Christine Berg

Participation Patterns in Preschool Children with an Autism Spectrum Disorder

An understanding of participation patterns in preschool-aged children with an autism spectrum disorder will allow the occupation therapy practitioner to focus on goals relevant to the child and family. This study compares participation patterns and barriers to participation in children with an autism spectrum disorder with those of children with no diagnosis. Using the Preschool Activity Card Sort, parent interviews revealed children with an autism diagnosis participate in fewer preschool activities of self-care, community mobility, vigorous leisure, sedentary leisure, social interaction, chores, and education than children with no diagnosis. Reasons for non-participation generally focused on child behaviors; parents gave opportunities to participate, but the child, for a variety of reasons, could not capitalize on the opportunity. Practitioners can assist the family in managing the childs responses and behavior in a wide range of preschool activities.

The Preschool Activity Card Sort.

Measuring the participation of preschoolers (children between 3 and 6 years of age) with disabilities in everyday activites has become a professional mandate for occupational therapists. This study outlines the development of the Preschool Activity Card Sort, which can establish a childs occupational profile through parent interview. Six of the nine International Classification of Functioning, Disability and Health activity and participation domains are included in the Preschool Activity Card Sort. A literature review and an analysis of parent time logs were used to compile photographs of preschoolers engaged in typical activities. Parents respond to these photographs during discussion about their childs participation in these everyday activities. When a child does not participate in age-appropriate activities, the Preschool Activity Card Sort helps determine whether it is due to child, family, or environmental barriers. Identifying these barriers assists the therapist and the family in determining therapeutic goals.

Executive function performance on the children's kitchen task assessment with children with sickle cell disease and matched controls

Objective: The aim of this study was to compare executive function abilities of 8- to 12-year-old children with sickle cell disease (SCD) with a matched control sample. The measures included the parent and teacher Behavior Rating Inventory of Executive Function (BRIEF); the Delis-Kaplan Executive Function System (D-KEFS), Free Sorting Test and Color Word Interference Test; and the Childrens Kitchen Task Assessment (CKTA), a new performance measure. Methods: Twenty-two children with SCD were recruited from one hematology clinic and 22 community children, matched on characteristics of age, gender, and race, were selected from a larger sample of controls for comparison. Parents and teachers completed rating scales. Results:As hypothesized, children with SCD scored significantly lower than matched controls on Digit Span Forward; on 5 of the 9 D-KFES Color Word Interference and Sorting tasks; on CKTA organization, initiation, and task completion; and on the BRIEFs parent and teacher Metacognitive Index (MI) and Global Executive Composite (GEC) scores. Conclusion:Cognitive and performance evaluations indicate lower executive function among children with SCD. Results substantiate the need for evaluative triangulation for children with SCD: Neurocognitive testing supported by performance testing, and adult reflection of a childs daily performance compared to other children. These elements will provide rich data to create educational support for children with SCD who have frequent hospitalizations, school absences, and the potential presence of cerebral vascular accident symptomology.

Weekly Calendar Planning Activity (WCPA): a performance-based assessment of executive function piloted with at-risk adolescents.

OBJECTIVE We piloted the Weekly Calendar Planning Activity (WCPA), a performance-based measure of executive function (EF), to establish a baseline for at-risk adolescents. METHOD Participants were 113 youths ages 16-21 who were enrolled at a charter school for youth returning to high school after dropping out. We administered the WCPA and collected demographic information. RESULTS On average, participants spent 15.9 min on the WCPA, made 7.9 errors, and followed 4.0 of 5 possible rules. No ceiling effect was observed in overall accuracy. Participants used a mean of 3.1 strategies (standard deviation = 1.9) while completing the WCPA. Participants who used more strategies spent more time planning and completing the task and were more accurate. CONCLUSION The WCPA may be useful to occupational therapists as a performance measure of EF. This assessment allows evaluation of complex task performance, strategy use, self-evaluation of performance, and error patterns, which can be used in developing intervention strategies.

Late Effects of Childhood Cancer, Participation, and Quality of Life of Adolescents

This study investigated the late effects of childhood cancer on participation and quality of life. Ninety-two percent of survivors (9 to 18 years of age) reported living with late effects of lower extremity pain and numbness, memory and attention deficits, and fatigue, depression, or both. Semistructured interviews with 25 survivors using the Canadian Occupational Performance Measure and the Adolescent Activity Card Sort captured frequencies, interests, and barriers for a range of activities. Survivors reported diminished engagement in vigorous leisure activities, chores, and community activities. Lower engagement in social activities was correlated with lower quality of life scores, as measured by the Pediatric Cancer Quality of Life Inventory-32. Despite these findings of significant cognitive and physical problems, none of the 25 survivors had individualized education programs in school, nor were any receiving occupational therapy at the time the survey was completed. The findings emphasize the importance of advocacy for occupational therapy services for survivors of childhood cancer and examination of adolescent survivor participation in, and goals for, typical activities.

Participation in Daily Activities of Young Adults with High Functioning Autism Spectrum Disorder

Young adults with an autism spectrum disorder (ASD) struggle to assume adult roles. This research assessed the feasibility of using the Adolescent and Young Adult Activity Card Sort (AYA-ACS) with emerging adults with high functioning ASD. Two phases were utilized during this research: (1) comparing the activity participation reported by emerging adults with an ASD and that reported by their caring adult; (2) examining the barriers to participation reported. Preliminary results demonstrate that the AYA-ACS appears to be a reliable and valid method of identifying emerging adults’ participation strengths as well as personal and environmental challenges in a variety of age-appropriate activities. The AYA-ACS could assist service providers by providing an understanding of the challenges to participation faced by this population and aid in developing client centered interventions.

Participation of Young Adults with High-Functioning Autism in Taiwan: A Pilot Study

This pilot study aimed to investigate the activity participation of young adults with high-functioning autism (HFA) living in Taiwan. Eleven young adults with HFA, their caring adults, and 11 matched typically developing youth were recruited across Taiwan. The Adolescent and Young Adult Participation Sort-Taiwanese version (AYAPS-T) was administered to all three groups to compare the activity participation. In addition, youth with HFA identified activities in which they desired to participate and barriers hindering their participation. The results of this study suggest that youth with H FA had lower participation rates in activities across different domains than their typically developing peers. Youth with HFA were able to identify the activities they desired to do and the barriers hindering their participation. No significant differences in participation were found between the results reported by the caring adults and youth with HFA. Occupational therapy practitioners may work on eliminating the personal and environmental barriers that impede participation as youth with HFA transition out of secondary school.

Participation and Self-Management Strategies of Young Adult Childhood Cancer Survivors

This study describes a connection between late effects, engagement in major life activities, and self-management strategies in young adult childhood cancer survivors. A mailed survey focused on late effects of pain, fatigue, depression, cognition, memory, and body image distortion and their impact on work, education, independent living, and community and social engagement. Additionally, survivors identified self-management strategies that minimize their late effects. Eighty-eight percent of the 42 responders struggled with at least one of the six late effects. Work and educational pursuits were affected, with memory and fatigue the most intrusive to daily activities. Self-management strategies of sleep/rest, fitness, quiet leisure, and support of family/friends were the most common. Reaching out to long-term follow-up cancer clinics, health professionals, survivors, or community resources were the least employed management strategies. Occupational therapists can look to community models for educating survivors about self-management, and take this opportunity to define new collaborative partnerships with long-term follow-up cancer clinics and community agencies to assist young adult survivors transitioning to adult roles.

Development of the Adolescent and Young Adult Activity Card Sort.

Emerging adulthood defines transition to employment, higher education, and domestic life. This study describes the development of an assessment of self-reported participation in a range of age-appropriate activities. Item selection was established from literature review, feedback from youth and professionals, the former Adolescent Activity Card Sort (AACS), and the original Activity Card Sort (ACS). Iterative item selection occurred with three separate samples of emerging adults and six professionals. Test–retest reliability was evaluated. The Adolescent and Young Adult Activity Card Sort (AYA-ACS) consists of chores (11 items), leisure (13), social (10), health and fitness (9), work (10), education (8), and parenting (9). Test–retest reliability showed significant moderate to substantial Kappa agreement (.48-.85) for all domains except parenting (κ = .15). This preliminary study describes the development of the AYA-ACS to be used with individuals who encounter challenges when transitioning to young adulthood.

Childhood Toxic Stress: A Community Role in Health Promotion for Occupational Therapists

People who experience the toxic stress of recurrent traumatic events in childhood have a higher risk for mental and physical health problems throughout life. Occupational therapy practitioners have a remarkable opportunity to be involved in addressing this significant public health problem. As health care practitioners already situated in the community, we have a responsibility to lead and assist in establishing and implementing occupation-based programs and to nurture the links between the child welfare system and existing intervention systems. In this article, we review the current research on toxic stress and recommendations made by other health care disciplines and offer strategies for occupational therapy practitioners to begin a dialogue on this critical, emerging issue.