Kris Pizur-Barnekow

Leisure and Social Participation and Health-Related Quality of Life in Caregivers of Children with Autism

The objective of this cross-sectional study was to compare health-related quality of life (HRQoL) in mothers of children with autism spectrum disorders (ASD) with a norm-based sample. An additional aim was to examine the relationship between engagement in leisure and social occupations and HRQoL in mothers of children with ASD. Thirty-three mothers of children with ASD, between 27 and 49 years of age, participated. Study participants between the ages of 35 and 44 years reported poorer mental HRQoL than a national sample, but comparable physical HRQoL. Findings also revealed inverse correlations between participation in hobbies and community/education activities and physical HRQoL (e.g., participation in hobbies and community education/activities increased as physical HRQoL decreased). The mental HRQoL of caregivers of children with ASD is lower than that of the general population, suggesting the need for occupational therapists to include psychosocial screening and referral for this group in their practice. In addition, results suggest that the relation between participation and health is complex, warranting further investigation.

“I Cried Because I Didn't Know if I Could Take Care of Him”: Toward a Taxonomy of Interactive and Critical Health Literacy as Portrayed by Caregivers of Children with Special Health Care Needs

Although the contributions of reading ability and numeracy skills in successful navigation of health-related systems are understood, the skills that comprise interactive and critical health literacy are not fully explicit. Using a phenomenological approach and the conceptual frame of health literacy as an asset, we conducted focus group interviews with 35 caregivers of children who had significant medical needs. Caregiver quotes were coded and categorized and then compared to the Revised Blooms Taxonomy. The purpose of the analysis was to better understand the interactive and critical health literacy skills caregivers use when coordinating their childrens care. The findings support a dynamic constructivist perspective of health literacy such that caregiver skill changed relative to the childrens health conditions. In addition, a taxonomic code of cognitive and communicative skills emerged from the data. This taxonomy may be useful in developing instrumentation to measure interactive and critical health literacy as well as in identifying a potential foci of interventions aimed at improving interactive and critical health literacy.

Readability of Early Intervention Program Literature

Accessibility of early intervention program literature was examined through readability analysis of documents given to families who have a child served by the Birth to 3 program. Nine agencies that serve families in Birth to 3 programs located in a county in the Midwest provided the (n = 94) documents. Documents were included in the analysis if they conveyed information about the nature of the program, the financial obligations of the family, intervention planning, and programmatic consent. The analysis indicated that a majority of the documents were written above the recommended fifth-grade reading level. Action steps to improve the accessibility of early intervention documents are discussed.

Service Coordinators’ Perceptions of Autism-Specific Screening and Referral Practices in Early Intervention

Service coordinators in a statewide early intervention program were surveyed to develop an understanding of screening and referral practices to identify children on the autism spectrum. Quantitative and qualitative data summarizing autism-specific screening and referral practices are reported. More than 50% of the respondents reported that they had never received a referral from a physician or another early intervention provider because a child has failed an autism-specific screening. While service coordinators identified that early intervention providers have a role in conducting autism-specific screening, more than 50% of the respondents indicated that they do not see autism-specific screening completed in early intervention settings. More than 80% of the respondents identified “a lack of knowledge” as the most significant barrier to autism-specific screening. Together, these findings suggest that early intervention providers may benefit from professional development that imparts knowledge, teaches skills, and addresses potential concerns of parents related to autism.

Child Caregivers’ Contingent Responsiveness Behaviors During Interactions With Toddlers Within Three Day Care Contexts

Increasingly, children spend much of their day in the care of adults other than their parents, such as child care providers. Consequently, it is important to analyze nonparental adults’ use of strategies suggested to foster language development, such as contingent responsiveness, during interactions with young children. This study examined child caregivers’ contingent responsiveness behaviors that followed toddlers’ communicative attempts within unstructured, semistructured, and structured daycare contexts. Child caregiver behaviors were coded as (a) no response (appropriate), (b) no response (inappropriate), (c) noncontingent response (appropriate), (d) noncontingent response (inappropriate), (e) contingent response and termination of the interaction (appropriate), (f) contingent response and termination of the interaction (inappropriate), and (g) contingent response leading to maintenance of the communicative interaction. Important similarities and differences in child caregivers’ contingent responsiveness behaviors for the three contexts suggest a need to prepare child caregivers to use strategies such as contingent responsiveness across contexts to facilitate language development.

An Investigation of Maternal Play Styles during the Co-Occupation of Maternal-Infant Play

Objective: The purpose of this secondary analysis was to examine if play styles used by mothers when their infants are 6 months or older are exhibited by mothers who play with their 3–4 month old infants. Method: Sixteen healthy, mostly Caucasian, maternal-infant dyads participated in a repeated measures design study that consisted of two, 3-minute play episodes separated by an interval ranging from 2 to 10 minutes in length. Digital video recordings of the first and second play episodes were analyzed and coded using three specific play styles cited in the literature (attention-supporting, attention-directing and control play). Duration of time spent in each play style was determined and descriptive statistics were used to summarize the percentage of time the mothers exhibited each style across the two play episodes. Dependent t-tests were used to examine differences in the amount of time spent in each play style across episode one and two. Results: Mothers exhibited attention-supporting play for the longest duration of time during play episodes one and two. Subsequently, the mothers engaged in attention-directing play. Control play was demonstrated the least. Statistically significant differences were noted in attention-supporting such that mothers increased the time spent using attention-supporting play during play episode two in comparison to play episode one. Conclusion: Mothers of very young infants appeared to adjust their play styles and this may reflect the dynamic nature of co-occupations such as maternal-infant play.

Online survey examining practitioners' perceived preparedness in the early identification of autism.

The purpose of this study was to examine the perceived preparedness of practitioners in the early identification of children ages birth to 6 yr with autism spectrum disorder (ASD). Both occupational therapists and occupational therapy assistants were included in this survey study. The online survey instrument consisted of 29 questions within six sections capturing participant demographics, delivery of occupational therapy services, action when autism is suspected, service delivery experience, resource sharing, and barriers to conducting autism screening. The results of the study provide baseline information concerning identified skills, practices, and barriers among 1,396 practitioners. Additionally, opportunities are revealed for professional development necessary to support practitioners in the early identification of children at risk for ASD through surveillance and screening among children ages birth to 6 yr.

Exploring ordinary childhood occupations through community partnerships.

The purpose of this paper is to discuss an innovative assignment, The Occupational Outline and Disability Status Report, and to describe how a community-academic partnership was formed. Community-academic collaborations provide students with the opportunity to observe children in natural environments. This partnership facilitates the development of clinical reasoning skills necessary for pediatric practice in community settings. Through observation of ordinary childhood occupations at a childrens museum and a written assignment, students identify the significance of play and social participation while hypothesizing about the influence of impairments on performance.

African American Fathers’ Occupational Participation: “Keeping the Mothers in a Positive Vibe”:

Infant mortality is a major public health issue in the United States that disproportionally affects African Americans. Evidence suggests reducing stress on African American women and engaging African American fathers may improve health and social outcomes for families. This study sought to understand the experiences of African American fathers through a positivistic lens and to inform future interventions that support father engagement. A descriptive, qualitative study using the Person, Environment, Occupation–Performance (PEO-P) model as a framework for analysis was conducted involving 45 fathers participating in four focus groups and one member-checking group. An initial content analysis was followed by constant comparative methods to identify categories related to the PEO-P model. Transcripts revealed a range of factors that enable or inhibit fathers’ occupational performance and engagement including environmental barriers such as societal expectations and perceptions. Occupational therapy practitioners may utilize population health approaches to support African American fathers’ occupational engagement.