Occupational Therapy's Emerging Role With Transitioning Adolescents in Foster Care

The American Occupational Therapy Association's Centennial Vision advocates for an emphasis on intervention and prevention services for children, young people, the aging, and those with severe and persistent mental illness. This article discusses mental health issues among adolescents in foster care, a population that would greatly benefit from occupational therapy services emphasizing skill development in the areas of independent living, vocation, and health. Additionally, current intervention modalities used by other disciplines with adolescents in foster care are explored. Finally, a pilot study demonstrating the opportunities for occupational therapists to influence the long-term outcomes of adolescents in foster care is described.     

Occupational therapy using a sensory integrative approach for children with developmental disabilities

This article provides an introduction and overview of sensory integration theory as it is used in occupational therapy practice for children with developmental disabilities. This review of the theoretical tenets of the theory, its historical foundations, and early research provides the reader with a basis for exploring current uses and applications. The key principles of the sensory integrative approach, including concepts such as "the just right challenge" and "the adaptive response" as conceptualized by A. Jean Ayres, the theory's founder, are presented to familiarize the reader with the approach. The state of research in this area is presented, including studies underway to further delineate the subtypes of sensory integrative dysfunction, the neurobiological mechanisms of poor sensory processing, advances in theory development, and the development of a fidelity measure for use in intervention studies. Finally, this article reviews the current state of the evidence to support this approach and suggests that consensual knowledge and empirical research are needed to further elucidate the theory and its utility for a variety of children with developmental disabilities. This is especially critical given the public pressure by parents of children with autism and other developmental disabilities to obtain services and who have anecdotally noted the utility of sensory integration therapy for helping their children function more independently. Key limiting factors to research include lack of funding, paucity of doctorate trained clinicians and researchers in occupational therapy, and the inherent heterogeneity of the population of children affected by sensory integrative dysfunction. A call to action for occupational therapy researchers, funding agencies, and other professions is made to support ongoing efforts and to develop initiatives that will lead to better diagnoses and effective intervention for sensory integrative dysfunction, which will improve the lives of children and their families.     

Model of Social Competence in an Early Childhood Environment

Maintaining relationships and interacting socially are essential aspects of children's occupational performance. A Model of Social Competence in an Early Childhood environment has been formulated to guide the assessment of and intervention for young children with issues in social skills. This article aims to (1) present the constructs that contribute to social competence for young children, (2) describe the interrelated contextual, foundation and environmental influences on social competence using the Model of Social Competence in an Early Childhood environment as a means of systematically examining these factors, and (3) discuss future directions for early intervention for children with social competence concerns. Cultural considerations will be discussed in relation to the Singaporean early childhood context.     

Promoting step responses of children with multiple disabilities through a walker device and microswitches with contingent stimuli

Children with severe or profound intellectual and motor disabilities often present problems of balance and locomotion and spend much of their time sitting or lying, with negative consequences for their development and social image. This study provides a replication of recent (pilot) studies using a walker (support) device and microswitches with preferred stimuli to promote locomotion in two children with multiple disabilities. One child used an ABAB design; the other only an AB sequence. Both succeeded in increasing their frequencies of step responses during the B (intervention) phase(s). These findings support the positive evidence already available on the effectiveness of this intervention in motivating and promoting children's locomotion.     

学前儿童睡眠问题与语言障碍的关系

睡眠是个体身心健康发展的重要保障。学前期的睡眠问题可能会对儿童的行为、认知、语言和健康等诸多方面产生负面影响。研究表明, 睡眠呼吸障碍、夜间睡眠不足以及入睡困难等睡眠问题是学前儿童语言障碍的潜在威胁性因素。学者们提出了睡眠记忆巩固假说、警觉性假说和突触稳态假说来解释睡眠问题影响学前儿童语言发展的内在机制。这些研究结果为语言障碍的早期干预提供了一种新思路, 即通过行为干预、药物治疗、手术治疗和游戏干预等睡眠问题干预方式来提高学前儿童的语言能力。未来的研究可以进一步深入分析睡眠问题与语言障碍相关联的内在机制, 了解不同年龄段儿童睡眠问题与语言能力的关系, 以及探究融合教育背景下有效的游戏干预方式。     

Occupational therapy and sensory integration for children with autism: a feasibility, safety, acceptability and fidelity study

Objective: To examine the feasibility, safety, and acceptability of a manualized protocol of occupational therapy using sensory integration principles for children with autism. Methods: Ten children diagnosed with autism spectrum disorder ages 4-8 years received intensive occupational therapy intervention using sensory integration principles following a manualized protocol. Measures of feasibility, acceptability and safety were collected from parents and interveners, and fidelity was measured using a valid and reliable fidelity instrument. Results: The intervention is safe and feasible to implement, acceptable to parents and therapist, and therapists were able to implement protocol with adequate fidelity. These data provide support for implementation of a randomized control trial of this intervention and identify specific procedural enhancements to improve study implementation.     

基于长尾效应的儿童创伤后应激障碍转归机制及干预策略

儿童PTSD具有“长尾效应”, 疾病负担重、发展结局存在较大异质性, 但是少有研究对我国儿童PTSD的转归进行系统性研究, 其转归类型、路径尚不明晰, 更缺少促进儿童PTSD复原的干预研究。因此, 本研究拟对儿童及青少年进行追踪调查和准实验研究, 探讨儿童PTSD的发展轨迹及转归类型和机制, 验证基于学校的综合干预服务对促进儿童PTSD恢复的效果, 为儿童PTSD干预及个性化诊疗提供证据。     

Reduction of Pain Sensitivity after Somatosensory Therapy in Children with Autism Spectrum Disorders

Children with autism spectrum disorders (ASD) often present with somatosensory dysfunction including an abnormal reactivity to tactile stimuli and altered pain perception. A therapy based on somatosensory stimuli has shown effectiveness in reducing pain sensitivity among adults with cerebral palsy. The present study aims at exploring the influence of somatosensory therapy on somatosensory parameters in children with ASD. Children with high-functioning ASD were randomly assigned to either the intervention (n?=?29) or the control group (n?=?30). The intervention group received a somatosensory therapy consisting of four types of exercises (touch, proprioception, vibration, stereognosis). Somatosensory function (pressure pain thresholds, tactile thresholds, stereognosis, proprioception) was assessed before and immediately after the therapy. Children in the intervention group showed a significant reduction of pain sensitivity and increase of tactile sensitivity after treatment, whereas children in the control group displayed increased pain sensitivity in the absence of changes of tactile sensitivity. No changes were observed for proprioception or stereognosis. The repetitive somatosensory stimulation therapy led to a decrease of pain sensitivity and an increase of tactile sensitivity. These findings may have important research and clinical implications, as promoting early tactile interventions in children with ASD may lead to a more adequate development of somatosensory processing and less somatosensory abnormalities upon adult life.     

Improving executive functions in 5‐ and 6‐year‐olds: Evaluation of a small group intervention in prekindergarten and kindergarten children

Research suggests a central role of executive functions for children's cognitive and social development during preschool years, especially in promoting school readiness. Interventions aiming to improve executive functions are therefore being called for. The present study examined the effect of a small group intervention implemented in kindergarten settings focusing on basic components of executive functions, i.e., working memory, interference control and cognitive flexibility. A total of 135 children enrolled in Swiss prekindergarten (5‐year‐olds) and kindergarten (6‐year‐olds) were involved. Results revealed that the small group intervention promoted gains in all three included components of executive functions: prekindergarten children substantially improved their working memory and cognitive flexibility processes, whereas significant training effects were found for the kindergarten children in interference control. Implications of these findings for early intervention programs and for tailoring preschool curricula are discussed, particularly with respect to children's school readiness. Copyright © 2011 John Wiley & Sons, Ltd.     

数学困难儿童的数学估计能力

对数学困难儿童(简称数困)的数学估计进行探讨有助于理解数困的成因和寻找适当的干预措施。本文在简要回顾数困和估计的概念基础上, 重点对近年来国内外关于数困儿童数学估计(主要是估算和估数)的表现及影响因素、神经基础和相关的干预研究进行了回顾和梳理, 并强调未来对数困儿童的数学估计研究应注重从选取被试、扩展研究范围和加强干预方案设计等方面开展探讨。     

Efficacy of Fun to Learn for the Young Program: Randomized Controlled Trial

Early intervention for children from disadvantaged backgrounds has been found to be effective in improving their learning and psychosocial outcomes. This study aimed to evaluate the efficacy of the Fun to Learn for the Young (FLY) program using randomized controlled trial design with no blinding of participants. Participants included 200 Hong Kong Chinese parent–child dyads (intervention:101; control: 99) with children aged 18?months from disadvantaged backgrounds. Participants were recruited from three non-governmental organizations. The intervention group participated in the 60-session FLY program which consisted of direct teaching to children and parent training. Parent participants from both groups completed questionnaires on child learning, child behavior and parenting before the intervention, at the end of 40 sessions, and 60 sessions. The children were individually assessed on their preschool concepts and language skills at these three time points. Results indicated that the children in the intervention group made more gains in preschool concepts, language skills, school readiness and motivation, compared with control group children (η _p ²?=?.018–.029). The results provided some initial evidence that the FLY program was an effective early intervention program in promoting child learning.     

Strengthening socio‐emotional competencies in a school setting: Data from the Pyramid project

Background. Development of socio‐emotional competencies is key to children's successful social interaction at home and at school. Aims. This study examines the efficacy of a UK primary school‐based intervention, the Pyramid project, in strengthening children's socio‐emotional competencies. Sample. Participants were 385 children from seven schools in two UK cities. All children were aged 7–8 years and in school Year 3. Children were screened for socio‐emotional difficulties through the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997 ) and a multi‐agency meeting of relevant professionals before being allocated to attend a Pyramid Club intervention (n= 103) or a comparison group (n= 282). Method. A 2 × 2 mixed‐model design was used: group (intervention group vs. comparison group) × 2 time points (pre‐ vs. 12 weeks post‐intervention) with repeated measures on the time factor to investigate the impact of the Pyramid Year 3 intervention. Teachers completed the SDQ‐T4‐16 for all children pre‐ and post‐intervention to measure participants’ socio‐emotional health status. Results. As measured by the two SDQ difficulty sub‐scales of Emotional and Peer problems and the SDQ strength sub‐scale of Prosocial behaviour, post‐intervention improvements in the Pyramid attendee group were of greater magnitude than those of the comparison group. Conclusions. The Pyramid project intervention improves the socio‐emotional health of vulnerable children through promoting positive outcomes as well as reducing socio‐emotional deficits. These findings further support the inclusion of a salutogenic approach in promoting children's socio‐emotional well‐being.     

‘Journey in the world of professions and work’: A career intervention for children

A structured ten-unit training was devised to stimulate some career adaptability resources such as optimism and hope toward the future, curiosity, career exploration, and occupational knowledge in children. Ten classes, for a total of 154 children (79 boys and 75 girls) with a mean age of 10.65 years (SD = 1.24), were randomly assigned to either the experimental, who was the focus of the intervention, or control group. At post-test the experimental group held significantly more hope, optimism, curiosity, career exploration, occupational knowledge, information, planning, and time perspective than the control group. The pattern of effect sizes strengthens the idea that the training enhanced experimental participants’ some career adaptability resources.     

Towards a model of female occupational behavior: a human development approach

Substantial evidence suggests that women have added the role of worker to their characteristic adult roles of wife and mother. The inclusion of a work cycle in the female life course is a significant alteration of traditional roles, and is likely to have a major impact on both individual lives and the social structure. However, little has been done to incorporate these changes into theoretical perspectives on occupational development. This paper examines the literature on women and work by reviewing, at the societal level, the trends in female labor force activity since 1900 and, at the individual level, theories of the development of occupational behavior. An integration of these two areas is then suggested through an evaluation of their relevance to the human development paradigm.     

School outcomes of a community-wide intervention model aimed at preventing problem behavior

The Early Intervention for Children at Risk for Developing Behavioral Problems (EICR) is a community-wide intervention model preventing and treating problem behavior and promoting social competence in children. The aim of the study was to test whether EICR would result in fewer incidences of problem behavior and improved learning climate in elementary schools in a Norwegian municipality. The municipality was divided in two, each section having equal chance of being assigned to the intervention condition. Participants were principals and school staff. One year after the initiation of EICR, the prevalence of student problem behavior was significantly lower, and student relations were significantly better for schools located in the intervention area than for schools located in the comparison area. The findings support further development, implementation and research on the EICR model.     

Individual Differences in Children��s Occupational Aspirations as a Function of Parental Traditionality

The current study was designed to test the application of the social-cognitive theory of gender development in predicting the traditionality of children??s occupational aspirations (Bussey and Bandura 1999). Of primary interest was the influence of children??s efficacy for nontraditional tasks on their occupational aspirations. Participants were 150 children and their mothers from the southern United States. Mothers reported their gendered attitudes, their perception of their children??s skills, and their family??s division of paid and unpaid labor. Children reported their occupational aspirations and efficacy for traditional and nontraditional skills, occupations, and school topics. Mothers who reported nontraditional attitudes had children with nontraditional occupational aspirations. This association was mediated by children??s efficacy for nontraditional tasks, indicating some support for the social-cognitive theory.     

Evaluation of an Internet-short message service-based intervention for promoting physical activity in Hong Kong Chinese adolescent school children: a pilot study

Evaluation of acceptability and preliminary efficacy of an Internet and short message service (SMS) intervention for promoting physical activity (PA) in Hong Kong Chinese school children. An 8-week quasi-experimental study non-randomly assigned 78 school children (mean age=12.8 years) to (a) an intervention group that received a stage-matched, Internet PA program two times a week and tailored SMS messages daily; or (b) a no-treatment control. Data were collected from September 2008 until June 2009. Acceptability measures included exposure rate and participant's satisfaction. Efficacy measures were changes in stage of motivational readiness (SMR) and self-reported PA level. Intervention participants demonstrated significant pre-post increments in SMR (Z=-2.558, p=0.011) and self-reported PA level [F(1, 76)=4.50, p=0.04]. There was a non-significant trend between groups in both SMR (p=0.24) and PA (p=0.13). Despite the similar ratings of satisfaction between Internet (M=3.12±0.74) and SMS (M=3.12±0.84), participants displayed distinct patterns of exposure with 66% exhibiting a weekly login rate of 0.5 times/person and an average of 3.75 minutes/visit/person. In contrast, 79% of participants read an average of 1.3 SMS/person/week and 47% voluntarily replied to ～3.8 SMS/person. These findings demonstrate the acceptability and preliminary efficacy of an Internet-SMS-based intervention for promoting PA in Hong Kong school children. The divergent exposure rates between the Internet and SMS may be a unique pattern for adolescents in early SMR. Future research should be cognizant of the importance of SMR since it may influence utilization and/or adherence.     

Promoting foot–leg movements in children with multiple disabilities through the use of support devices and technology for regulating contingent stimulation

The present study assessed the possibility of promoting pre-ambulatory foot–leg movements in children with multiple disabilities by motivating their action through contingent stimulation combined with a support device. Two children aged 10 and 8 years participated. Microswitch technology (i.e., pressure sensors under the shoes or optic sensors at the front–inner side of the shoes) served for detecting the foot–leg movements and providing contingent stimulation on their occurrence. Sensor activation produced 5 s of stimulation during intervention. Data showed that both children had significant increases in foot–leg movements during the intervention phases. Implications of the data in terms of skill acquisition and further intervention prospects are discussed.     

Preventing Serious Conduct Problems in School-Age Youth: The Fast Track Program

Children with early-starting conduct problems have a very poor prognosis and exact a high cost to society. The Fast Track project is a multisite, collaborative research project investigating the efficacy of a comprehensive, long-term, multicomponent intervention designed to prevent the development of serious conduct problems in high-risk children. In this article, we (a) provide an overview of the developmental model that serves as the conceptual foundation for the Fast Track intervention and describe its integration into the intervention model; (b) outline the research design and intervention model, with an emphasis on the elementary school phase of the intervention; and (c) summarize findings to date concerning intervention outcomes. We then provide a case illustration, and conclude with a discussion of guidelines for practitioners who work with children with conduct problems.     

Community Organization and Planning Consultation

This paper focuses upon the role of the occupational therapist as a health agent with resultant responsibilities for participation in health planning and preventative program development. Included is a discussion of community problem solving methods, an overview of community organization, and principles of preventative intervention. A community-wide assessment methodology upon which to base planning decisions is presented. The principles of prevention, community assessment, and occupational therapy program development are emphasized through a discussion of a mental health model which evolved in a military community.