Cognitive Orientation to (daily) Occupational Performance (CO-OP) with children with Asperger's syndrome who have motor-based occupational performance goals

Background/aim:  Motor difficulties associated with Asperger's syndrome (AS) are commonly reported, despite these not being diagnostically significant. Cognitive Orientation to daily Occupational Performance (CO-OP) is a verbal problem-solving intervention developed for use with children with developmental coordination disorder to address their motor-based difficulties. This paper reports on two case studies of children with AS illustrating the outcomes of CO-OP to address motor-based occupational performance goals.
Methods:  A case study approach was used to document how two children with AS engaged in 10 weekly sessions of CO-OP addressing child-chosen motor-based occupational performance goals and the outcomes of this intervention.
Results:  Pre and post-intervention assessment using the Canadian Occupational Performance Measure, Vineland Adaptive Behaviour Scales and the Performance Quality Rating Scale indicated that both children were able to engage in CO-OP intervention to successfully improve their occupational performance.
Conclusions:  Further research into the application of CO-OP with children with AS is warranted based on preliminary positive findings regarding the efficacy of this intervention to address motor-based performance difficulties in two children with AS.     

Efficacy of the cognitive orientation to daily occupational performance with Brazilian children with developmental coordination disorder

Background: Children with Developmental Coordination Disorder (DCD) have difficulties performing daily activities which reflects negatively on participation, impacting their lives.

Objectives: To examine the effects of the cognitive orientation to daily occupational performance Approach (CO-OP Approach) protocol on occupational performance and satisfaction of Brazilian children who have DCD; to examine whether children could transfer strategies and skills learned during CO-OP to untrained goals.

Methods: A pre-post group comparison design with eight boys aged 6–10 years old. Children participated in 12 CO-OP sessions with their parents twice a week, with an extra session added to the protocol for parents´ orientation. The Canadian Occupational Performance Measure and the Performance Quality Rating Scale were used as outcome measures. The study was registered by the United States Institutes of Health at ClinicalTrials.gov (NCT03112746).

Results: Intervention resulted in higher, clinically and statistically significant, occupational performance measures according to parents, children’s, and external evaluators’ perspectives. All children improved occupational performance on their selected goals and five children could transfer the ability to use cognitive strategies to tasks not addressed in therapy.

Conclusions: This study provides initial directions for future research to investigate the applicability and to implement CO-OP approach on pediatric settings in Brazil.     

Understanding children's motivation from a self-determination theoretical perspective: Implications for practice

Background:  This paper investigates three human psychological needs — autonomy, competence and relatedness — within the context of self-determination theory (SDT). Meeting these needs in therapeutic environments is congruent with principles of client-centred practice.
Aims:  A key objective is to describe how SDT can increase understanding of children's motivation and their willingness to engage in occupations. An additional objective is to investigate commonalities between SDT and specific client-centred approaches such as cognitive orientation to daily occupational performance (CO-OP).
Method and Results:  Literature about SDT is reviewed and a model of motivation based on self-determination and flow theory is presented. Clinical examples are used to highlight theoretical principles.
Conclusions:  It is proposed that understanding theories of motivation, such as SDT and flow, can further occupational therapists' understanding of the psychological processes involved in client-centred practice, particularly when working with children. This information has the potential to enhance clinical knowledge about activity choices to promote children's participation.     

Maternal parenting stress and its correlates in families with a young child with cerebral palsy

Objective   To investigate factors predicting parenting stress in mothers of pre-school children with cerebral palsy.
Method   Eighty mothers and children participated. Mothers completed the Parenting Stress Index (PSI) and the following measures of family functioning: family support, family cohesion and adaptability, coping strategies, family needs and locus of control. Children were assessed using the Griffiths Scales and the Gross Motor Function measure. The child's home environment was assessed using Home Observation for Measuring the Environment.
Results   Mothers had higher mean total PSI scores than the means for the typical sample; 43% had total PSI scores above the threshold for clinical assessment. Cluster analysis demonstrated five distinct clusters of families, more than half of whom were coping well. High stress items were role restriction, isolation and poor spouse support, and having a child who was perceived as less adaptable and more demanding. Lower stress items indicated that this sample of mothers found their children emotionally reinforcing and had close emotional bonds. Regression analysis showed that the factors most strongly related to parenting stress levels were high family needs, low family adaptability and cognitive impairment in the child.
Conclusions   The results confirmed the individuality of families, and that individual characteristics of coping and feeling in control, together with family support and cohesion, are associated with variation in amount of stress experienced in parenting a child with cerebral palsy.     

Motor skills in adolescents with low birthweight

Background   Minor motor problems have been reported in low birthweight children, but few studies have assessed motor skills in adolescents.
Objective   To examine the prevalence of motor problems in adolescents with low birthweight.
Methods   Fifty-four very low birthweight (VLBW: birth weight ≤1500 g), 59 term small for gestational age (SGA: birthweight <10th centile), and 83 control (birthweight ≥10th centile at term) children were assessed with the movement assessment battery for children (Movement ABC) at the age of 14 in a population-based study.
Results   One in four VLBW children [odds ratio (OR) 9.3, 95% confidence interval (CI) 2.5–34.5] and one in six SGA children (OR 4.7, 95% CI 1.2–18.4) had motor problems compared with controls (3.7%). There were no sex differences in motor problems in the VLBW group, and the increased risk was consistent across the continuum of the Movement ABC. For SGA children, the increased risk of motor problems was particularly in manual dexterity in boys.
Conclusion   VLBW and SGA adolescents have increased risk of motor problems compared with control children.     

Deficits in motor co-ordination and attention at 3 years of age predict motor deviations in 6.5-year-old children who needed neonatal intensive care

Background   A total of 189 children without major impairments who needed neonatal intensive care (NIC) were followed up at ages 3 and 6.5 years.
Aim   To determine the prevalence of different motor deviations at age 6.5 years and the co-occurrence of attention deficits; also, to analyse the predictive ability of motor co-ordination and attention assessments at age 3 years for motor deviations at 6.5 years.
Method   A combined assessment of motor performance and behaviour (CAMPB) was used at the 3-year examination. The Test of Motor Impairment (TOMI) and the Motor-Perceptual Development (MPU) were used together with the criteria of the diagnostic and statistical manual of mental disorders (DSM-IV-TR) to define motor deviations.
Results   At 6.5 years 64% of the children showed a motor deviation either as a delay according to MPU, a problem according to TOMI or Developmental Coordination Disorder (DCD) according to DSM-IV-TR. Higher proportions of children with attention deficit (50%) were found in the DCD group. The predictive ability of CAMPB was analysed in two ways: when all children with either a co-ordination or attention deficit, or both, at 3 years were considered to be at risk for motor deviations at 6.5 years, the sensitivity reached 78% and the specificity was 42%. But when only the 3 year olds with a combined deficit were considered to be at risk, the sensitivity was 37% and the specificity 89%; however, a positive predictive value of 86% was reached.
Conclusion   At 6.5 years of age a majority of NIC children with no major impairments showed motor deviations. To fulfil the DCD criteria in DSM-IV-TR, a strict definition of motor deviations is recommended. Attention deficits are more prevalent among children with DCD. Deficits in motor co-ordination and/or attention in 3-year-old children are strong predictors of motor deviations and, especially, of DCD at 6.5 years of age.     

A randomized, controlled evaluation of early intervention: the Born to Learn curriculum

Background   This study addressed the need for studies of the efficacy of the Born to Learn (BTL) curriculum.
Methods   Based on random assignment, 227 families of infants received the BTL curriculum conducted in monthly home visits, and 237 families received general child development education only.
Results   The BTL curriculum resulted in higher mastery motivation (task competence) at 36 months ( P  < 0.05) and greater effects for children from low ( P  < 0.01) versus high socio-economic status on mastery motivation and cognitive development at 24 months. No effects were found on a wide range of other developmental outcomes.
Conclusion   Future studies should document the BTL curriculum effectiveness in diverse settings and samples.     

Promoting healthy vision in students: progress and challenges in policy, programs, and research

Background:  An estimated 1 in 5 American children has a vision problem. Children living in poor urban environments have twice the normal rate of vision problems. Uncorrected vision problems can worsen over time and result in permanent vision loss. Early detection and treatment of vision problems is therefore essential in optimizing children's health and development. Federal-, state-, and school-based prevention efforts continue to evolve to identify and serve children with vision problems.
Methods:  Review of current literature on (1) major vision problems among children, (2) unique problems faced by low-income children with poor vision, and (3) the rise in health policy and program efforts to support the goal of healthy vision for each child. The preliminary relationship established between vision and academic performance is also discussed.
Results:  Low-income children have a disproportionate amount of vision problems and face several barriers to acquiring vision care. Varied actions among states include legislation requiring screening and follow-up before entry into elementary school.
Conclusions:  States and schools can take concrete steps to increase the number of children identified and treated for vision problems. Health policy and programs should also address common barriers to children receiving and wearing their glasses at home and in the classroom. Further research is necessary to assess the relationship between children's vision and educational outcomes. To the extent that vision is associated with academic success, policies and programs can be shaped to address the achievement gap that exists among our nation's youth and to support the goal of healthy vision for each child.     

Relationships between body fatness, small-screen sedentary activity and regionality among schoolchildren in Victoria, Australia

Objective:  To examine the difference in body fatness and engagement in small-screen activities across children living in different degrees of regionality, and to examine the relationship between child body fatness and small-screen activities.
Design:  Cross-sectional study design.
Participants:  Grade 5–6 schoolchildren ( n =  393) from central and metropolitan Victoria, and a parent/guardian of each child ( n =  393).
Main outcome measures:  Parents completed a questionnaire on their child's engagement in television (TV) viewing and video game playing (VGP). Children's weight and height were measured by a researcher. Body mass index (BMI) (kg/m²) was calculated and adjusted for age and sex. Regionality (metropolitan, population  >  100 000; regional, 100 000  >  population  <  20 000; and rural, population  <  10 000) and socioeconomic status (socioeconomic indexes for areas: index of disadvantage) were assigned according to school attended.
Results:  BMI did not differ across regionality or sex. Boys engaged in more VGP than girls, and metropolitan children engaged in more VGP than rural and regional children. TV viewing did not differ across sex or regionality. VGP did not predict BMI, and TV viewing did not predict girls' BMI. Three to four per cent of the variance in boys' BMI was predicted by TV viewing.
Conclusions:  Boys and metropolitan children engage in more VGP. Boys', but not girls', BMI is related to TV viewing. Interventions designed to decrease engagement in TV viewing should be targeting boys.     

Improving handwriting without teaching handwriting: The consultative clinical reasoning process

Background and Aim:  Children who have difficulty with handwriting are often referred for occupational therapy. This case report describes a dynamic intervention process and consultative relationship between an occupational therapist and physiotherapist, meeting the needs of an adolescent with handwriting problems.
Methods and Results:  Examples are given of the collaborative clinical reasoning process, problem-solving strategies, and ongoing adaptation of activities, materials, and equipment, leading to moderate improvement in handwriting and significant improvements in school reports and athletic competence, maintained for 6 years.
Conclusion:  Clinical decisions for selecting and modifying intervention techniques can be derived from assessment of occupational performance areas and performance components (underlying motor, sensory, and perceptual deficits interfering with the production of legible handwriting), within relevant performance contexts.     

Parents' reactions to the diagnosis of cerebral palsy: associations between resolution, age and severity of disability

Background   For parents, receiving a diagnosis, typically in early childhood, that their child has cerebral palsy may conjure up high distress and anxiety. Resolution of these initial reactions may help parents to focus on the challenges and needs of their children. Aims of the study were to test whether parents of older children displayed resolution more often than parents of younger children, and whether parents of children with less severe cerebral palsy also showed more resolution.
Method   Resolution of reactions to diagnosis was assessed with the Reaction to Diagnosis Interview, in a clinic-based sample of 255 parents of children with cerebral palsy aged between 1.4 and 17.3 years. Physicians rated motor ability using the Gross Motor Function Classification System.
Results   Overall, the responses of 81.6% of the parents were predominantly indicative of resolution. Unresolved reactions were significantly more often found among parents of younger children and parents of children with more severe motor disabilities. Among parents of teenage children, resolution was more often apparent from a focus on action to better the lives of their children, whereas in parents of younger children, it was more apparent from their focus on constructive thoughts and information seeking.
Conclusions   Given time, the large majority of parents may resolve their reactions to the diagnosis that their child has cerebral palsy. Parents of the most severely affected children may need specific support which, given the age trends, might be aimed at different resolution processes for parents of younger and older children.     

Feeding strategies used by primary school meal staff and their impact on children's eating

Background:  In parent–child interactions, feeding strategies including pressure, restriction, modelling, rewards, encouragement and repeated taste exposure have been reliably shown to influence children's eating. Because there is no evidence that the psychosocial interactions inherent in the strategies are context-dependent, the present study investigated their utilisation during primary school meal supervision.
Methods:  A case study of one Local Authority in Wales was conducted involving eleven primary schools stratified into socio-economic quartiles. Focussed observations were carried out over two to three lunchtimes per school to explore the feeding strategies, outcomes and behaviours inherent in the dining hall context. These were supplemented by semi-structured interviews with catering staff and midday supervisors, which were carried out after the observation session.
Results:  Most feeding strategies used by school meal staff reflected those reported in the literature (e.g. pressure, encouragement and rewards), although purposeful modelling of eating behaviours was not found and the imposition of food norms, such as eating dessert last, was common. Dining hall staff readily, if not consistently, used these strategies, although the constraints and opportunities of each dining hall context influenced their selection and implementation. However, even if children left the service point with nutritionally balanced meals, they often failed to eat them.
Conclusions:  Because repeated taste exposure is known to increase liking for foods, further studies are recommended to investigate how the naturally occurring feeding strategies evident in primary school dining halls could be harnessed to encourage children to taste the nutritionally balanced schools meals that school meal transformation programmes will expose them to.     

Directly observed physical activity levels in preschool children

Background:  Millions of young children attend preschools and other structured child development programs, but little is known about their physical activity levels while in those settings. The purpose of this study was to describe the physical activity levels and demographic and school-related correlates of physical activity in children attending preschools, using a direct observation measurement system.
Methods:  The Observational System for Recording Physical Activity in Children-Preschool Version was used to measure physical activity levels and related factors in four hundred ninety-three 3- to 5-year-old children in 24 preschools. A minimum of six hundred 30-second observation intervals were recorded for each child. Physical (height/weight) and demographic data also were collected.
Results:  Children engaged in moderate-to-vigorous physical activity (MVPA) during less than 3% of the observation intervals and were sedentary during more than 80% of the observation intervals. Boys were more likely than girls to engage in MVPA (p = .01), and 3-year-old boys were more active than 4- and 5-year-old boys (p = .01). The preschool that a child attended explained 27% of the variance in activity levels.
Conclusions:  The study indicates that young children are physically inactive during most of their time in preschool. The preschool that a child attended was a stronger predictor of physical activity level than any other factor examined. Additional research is needed to identify the characteristics of preschools in which children are more active.     

Movement skills proficiency and physical activity: A case for Engaging and Coaching for Health (EACH)–Child

Background/aim:  Supporting children's participation in health-enhancing physical activities is an important occupational goal for therapists. Fundamental movement skills (FMS) are thought to underpin and enable many activity options. This study had two goals: first, to examine the relationship between fundamental movement skills (FMS) and physical activity, and second, to use this and existing evidence to inform strategies whereby children's motivation for and engagement in physical activity can be supported.
Methods:  A cross-sectional investigation of 124 children, aged 6–12 years, was undertaken. FMS were assessed using the Movement Assessment Battery for Children (M-ABC) and physical activity by pedometer step counts.
Results:  A weak but significant association was found between weekend physical activity and balance skills for girls. Correlations between physical activity and ball skills or manual dexterity were not significant for either gender, however, having age appropriate ball skills did result in greater but not significant levels of physical activity for all children when grouped together.
Conclusions:  Findings from this study question the magnitude of the relationship between children's FMS and physical activity as measured by pedometers. If the goal of health enhancement through physical activity engagement is to be realised, it is proposed that community, occupation-based approaches may offer more potential than skills-based interventions at increasing activity participation. The concept of Engaging and Coaching for Health (EACH)-Child is introduced to this end. Occupational therapists are encouraged to work collaboratively with school and community organisations to assist children to find the physical activities that best accommodate their interests, abilities and offer opportunities for lifelong engagement.     

Testing an empirically derived mental health training model featuring small groups, distributed practice and patient discussion

Objectives  Internationally, family doctors seeking to enhance their skills in evidence-based mental health treatment are attending brief training workshops, despite clear evidence in the literature that short-term, massed formats are not likely to improve skills in this complex area. Reviews of the educational literature suggest that an optimal model of training would incorporate distributed practice techniques; repeated practice over a lengthy time period, small-group interactive learning, mentoring relationships, skills-based training and an ongoing discussion of actual patients. This study investigates the potential role of group-based training incorporating multiple aspects of good pedagogy for training doctors in basic competencies in brief cognitive behaviour therapy (BCBT).
Methods  Six groups of family doctors ( n  = 32) completed eight 2-hour sessions of BCBT group training over a 6-month period. A baseline control design was utilised with pre- and post-training measures of doctors' BCBT skills, knowledge and engagement in BCBT treatment.
Results  Family doctors' knowledge, skills in and actual use of BCBT with patients improved significantly over the course of training compared with the control period.
Conclusions  This research demonstrates preliminary support for the efficacy of an empirically derived group training model for family doctors. Brief CBT group-based training could prove to be an effective and viable model for future doctor training.     

Dual-task study of cognitive and postural interference: a preliminary investigation of the automatization deficit hypothesis of developmental co-ordination disorder

Background   The purpose of this study was to investigate whether children with developmental co-ordination disorder and balance problem (DCD-BP) had greater problems than controls in performing a primary balance task while concurrently completing different cognitive tasks varying in oral or listening cognitive complexity, as well as to investigate the automatization deficit hypothesis of DCD-BP.
Methods   Children with DCD-BP ( n = 39), along with age-matched control counterparts ( n = 39), were placed on automatic processing situation under dual-task conditions. All children were required to perform a primary task, five dual-task paradigms (oral counting task, auditory–verbal reaction task, auditory–choice reaction task, auditory–memory task and articulation alone) and an eyes-closed balancing task.
Results   In the primary task condition, the differences were not statistically significant ( P = 0.393) between children with and without DCD-BP. However, children with DCD-BP were significantly more impaired on three of five dual-task conditions (oral counting task: P = 0.003; auditory–verbal reaction task: P = 0.011; auditory–memory task: P = 0.041) compared with the single-task situation, with the exception of the auditory–choice reaction task ( P = 0.471) and articulation alone ( P = 0.067).
Conclusions   These results suggest that children with DCD-BP were more cognitively dependant and may have an automatization deficit.     

Stress in mothers of preterm infants in Bangladesh: associations with family, child and maternal factors and children's neuro-development

Background   The aim of this paper was to ascertain stress experienced by mothers of prospectively followed up preterm infants, and associations with family, child and maternal factors and children's neuro-development.
Methods   Within a follow-up study of preterm infants <33 weeks gestational age at a Child Development Center in Dhaka Shishu Hospital, mothers were interviewed with the Self-Report Questionnaire (SRQ) at each visit. Association between SRQ scores and child, family and maternal variables at first and final visit and children's neuro-developmental outcomes was determined.
Results   Low income mothers were more compliant (54%) compared with the defaulters (31%) ( P  = 0.0001) among the 159 mothers enrolled. Of the 88 mothers who were followed up until a mean age of 22 months of their child, 29.3% were at high risk for psychiatric morbidity at first visit compared with 23.9% on their last visit. Use of abortifacients ( P  = 0.026) and higher maternal age ( P  = 0.040) were significantly associated with maternal stress at first visit; while at last follow-up, total number of visits had the most significant association ( P  = 0.041). Twenty-five per cent and 19% of mothers were at risk for psychiatric morbidity in children developing normally and those with neuro-developmental impairments respectively.
Conclusions   Mothers at risk for psychiatric morbidity can be helped through follow-up support within public hospitals close to their homes, which is most availed by low income families. Neuro-developmental monitoring of high-risk infants closer to homes may be more feasible in resource poor countries than reliance on hospital visits, which increase stress. Biological markers of stress and coping strategies need further research.     

Planning for the end of children's lives – the lifetime framework

Aim   This paper describes the development of 'a best practice framework', following review of a sample of notes of children known to the Lifetime Service, where the child has a non-malignant life limiting condition, to improve child and family engagement in the planning process at the end of life.
Background   There is very little literature about how to engage with families to decide end of life plans for children with life limiting conditions.
Method   An audit of clinical case notes was followed by the development of 'a best practice framework' through a Delphi process involving clinical practitioners.
Results   The 3 × 3 framework is presented to aid communication with parents and children at this difficult time of decision-making.
Conclusion   This new framework has been well received by both parents and practitioners, and its use will be audited in the future.     

Parent Reactions to a School-Based Body Mass Index Screening Program

Background:  This study assessed parent reactions to school-based body mass index (BMI) screening.
Methods:  After a K-8 BMI screening program, parents were sent a letter detailing their child's BMI results. Approximately 50 parents were randomly selected for interview from each of 4 child weight–classification groups (overweight, at risk of overweight, normal weight, underweight) to assess parent recall of the letter, reactions to BMI screening, and actions taken in response to the child's BMI results.
Results:  Most parents found the BMI screening letter easy to read and had poor recall of numerical information (eg, the child's BMI percentile) but good recall of the child's weight classification (eg, normal weight or overweight). Most parents, and ethnic-minority parents in particular, supported school-based BMI screening. Parents of children whose weight was outside of the normal range were more likely to recall receiving the letter and talking to the child and the child's doctor about it. Parents who recalled their child as being overweight were more likely to report changing the child's diet and activity level. Most parents, and ethnic-minority parents in particular, wanted their child to participate in an after-school exercise program. An overweight condition in parents, but not children, was associated with an interest in family-based cooking and exercise classes.
Conclusions:  Most parents, and ethnic-minority parents in particular, viewed school-based BMI screening and after-school exercise programs favorably. Parents reported taking action in response to a BMI result outside of the normal range. Parents who were overweight themselves were particularly interested in family cooking and exercise classes.