Development, reliability, and validity of the Sensory Adventure Measure.

INTRODUCTION: Sensory modulation refers to a condition in which an individual's behavioural responses to sensory stimuli do not correspond to the nature or intensity of the stimuli. Sensory modulation affects children's participation in everyday activities and their well-being. The most common assessments used are caregiver questionnaires. Our aim is twofold; first to develop a clinical evaluative measure, the Sensory Adventure Measure (SAM), for directly assessing sensory modulation in children via therapists and children's self-report, second, we aim to establish its reliability and validity. METHODS: The study sample comprised 87 children ranging in age from 4 to 6 years and 11 months old divided into two groups: study group included 63 children with mild developmental disabilities and the control group included 24 typically developed children. The SAM's internal consistency, test-retest reliability, and inter-rater reliability were examined. In addition, criterion validity was established using the total score of the Short Sensory Profile (SSP) and construct validity was established by known group differences. RESULTS: The SAM exhibited good internal consistency (α = 0.83, 0.85) and moderate to very good test-retest reliability (r = 0.96, 0.98, 0.75). Inter-rater reliability was strong (r = 0.80-0.83). Moderate correlation was found between the SAM Therapist Rating of Magnitude total score and the total score of the SSP and significant differences were found in the SAM scores between groups thus establishing validity. CONCLUSIONS: The SAM demonstrated good psychometric properties and can be used as a reliable and valid measure to assess sensory modulation among children aged 4 to 6 years. The SAM can be used by therapists to assess sensory modulation disorder based on observed responses to sensory stimuli and the child's self-report. The SAM contributes additional perspective to the evaluation process of sensory modulation disorder.

Participation in Everyday Activities of Children with and without Specific Learning Disorder.

AIM: To evaluate the participation in everyday activities of school-aged children with and without Specific Learning Disorder (SLD) in two samples using two different standardized measures of participation. METHODS: Study 1 comprised 60 children between 8 and 12 years (M = 10.2, SD = 1.2), 30 of them with and 30 without SLD. Participation was assessed by the LIFE-H questionnaire. Study 2 comprised 30 children between 8 and 12 years (M = 10.1, SD = 1.3), 14 of them had SLD, and 16 were typically developing children. Participation was assessed using the Child Participation Questionnaire. RESULTS: As expected, the participation of children with SLD was significantly decreased in the learning domain compared with children without SLD as well as most other occupational domains. Parents of children with SLD reported lower child's enjoyment and lower parental satisfaction compared to parents of children without SLD. CONCLUSIONS: Participation and satisfaction of children and families was lower in children with SLD. We suggest measuring participation and addressing it in evaluations and interventions with this population in order to support their engagement in daily activities beyond school participation and to focus on additional needs of this population.

Relationships among Sensory Responsiveness, Anxiety, and Ritual Behaviors in Children with and without Atypical Sensory Responsiveness.

AIM: To explore relationships between sensory responsiveness, anxiety, and ritual behaviors in boys with typical and atypical sensory responsiveness. METHOD: Forty-eight boys, ages 5-9 participated in the study (28 boys with atypical sensory responsiveness and 20 controls). Atypical sensory responsiveness was defined as a score of ≤154 on the Short Sensory Profile. Parents completed the Sensory Profile, the Screen for Child Anxiety Related Emotional Disorders, and the Childhood Routines Inventory. RESULTS: Children with atypical sensory responsiveness had significantly higher levels of anxiety and a higher frequency of ritual behaviors than controls. Atypical sensory responsiveness was significantly related to both anxiety and ritual behaviors, with anxiety mediating the relationship between sensory modulation and ritual behaviors. CONCLUSIONS: The findings elucidate the potential consequences of atypical sensory responsiveness and could support the notion that ritual behaviors develop as a coping mechanism in response to anxiety stemming from primary difficulty in modulating sensory input.

Sensory modulation and daily-life participation in people with schizophrenia.

Schizophrenia is considered to be an extreme mental health disturbance that affects a person's well-being and participation in everyday activities. Participation in meaningful everyday occupations is an important component of recovery from mental illness, the ultimate goal of mental health services. The participation restrictions of people with schizophrenia have been widely investigated through different factors, such as illness symptoms and course, cognition, and demographic data; however, the resulting explanations were incomplete. The purpose of the study was to explore the contribution of sensory modulation (SM), in addition to cognition and schizophrenia symptoms, to participation in daily life activities of people with schizophrenia. Forty nine in-patients with schizophrenia (study group) and 32 adults without mental illness (control group) comprised the study. They were assessed for their participation patterns, sensory modulation processes, cognitive functioning and symptoms severity. Results indicate significant differences between the study groups in most measurements addressed: participation (diversity and satisfaction), sensory modulation scores (intensity of the response and frequency of response), and cognitive measurements. The most contributive parameters for the prediction of participation dimensions among people with schizophrenia were negative symptoms severity and general cognitive status. In conclusion, people with schizophrenia experience SM disorder with an under responsive tendency. However the complex condition of schizophrenia dominates its influence on participation dimensions.

Equine Assisted Occupational Therapy for Children with Adhd (Astride): Protocol Development and Preliminary Study.

Objective: Children with Attention Deficit Hyperactivity Disorder (ADHD) are often referred to Equine-Assisted Services (EAS) for therapy despite lack of validated protocols in the field. This paper reports the development and validation of ASTride (ADHD Skills Therapy): a protocol of Equine-Assisted Occupational Therapy (EAOT) intervention for children aged 6-12 with ADHD. The intervention addresses deficits in cognitive-emotional functions and participation. Method: Phase one of the intervention development includes theoretical framework and core content based on an in-depth review of existing literature. Subsequently, the intervention protocol was revised by a panel of experts. Phase two includes a pilot study, during which five children diagnosed with ADHD (mean age= 10.40 year, SD 2.966) participated in a 12-week EAOT intervention according to the suggested protocol, with pre- and post-assessments conducted. Results: Statistically significant improvements were found in executive functions, as reflected in the Behavioral Regulation Index (BRI) total score. Additionally, hope perception and everyday performance improved following the intervention. Conclusions: Results support the feasibility of ASTride intervention protocol for the improvement of cognitive and emotional functions as well as everyday performance.

Breastfeeding-related Pain, Sensory Over-responsiveness, and Exclusive Breastfeeding at 6 Months: A Prospective Cohort Study.

BACKGROUND: Exclusive breastfeeding (EBF) is recommended for the first 6 months of life, yet EBF rates at 6 months (T3) in most developed countries are low. Painful and nonpainful sensory stimuli processing is linked, and while pain has been suggested to restrict breastfeeding, its coupling with sensory over-responsiveness (SOR) in relation to breastfeeding has not yet been reported. OBJECTIVE: We aimed to explore whether breastfeeding-related pain, SOR, and general pain sensitivity predict nonexclusive breastfeeding (NEBF) at T3. STUDY DESIGN: In this prospective study, participants were recruited at 2 days postpartum (enrollment). For the assessment of breastfeeding-related pain, participants completed the visual analogue scale and the Short-Form McGill Pain Questionnaire at enrollment, and at 6 weeks after birth. At T3, they completed the Pain Sensitivity Questionnaire and the Sensory Responsiveness Questionnaire-Intensity Scale and then provided information about their breastfeeding status. Participants were divided into two groups accordingly: EBF and NEBF. RESULTS: A total of 164 participants were reached at T3: EBF (n = 105) and NEBF (n = 59). The incidence of SOR was significantly higher among NEBF compared with EBF participants (25.4% vs. 11.4%; p = .020). Between enrollment and 6 weeks after birth, 72.3% of the EBF participants had reported a ≥30% pain reduction, compared with 44.8% of the NEBF participants (p = .001). Logistic regression modeling revealed that both breastfeeding-related pain reduction and SOR predicted NEBF at T3 (p < .001), indicating a 3.2 times (p = .001) and 2.5 times (p = .041) odds ratio for NEBF, respectively. CONCLUSIONS: SOR and sustained breastfeeding-related pain predict NEBF at T3 and may emerge as substantial breastfeeding barriers.

Validation of the Israeli version of the Rivermead Behavioral Memory Test for children following acquired brain injury.

OBJECTIVE: To further validate the Rivermead Behavioral Memory Test for Children (RBMT-C) for use in children with acquired brain injury (ABI). We hypothesized that the RBMT-C could differentiate between children with and without ABI. We also hypothesized that construct validity would be supported by significant correlations with additional cognitive tests. METHOD: A total of 58 children (6-11 years old), comprising 29 children diagnosed as having ABI (15 girls, 14 boys) and 29 healthy children (15 girls, 14 boys), participated. Children were administered the RBMT-C and the Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch). The Functional Independence Measure for Children (WeeFIM) was completed by the staff members. RESULTS: There were significant differences in memory between children with ABI and the healthy children [t (35) = 4.94, P < .00]. Significant correlations were found between memory as measured by the RBMT-C and cognitive status as measured by the DOTCA-Ch, as well as cognitive function scores in the WeeFIM supporting convergent validity. Nonsignificant correlations were found between the motor function scores (WeeFIM) and the memory scores (RBMT-C), supporting divergent validity. CONCLUSIONS: The study results suggest that the RBMT-C can differentiate between children with and without memory difficulties. However, further studies are needed to establish the Israeli version validity.

Complementary contribution of parents and therapists in the assessment process of children.

BACKGROUND/AIM: Traditional developmental models assume that the underlying capacities of children contribute to their participation. In this framework, preschoolers who are referred for occupational therapy services usually undergo an assessment intended to identify capacities in certain domains. Contrary to this, newer ecological models assume that child participation is a consequence of a multidimensional interaction between personal and environmental factors. As a result clinicians are increasingly focusing their assessment on performance and participation. This study aimed to assess the correlation between children's performance skills, their capacities and participation; and to explore whether parents' observations, alongside therapist observations and standardised assessments, contribute to an enhanced understanding of child participation. METHOD: Participants included 188 parents and their children, aged 4-6 years, with and without mild developmental difficulties. Data were collected using standardised assessments for child capacities, and questionnaires completed by parents and occupational therapists regarding child participation and performance skills. RESULTS: Significant correlations were found between parent assessments of child performance skills and child participation, but not with child capacities. The opposite was found to be true for occupational therapist assessments of child performance skills which were found to correlate with child capacities, but not with participation. Additionally, an interaction effect was found for both groups. Occupational therapists reported higher performance skills as compared to parents, but the difference was only significant for children without mild difficulties. CONCLUSION: As suggested by ecological models of child participation, the findings highlight the importance of parent-therapist collaboration in the assessment process of children.

The Effect of a Short-Term Occupational Therapy Intervention on the Participation and Personal Factors of Preschoolers with Developmental Disabilities.

BACKGROUND: Preschoolers with developmental disabilities are referred to occupational therapy due to their decreased participation in daily life occupations. The purpose of this study was to evaluate the improvement in preschoolers' participation and sensory-motor abilities following an occupational therapy intervention. MATERIALS AND METHODS: A prospective cohort study of 38 preschoolers and their parents was conducted using an interrupted time-series design, including assessments at three time points: base line (upon referral to an occupational therapy assessment), pre-intervention, and post-intervention after 9-12 sessions of occupational therapy interventions. Children were evaluated with the Developmental Test of Visual-Motor Integration, as well as the balance and fine motor precision sub tests of the Bruininks-Oseretsky Test of Motor Proficiency. Parents completed the Children's Participation Questionnaire and the Child Performance Skills Questionnaire. Each intervention session was documented by the therapists using the Documentation of Occupational Therapy Session Intervention form. RESULTS: Significant improvement in children's sensory-motor abilities were found in balance, visual integration, and fine motor precision post-intervention. There were also improvements in the measures of diversity, children's independence, and parental satisfaction. CONCLUSIONS: A short-term occupational therapy intervention applied to preschoolers with developmental disabilities is effective in improving their sensory-motor abilities, as well as in promoting their participation in daily activities.

Does infant sensory responsiveness explain exclusive breastfeeding 6 months after birth?-a cohort prospective study.

Background: Although exclusive breastfeeding (EBF) is recommended for the first 6 months of life, breastfeeding rates in most developed countries are low. Sensory over-responsivity (SOR) has been found to interfere with infant and childcare, development, and routines, but has not yet been examined as a breastfeeding barrier. The aim of this study was to explore the association between infant sensory responsiveness and EBF and whether it can predict EBF cessation prior to 6 months of age. Methods: In this cohort prospective study participants were 164 mothers and their infants recruited 2 days after birth in a maternity ward between June 2019 and August 2020. At this time, participating mothers completed a demographic and delivery information questionnaire. At 6 weeks after birth, the mothers completed the Infant Sensory Profile 2 (ISP2), reporting their infants' sensory responsiveness in daily activities. At 6 months, infants' sensory responsiveness was assessed using the Test of Sensory Functions in Infants (TSFI) and the Bayley Scales of Infant and Toddler Development-3rd Edition (Bayley-III) was administered. Additionally, mothers provided information about their breastfeeding status and were divided into two groups accordingly: EBF and non-EBF (NEBF). Results: The incidence of atypical sensory responsiveness (mostly of the SOR type) at 6 weeks was twice as high among NEBF infants than EBF infants (36.2% vs. 17%, χ2=7.41, P=0.006). Significant group differences were found in the ISP2 touch section (F=10.22, P=0.002). In addition, NEBF infants displayed more SOR behaviors than EBF infants in the TSFI deep touch (F=2.916, P=0.001) and tactile integration subtests (F=3.095, P<0.001), and had lower scores in the adaptive motor functions subtest (F=2.443, P=0.013). Logistic regression modeling revealed that ISP2 at 6 weeks (typical vs. atypical) and TSFI total score at 6 months predicted 28% of NEBF at 6 months (χ2=23.072, P=0.010). Conclusions: Infant atypical sensory responsiveness, predominantly of the SOR type, was found to predict NEBF at 6 months after birth. This study contributes to the understanding of EBF barriers, highlighting the importance of early identification of SOR in infants. Findings may suggest developing early sensory interventions and providing individualized breastfeeding support tailored to the infant's unique sensory profile.

Study of recovery model implementation in psychiatric hospitals: Clients and multidisciplinary staff perspective.

The recovery model guides mental health services. However, the delivery of recovery-oriented services in inpatient settings is still a challenge. Factors affecting recovery model implementation can be classified into three types: the hospital environment, the inpatient and the service provider. This study aims to quantitatively evaluate the impact of environment, inpatient and service provider factors on recovery model implementation in hospitals. Forty-five service providers and 42 inpatients from three types of wards (acute locked, acute open and daycare) of two hospitals participated in this cross-sectional study. We assessed inpatient cognition, functional capacity and illness severity. In addition, we retrieved information on service providers' professional status and evaluated the recovery model knowledge and attitudes. Implementation of the recovery model was measured using the Recovery Self-Assessment, both the inpatient and service provider versions. Differences were found between the three types of wards in recovery orientation as reported by service providers ( χ 2 2  = 15.3, P < 0.001), but not by inpatients ( χ 2 2  = 2.34, P > 0.05). Providers' internalized knowledge and attitudes toward recovery, inpatients' functional capacity and age of illness onset were associated with recovery implementation (0.31 < r < 0.48, P < 0.05). The findings confirm quantitatively the multilevel nature of factors that affect the implementation of the recovery model in psychiatric hospitals. The inpatients' perspective should be incorporated into the service development process. Based on the study results, the reduction in the restrictive features of the wards' environment is recommended. Promotion of the recovery model implementation in the hospital setting requires the expansion of staff's internal positive attitudes toward recovery.

An escalating continuum of learning and attention difficulties from premutation to full mutation in female carriers of FMR1 expansion.

Objective: Carriers of Fragile X premutation may have associated medical comorbidities, such as Fragile X-associated tremor and ataxia (FXTAS) and Fragile X-associated premature ovarian insufficiency (FXPOI). We examined the Fragile X premutation effect on cognition, and we assumed that there is a direct correlation between the continuous spectrum of specific learning and attention deficits to the number of CGG repeats on the FMR1 gene. Methods: A total of 108 women were referred to our center due to a related Fragile X syndrome (FXS) patient, 79 women carried a premutation of 56-199 repeats, and 19 women carried a full mutation of more than 200 CGG repeats on FMR1 gene. Genetic results of CGG repeats, demographic information, structured questionnaires for ADHD, learning disabilities of language and mathematics, and independence level were analyzed in women carrying the FMR1 premutation and compared to the group carrying the full mutation. Women with FXS and FXTAS were excluded. Results: When analyzed as a continuum, there was a significant increase in the following complaints which were associated with a higher number of repeats: specific daily function skills such as driving a car, writing checks, disorientation in directions, and also specific learning difficulties such as spelling and math difficulties. Additionally, when tested as a categorical independent variable, we observe that women with the full mutation were more likely to have ADHD or other learning disability diagnoses in the past than during premutation (<200 CGG repetitions). Conclusion: Specific learning and attention difficulties and resulting daily function difficulties correlate with an increased number of CGG repeats and are more likely to be associated as a common feature of premutation and full mutation in a female premutation carrier. Despite evidence of learning and attention difficulties, it is encouraging that most female carriers of the premutation and full mutation function well in most areas. Nevertheless, they face significant difficulties in specific areas of functioning such as driving, and confusion in times and schedules. Those daily function skills are mostly impacted by dyscalculia, right and left disorientation, and attention difficulties. This may aid to design specific interventions to address specific learning deficits in order to improve daily function skills and quality of life.

The Role of Motor Coordination, ADHD-Related Characteristics and Temperament among Mothers and Infants in Exclusive Breastfeeding: A Cohort Prospective Study.

Although exclusive breastfeeding is recommended for the first 6 months of life, breastfeeding rates are low. Motor skills and ADHD-related characteristics have not yet been examined as breastfeeding barriers. The aim of this study was to explore whether mothers' and infants' motor skills, mothers' ADHD-related characteristics and infants' temperament are associated with exclusive breastfeeding at 6 months after birth. Participants were 164 mothers and their infants recruited 2 days after birth. Mothers completed a demographic and delivery information questionnaire, the Infant Feeding Intentions Scale and the Iowa Infant Feeding Attitude Scale. At 6 months, mothers completed the Adult DCD (developmental coordination disorder)/Dyspraxia Checklist, the Adult ADHD (attention deficit hyperactivity disorder) Self-Report Scale Symptom Checklist-v1.1, and the Infant Characteristics Questionnaire, and provided information about their breastfeeding status. They were then divided into two groups accordingly: EBF (exclusive breastfeeding) and NEBF (non-exclusive breastfeeding). Infants were observed using the Test of Sensory Functions in Infants and the Alberta Infant Motor Scale. At 6 months, NEBF mothers reported higher prevalence of DCD (10.2% vs. 1.9%, χ2 = 5.561, p = 0.018) and ADHD (20.3% vs. 8.6%, χ2 = 4.680, p = 0.030) compared to EBF mothers. EBF infants demonstrated better motor coordination (t = 2.47, p = 0.016, d = 0.511), but no temperament differences compared to NEBF infants. Maternal DCD, ADHD and poor infant motor coordination are associated with non-exclusive breastfeeding and may become exclusive breastfeeding barriers. These findings may assist in identifying women at risk of not exclusively breastfeeding and encourage tailoring interventions for achieving higher exclusive breastfeeding rates.

Efficiency of the home parental programme in visual-motor home activity among first-grade children.

BACKGROUND: The objectives of this study were to assess the efficacy of the home parental programme (HPP) in improving children's visual-motor skills, and to assess parent satisfaction with the programme. METHODS: Forty-five children and their parents participated in the study: 23 children and their parents in the study group (children receiving consultation in the classroom and whose parents participated in the HPP) and 22 children and their parents in the control group (children receiving consultation in the classroom only). All children were recruited based on their scores on the Visual Motor Integration test or upon teacher referral. The Developmental Test of Visual Perception-2 administered before and after intervention served as an outcome measure. HPP lasted approximately 12 weeks and included relevant visual-motor activities carried out at home by the parents with their children. RESULTS: The study failed to prove that HPP improved children's visual-motor skills beyond the other service delivery methods used in the present study. CONCLUSIONS: Parent satisfaction was significantly higher among those who participated in the HPP. Parents showed high compliance with the friendly programme despite their low socio-economic status.

Effect of focus of attention and age on motor acquisition, retention, and transfer: a randomized trial.

BACKGROUND AND PURPOSE: Adult participants benefit more from external focus than internal focus when learning a new motor skill. Because learners from different age groups use different learning strategies, the purpose of this study was to investigate whether the effect of attention focus varies among children and adults. SUBJECTS AND METHODS: Thirty-four children and 32 adults were randomly assigned to internal or external focus-of-attention practice groups. Throwing darts toward a static target, participants performed 50 acquisition trials, 20 retention trials, and 20 transfer trials. RESULTS: The results indicate that focus of attention varies between children and adults in accuracy and variability in the acquisition phase and in accuracy in the transfer phase. No interactions were found in the retention phase. DISCUSSION AND CONCLUSION: The findings suggest that external focus is more effective than internal focus in adults; therefore, physical therapists should instruct adult clients to focus their attention externally to facilitate motor learning. Physical therapists working with children should perhaps direct the client's attention internally; however, further study is needed.

Comorbidity between balance and anxiety disorders: verification in a normal population.

Comorbidity between balance and anxiety disorders has been documented in clinical psychiatric and neurological samples. The authors aimed to determine whether the comorbidity of balance and anxiety disorders has an analogous representation in the normal population. Participants were 20 undergraduate students ages 22-29 years. The authors assigned them to high or low trait anxiety groups and performed a balance task in 3 experimental stages: baseline, training, and test. The baseline and test stages consisted of 4 wobbly and 4 stable trials each. The authors measured state anxiety in the form of auditory startle responses (ASRs) during the stable trials. In the baseline stage, the ASR amplitudes were higher in the high trait anxiety participants. In the test stage, the low trait anxiety participants performed the balance task better than the high trait anxiety participants did. These data suggest that the clinical entity designated as a comorbidity of balance and anxiety disorders has an analogous representation in the normal population.

Managing Everyday Occupations as a Predictor of Health and Life Satisfaction Among Mothers of Children With ADHD.

OBJECTIVE: Raising a child with special needs disturbs the balance of family life and affects mothers' everyday life. The purpose of this study was to assess the contribution of occupational competence, occupational settings, and role load to the health and life satisfaction of Arab mothers of children with and without ADHD. METHOD: Participants included 40 Israeli Arab women aged 25 to 40 years. Half were mothers of children with ADHD and half were mothers of children without ADHD. Data were collected by using four self-report questionnaires. RESULTS: Occupational competence and occupational settings predicted mothers' mental health and life satisfaction. Having or not having a child with ADHD only reflects a minor contribution. CONCLUSION: Enhancing mothers' occupational competence and settings may increase their health and life satisfaction. This study highlights the need to focus on maternal occupational competence and settings as they affect mothers' health and well-being when providing intervention to children with ADHD.

A short-term graphomotor program for improving writing readiness skills of first-grade students.

OBJECTIVE: Children with fine-motor problems and handwriting difficulties often are referred for occupational therapy. The objective of this study was to test the efficacy of a short-term treatment on the fine-motor and graphomotor skills of first-grade students. METHOD: We recruited 52 first-grade students who had scored below the 21st percentile on the Visual-Motor Integration test from schools in a city with a low socioeconomic, mixed (Arab and Jewish) population. The children were randomly divided into an intervention group and a control group. Before and after the intervention, we administered two tests to both groups. RESULTS: Students in the intervention group made significant gains both in the total score on the graphomotor test (Developmental Test of Visual Perception) and on the fine-motor test (Bruininks-Oseretsky Motor Development Scale). CONCLUSION: This study provided preliminary evidence of the efficacy of a short-term graphomotor intervention. The results increased the feasibility of implementing occupational therapy intervention in the Israeli school system, allowing treatment of more children using the same resources.

Motor Difficulties and Their Effect on Participation in School-Aged Children.

PURPOSE: The purpose was to examine whether children diagnosed with motor problems in the preschool period still exhibit motor problems at school age and the impact of these difficulties on participation. METHOD: The study group comprised 60 children 7-12 years old who were referred to occupational therapy 4-6 years prior to study initiation due to motor difficulties. The control group comprised 28 age-matched children with typical development. Parents completed the Participation, Developmental Coordination Disorder and Performance Skill Questionnaire 4-6 years after treatment. RESULTS: Significant differences were found between children with and without motor difficulties in motor function, but not in any of the participation domains except for parental satisfaction. Children in the control group had significantly higher scores than children with motor difficulties in motor and process skills. CONCLUSIONS: Motor difficulties persist into school years. Children with motor difficulties manifest performance skill problems, however they succeed in narrowing the gap and participate similar to their peers.