Annette Joosten

Parents' Perspectives on Inclusive Schools for Children with Autism Spectrum Conditions.

Children with autism spectrum conditions (ASC) increasingly participate in inclusive education. The present study reviewed studies of children with ASC for parents’ perceptions of aspects they believed contributed to inclusive mainstream school settings. Understanding the parental perspective on the facilitators for inclusion of their child with ASC in mainstream schools is likely to improve inclusive practice. Twenty-eight empirical articles revealed that parents perceived teachers as playing a vital role in the inclusion of their children with ASC. The school was considered important in creating an environment that enabled inclusion, particularly through positive peer relations, prevention of bullying and help from support staff. At the societal level, funding and legislative policies were considered important. By understanding these aspects, policy-makers, teachers, school administrators and therapists may better be able to address parents’ inclusion concerns and thereby develop strategies to improve inclusion in mainstream schools.

Evaluating the Psychometric Properties of the Eating Assessment Tool (EAT-10) Using Rasch Analysis

Early and reliable screening for oropharyngeal dysphagia (OD) symptoms in at-risk populations is important and a crucial first stage in effective OD management. The Eating Assessment Tool (EAT-10) is a commonly utilized screening and outcome measure. To date, studies using classic test theory methodologies report good psychometric properties, but the EAT-10 has not been evaluated using item response theory (e.g., Rasch analysis). The aim of this multisite study was to evaluate the internal consistency and structural validity and conduct a preliminary investigation of the cross-cultural validity of the EAT-10; floor and ceiling effects were also checked. Participants involved 636 patients deemed at risk of OD, from outpatient clinics in Spain, Turkey, Sweden, and Italy. The EAT-10 and videofluoroscopic and/or fiberoptic endoscopic evaluation of swallowing were used to confirm OD diagnosis. Patients with esophageal dysphagia were excluded to ensure a homogenous sample. Rasch analysis was used to investigate person and item fit statistics, response scale, dimensionality of the scale, differential item functioning (DIF), and floor and ceiling effect. The results indicate that the EAT-10 has significant weaknesses in structural validity and internal consistency. There are both item redundancy and lack of easy and difficult items. The thresholds of the rating scale categories were disordered and gender, confirmed OD, and language, and comorbid diagnosis showed DIF on a number of items. DIF analysis of language showed preliminary evidence of problems with cross-cultural validation, and the measure showed a clear floor effect. The authors recommend redevelopment of the EAT-10 using Rasch analysis.

Investigating the experiences in a school-based occupational therapy program to inform community-based paediatric occupational therapy practice

BACKGROUND/AIM A collaborative approach with teachers is required when providing community-based occupational therapy to educationally at risk children. Collaborators share common goals and interact and support each other but challenges arise in providing collaborative occupational therapy in settings outside the school environment. The aim of this study was to capture experiences of teachers and occupational therapists working within a school-based occupational therapy program to determine if their experiences could inform collaborative practice. METHOD In this pilot study, participant responses to questionnaires (n = 32) about their experiences formed the basis for focus groups and individual interviews. Two focus group were conducted, one with teachers (n = 11) and one with occupational therapy participants (n = 6). Individual interviews were conducted with the supervising occupational therapist, school principal and two leading teachers. Descriptive statistics were used to analyse the data from closed questions, and thematic analysis using a constant comparison approach was used to analyse open ended questions, focus groups and interviews. RESULTS Three main themes emerged: (i) the need for occupational therapists to spend time in the school, to explain their role, build relationships, understand classroom routines and the teacher role; (ii) occupational therapists need to not see themselves as the expert but develop equal partnerships to set collaborative goals and (iii) occupational therapists advocating for all parties to be informed throughout the occupational therapy process. CONCLUSION The pilot study findings identified teacher and therapist experiences within the school setting that could inform improved collaborative practice with teachers and community-based occupational therapists and these findings warrant further investigation.

Utilisation of evidence-based practices by ASD early intervention service providers

A number of autism intervention practices have been demonstrated to be effective. However, the use of unsupported practices persists in community early intervention settings. Recent research has suggested that personal, professional and workplace factors may influence intervention choices. The aim of this research was to investigate knowledge and use of strategies, organisational culture, individual attitudes, sources of information and considerations informing intervention choices by early intervention providers. An online survey was completed by 72 early intervention providers from four organisations across Australia. Providers reported high levels of trust and access of information from internal professional development, therapists and external professional development. A range of considerations including child factors, family values and research were rated as important in informing intervention choices. Participants reported greater knowledge and use of evidence-based and emerging practices than unsupported. Levels of use were linked to levels of knowledge, as well as some organisational and attitudinal factors. Areas for future research and implications are discussed.

Management strategies of mothers of school‐age children with autism: Implications for practice

BACKGROUND/AIM Mothering children with autism results in mothers spending more time on daily tasks as well as managing the disorder. The need for mothers to self-manage often increases when the child is school aged. Mothers develop strategies, and occupational therapists and other health professional rely on or expect mothers to be involved in meeting the extra needs of their children with autism and other family members. Little is known about the strategies adopted by the mothers. The aim of this study was to explore the strategies mothers used to manage their roles and emotions, and their childs behaviours. METHOD In-depth individual interviews were conducted with seven mothers and data were analysed in this qualitative study using phenomenological analysis. RESULTS Findings revealed that the mothers had adopted strategies to manage their roles, their emotions and their childs behaviour. However, the strategies were often shaped by the expectations of others or circumstances beyond their control and at times added further to their stress. CONCLUSIONS Mothers of children with autism developed strategies to self-manage their lives and their childs disorder. However, even when these strategies were effective, they sometimes placed further stress on the mothers. The mothers provided insights to how they coped but need help to consider the support they require and therapists need to consider the pressures of expecting mothers to self-manage their childs disorder, their own lives and their family. Family-centred practice emphasising collaboration with mothers needs to be maintained with school-aged children.

Is using the strengths and difficulties questionnaire in a community sample the optimal way to assess mental health functioning

An important characteristic of a screening tool is its discriminant ability or the measure’s accuracy to distinguish between those with and without mental health problems. The current study examined the inter-rater agreement and screening concordance of the parent and teacher versions of SDQ at scale, subscale and item-levels, with the view of identifying the items that have the most informant discrepancies; and determining whether the concordance between parent and teacher reports on some items has the potential to influence decision making. Cross-sectional data from parent and teacher reports of the mental health functioning of a community sample of 299 students with and without disabilities from 75 different primary schools in Perth, Western Australia were analysed. The study found that: a) Intraclass correlations between parent and teacher ratings of children’s mental health using the SDQ at person level was fair on individual child level; b) The SDQ only demonstrated clinical utility when there was agreement between teacher and parent reports using the possible or 90% dichotomisation system; and c) Three individual items had positive likelihood ratio scores indicating clinical utility. Of note was the finding that the negative likelihood ratio or likelihood of disregarding the absence of a condition when both parents and teachers rate the item as absent was not significant. Taken together, these findings suggest that the SDQ is not optimised for use in community samples and that further psychometric evaluation of the SDQ in this context is clearly warranted.

A systematic review of pragmatic language interventions for children with autism spectrum disorder

There is a need for evidence based interventions for children with autism spectrum disorder (ASD) to limit the life-long, psychosocial impact of pragmatic language impairments. This systematic review identified 22 studies reporting on 20 pragmatic language interventions for children with ASD aged 0–18 years. The characteristics of each study, components of the interventions, and the methodological quality of each study were reviewed. Meta-analysis was conducted to assess the effectiveness of 15 interventions. Results revealed some promising approaches, indicating that active inclusion of the child and parent in the intervention was a significant mediator of intervention effect. Participant age, therapy setting or modality were not significant mediators between the interventions and measures of pragmatic language. The long-term effects of these interventions and the generalisation of learning to new contexts is largely unknown. Implications for clinical practice and directions for future research are discussed.

Gaze and visual search strategies of children with Asperger syndrome/high functioning autism viewing a magic trick

Abstract Objective: To examine visual search patterns and strategies used by children with and without Asperger syndrome/high functioning autism (AS/HFA) while watching a magic trick. Limited responsivity to gaze cues is hypothesised to contribute to social deficits in children with AS/HFA. Methods: Twenty-one children with AS/HFA and 31 matched peers viewed a video of a gaze-cued magic trick twice. Between the viewings, they were informed about how the trick was performed. Participants’ eye movements were recorded using a head-mounted eye-tracker. Results: Children with AS/HFA looked less frequently and had shorter fixation on the magician’s direct and averted gazes during both viewings and more frequently at not gaze-cued objects and on areas outside the magician’s face. After being informed of how the trick was conducted, both groups made fewer fixations on gaze-cued objects and direct gaze. Conclusions: Information may enhance effective visual strategies in children with and without AS/HFA.

Weighted vests did not improve competing behaviours or joint attention of 2 year olds with Autism Spectrum Disorder (ASD)

Difficulties ‘withdrawing’ an intervention based on learning may be the reason for this. The design was strengthened by inclusion of a one-month follow-up. Performance variability during baseline phase may have warranted additional observations; however the Single-Case Experimental Design (SCED) Scale recommendations were met (Tate et al., 2008). Participants received seven to nine, one hour CO-OP treatment sessions. The dynamic nature of assessment and intervention occurring within the same therapy session may artificially inflate the observed performance capacity of each participant depending on the degree of prompting and facilitation being provided by the CO-OP therapist. A greater separation between intervention and assessment may yield more rigorous data during intervention phases. Use of independent ratings of client-selected goals as the primary outcome measure demonstrates ecological validity and consistency with stroke guidelines (National Stroke Foundation, 2010). Although difficulties using this method were acknowledged by the authors, the integral nature of goal setting as part of the CO-OP necessitates measurement of goal attainment as an indicator of treatment outcome. Functional performance (PQRS) improved on all goals during the CO-OP intervention phase; exceeding 2SD band on 4/9 goals immediately post-intervention, and 8/9 goals at one month follow-up. Although fewer than half the set goals demonstrated statistically significant change immediately post-intervention, participants rated a clinically significant change in performance satisfaction for 8/9 goals. Satisfaction with improving performance may be evident even before performance has achieved maximal outcome, and may contribute to increased motivation. This study adds to current evidence supporting global cognitive strategy approaches such as CO-OP, challenging occupational therapists to think beyond the traditional dichotomy of remedial vs. functional retraining in neurorehabilitation (Kennedy et al., 2008). The strategies integral to CO-OP and other similar cognitive strategy approaches appear to be beneficial for clients with occupational performance difficulties due to either cognitive or motor impairments, and may in fact promote a more integrated approach to occupational therapy intervention rather than “retraining” individual impairment areas.

Factors associated with stress in families of children with autism spectrum disorder

ABSTRACT Purpose: The purpose of this study was to identify key factors associated with severe stress in families raising a child with autism spectrum disorder (ASD). Methods: Questionnaires were mailed to families with one or more children with a diagnosis of ASD. Data from 543 surveys were analyzed using univariate and multivariate logistic regression. Results: Forty-four percent (n = 241) of the caregivers reported severe family stress related to raising a child with ASD. Severe family stress was associated with (1) reduced ability to socialize; (2) not having accessed individual therapy; (3) negative co-parent relationships; and (4) high out of pockets costs due to the child’s ASD. The specific ASD diagnosis, comorbid conditions, socio-demographic variables, and social support were not associated with severe family stress. Conclusion: The findings of the current study highlight the importance of a systemic approach to family stress, whereby individual, family, and ecological factors are investigated.