personal alarms and emergency panic buttons to anti-tip and
crash-prevention features. This signifies a level of apprehension and awareness of
potential dangers; which children evidently wish to mitigate. Beyond these most basic
needs, children’s ‘Dream Wheelchair’ designs also include an awareness of their
‘Psychological Needs’, covering topics such as family, interaction, friendships,
participation in social activities, independence, freedom and self-confidence. Within this
tier, children placed emphasis on the desirability of their wheelchair, both seeking respect
from others as well as appealing to their own personal styles and often bold visual
preferences. ‘Self-fulfilment Needs’ was the least populated tier amongst children’s
designs, involving features to facilitate learning, development, achieving goals and
pursuing grand adventures. It could be argued that beyond the tier of self-fulfillment sits
a zone of transcendence, in which the child shifts their focus to beyond their own needs.
Figure 6. Maslow’s Hierarchy of Needs [58].

26
A Spotlight on Altruism
Many children make explicit reference to the value of companionship through designing
considerate accessories or features to be used by, or engage with, others in ways that
existing wheelchairs do not. Whether referring to a parent, carer or friend, this type of
altruism-by-design produces important considerations around children’s desire to explore
their social role beyond the functional aspects of mobility, signalling their concern for the
wellness of others and the participation of adults and children ‘at their side’, in ways that
dismantle a rhetoric of need and dependency. This highlights altruism as both a value and
design function capable of increasing the potential of a wheelchair from improving
mobility experiences to facilitating child-initiated socialisation, through empowering
other (potentially able-bodied) people. Examples include a dedicated tea-making facility
“for mum”, a passenger seat “to travel together”, a platform “so they can keep up”, and a
toy machine “so I can give toys to all the children that I see”. By seeking to include
others through these design features, it is possible to see that the children are considering
different ways to induce equality and shared participation in their wheelchair experience.
Uncovering Mobility Narratives Versus Capturing Design Specifications
The richness, diversity, and level of granularity of the drawings and texts enable different
levels of data analysis with two distinct potential outcomes. On one level, children’s
‘Dream Wheelchair’ designs can help capture specific user requirements and product
features, informing the design of paediatric wheelchairs through collecting URS (User
Requirements Specifications) and PDS (Product Design Specifications). In this capacity,

27
the study is aimed at ‘problem solving’, and recognised as a ‘Research For Design’
activity. On the other level, the designs help uncover children’s high-level narratives,
social imaginaries, and meanings around childhood, mobility, and disability. Instead of
interpreting children’s input literally, based heavily on the feasibility of solutions, their
designs can be unpicked, analysed and utilised to identify what is missing from the
current state of IPM design according to their distilled perspectives and narratives [21]. In
this capacity, the study is aimed at ‘problem framing’, recognised distinctively as a
‘Research Through Design’ activity to illuminate a range of child-centred IPM frames
beyond the default frame of ‘a way to move around’.
6.2. Considerations for Elevating Children’s Voice through Design Research
Problem Framing Over Problem Solving
One key and recurrent issue in design exercises of this nature is a lack of clarity from the
outset regarding the intended outcome of the activity, distinguishing between ‘problem
framing’ and ‘problem solving’ [10]. Unconstrained imagination and creativity result in
some aspects of the children’s design ideas not conforming to certain existing
manufacturability constraints. We argue that the viability and feasibility of children’s
designs (or dreams) should not be judged according to industry capabilities. For example,
the concept of a flying wheelchair does not seem viable as a solution, but when unpicking
children’s expressions, it becomes apparent that these designs mostly refer to using a fly
or hover function to specifically overcome steps or rough terrain, clearly highlighting and
framing a critical socio-environmental problem. Rather than viewing this as a downfall to
using such speculative design approaches with children, these instances should be

28
considered as opportunities to view children’s design input as narratives for ‘problem
framing’ rather than for ‘problem solving’. By proactively acknowledging and capturing
the ordinarily marginalised narratives of children in this way, designers can ensure a
child-centred approach is taken when negotiating which stakeholder narratives to embed
and scale through their design [59]. This process will inevitably involve balancing
tensions between form, function and fashion required to incorporate child-centred
insights without compromising essential functional requirements.
Whose Voice is It?
Children are lived experience experts in their own mobility; their perceptions, opinions
and ideas around their mobility thus infer significant value to the IPM design process.
The inclusion of children who cannot express themselves without support requires
facilitating and capturing their voice in a way that respects subjectivity, avoiding others’
voices becoming entangled in the process. Designs which were heavily assisted by adults
were typically accompanied by third person narrative, using the adult’s choice of
language rather than using the child’s own ways of expressing and representing their
views. There are certainly areas of the IPM design process where different stakeholder
voices are indispensable, however, to optimise the child-centred approach it is important
for assisting adults or able-bodied peers to remain aware of their possible influences and
to ensure their role is that of a facilitator and not of co-designer.
Communication Mediums

29
Visual dialogue and an aesthetic language can support the bridging between self-
expression and meaningful participation that is not solely reliant on verbal capability and
verbal construction [14,60]. It is legitimate to propose that many of the children’s ideas
may not have come to life through verbal responses to (verbal) questioning. It could be
argued that the use of visualisation and drawing, aided in some cases by annotation and
labelling, engaged and validated children’s experimental audacity in ways that language
alone would have inherently hindered. Drawings are affected by knowledge, age and the
ability to draw but offer children a powerful way of visually manifesting thoughts to
explore desires, values, meanings and priorities that may be difficult to narrate through
other mediums. The thoughtfulness and considered characteristics of each design would
suggest that the children involved were resourceful in utilising their creative capital,
making bold experiments and ‘requests’ in the shaping and representing of their ‘Dream
Wheelchair’ and its function, whether realistic, realisable, or fantastic.
Children as Masked Collaborators in Design Research
This research reveals that when designers engage with children’s voice through
secondary data, they are able to avoid influencing or steering children’s ideas and
priorities. In a similar way to narrative interviewing, this gives children full control over
the activity meaning they are influenced as little as possible by others. A clear advantage
to engaging with children’s voice in this secondary manner is the ability to obtain and
work remotely with a large-scale dataset, for minimal cost and time, by essentially
leapfrogging the data collection phase. A limitation to this method was that the dataset
was provided to the research team in a fully anonymised format, which made the study

30
simpler in terms of ethical approval but meant there was no way to gain any additional
information about the children who had created the designs, nor ask them to confirm if
the researchers’ interpretations and analysis of their designs were accurate. Despite
offering an efficient way to gather large scale design input from children, deeper insights
could be uncovered by the researchers being able to collect further specific information
about each child-designer to get to know them better in connection to their context. Such
additional insights, gained through meeting the children may have enabled a deeper
analysis or identification of noteworthy contextual variables in their designs (beyond
age); for example: geographic location (rural or urban environment), gender identity and
cultural or lifestyle choices. It could be worthwhile using research triangulation to test the
analysis results to test any assumptions or interpretations made by the researchers.
The Powers and Perils of a Design Brief
Deciding on the scope of a design project or competition is a critical ethical decision
which channels attention towards one particular area [44]. Language choice, wording and
clarity of communication in a design brief is thus very important. Using the word
‘wheelchair’ entwines the topics of disability, childhood, and mobility into the same
thread as children’s underlying assumptions and social imaginaries around what a
wheelchair is, at the same time as reinforcing the idea that the wheelchair is the object
which requires design attention rather than the focus being on the child and their
surrounding environment. Using the word ‘wheelchair’ in the competition title
intentionally influenced and constrained the scope of entries to focus solely on
wheelchairs as opposed to considering alternative or imagined forms of mobility and

31
access, whilst excluding children with mobility impairments who at that time used
equipment other than wheelchairs, such as walking aids, prosthetics and exoskeletons.
7. CONCLUSIONS AND FUTURE RESEARCH
This paper promotes a child-centred approach to framing using children’s designs. It
provides industry practitioners and design researchers with the methodology and tools
necessary to conduct a child-centred design analysis, and presents a range of quantitative
and qualitative insights pertinent to the design of inclusive paediatric mobility
interventions. Aimed at eliciting and elevating children’s voice, this paper makes three
core design contributions:
Firstly, on a theoretical level, a child-centred framework for analysing children’s designs
through an interdisciplinary lens is developed. The framework could be applied in
various contexts and domains, both closely related and more distant from IPM, in order to
thoroughly analyse children’s designs and help elicit meaning. For example, a similar
dream wheelchair design activity could be conducted with children in a contrasting
context to the UK, and the trending topics and insights revealed through analysis could be
compared with those in this paper to highlight possible contextual influences on child-
centred design.
Secondly, on an empirical level, quantitative and qualitative insights are
uncovered through analysing 130 ‘Dream Wheelchair’ designs. The analysis explored
individual (5.1, 5.2 and 5.3) and collective (6.1) meanings from children’s voice
including insights around the topics of incremental versus radical innovation,
technologically-enabled or ‘techno-ableist’, spectrum of requirements and desires, a

32
spotlight on altruism, and uncovering mobility narratives versus capturing design
specifications. These insights illuminate alternative child-centred frames and imagined
futurescapes which move beyond the default IPM frame of ‘a way to move around’.
These could be implemented by IPM practitioners and researchers to steer future strategy,
and design and develop IPM interventions to achieve more appropriate child-centred
outcomes.
Thirdly, on a reflective level, the study is reflected on to explore how children’s
voice could be elevated through design research (6.2), putting forward key considerations
around the topics of: problem framing over problem solving, whose voice is it,
communication mediums, children as masked collaborators in design research, and the
powers and perils of a design brief.
Future research should explore how the new framework and insights from this
study can be used to inform child-centred product design and improve outcomes for
children with disabilities. Moving forward, the question of how children’s voice -
particularly their higher-level narratives - should be translated into technical design
specifications, needs to be further explored. This could play a central role in streamlining
the incorporation of child-centred insights into design interventions. It is hoped that
furthering this research thread will produce more viable design practices, informed by a
holistic approach to socially just participation that elevates the voice of children with
disabilities and responds to their ideas and dreams

33
ACKNOWLEDGEMENTS
The authors would like to thank the Wheels of Change project and the PPL Dream Fund
initiative for sharing the secondary data used in this study, and acknowledge the Hugh
Greenwood Fund for Children's Health Research for supporting the study conduct.
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