Narrative Theater to Examine and Mitigate Anti-Black Racism Within Occupational Therapy.

Theater has long-standing roots in social justice and holds promise for reducing racist attitudes and behaviors. Objectives of this study were to (a) collect and theatrically portray narratives from Black occupational therapy students and practitioners to a national audience and (b) examine the impact of the theatrical performance on anti-Black racism among attendees. The Identity Development Evolution and Sharing (IDEAS) model guided translation of narratives into a filmed performance. Paired t-test of pre/post administration of the Acceptance and Action Questionnaire-Stigma (AAQ-S) measured changes in stigma beliefs. Qualitative thematic analysis of an open-ended post-survey question elucidated experiences of the performance. The performance engendered significant decreases in stigma; qualitative data elucidated potential mechanisms of change. This study provides insight into experiences of anti-Black racism within occupational therapy and offers a promising means for occupational therapists to engage in anti-Black racism.

Parent-Mediated Intervention for One-Year-Olds Screened as At-Risk for Autism Spectrum Disorder: A Randomized Controlled Trial.

Theoretically, interventions initiated with at-risk infants prior to the point in time a definitive autism spectrum disorder (ASD) diagnosis can be made will improve outcomes. Pursuing this idea, we tested the efficacy of a parent-mediated early intervention called Adapted Responsive Teaching (ART) via a randomized controlled trial with 87 one-year-olds identified by community screening with the First Year Inventory as at-risk of later ASD diagnoses. We found minimal evidence for main effects of ART on child outcomes. However, ART group parents showed significantly greater increases in responsiveness to their infants than control group parents. Further, significant indirect (mediation) effects of assignment group on multiple child outcomes through changes in parent responsiveness supported our theory of change.

Predictors of Parent Responsiveness to 1-Year-Olds At-Risk for Autism Spectrum Disorder.

Parent responsiveness is critical for child development of cognition, social-communication, and self-regulation. Parents tend to respond more frequently when children at-risk for autism spectrum disorder (ASD) demonstrate stronger social-communication; however, it is unclear how responsiveness is associated with sensory characteristics of children at-risk for ASD. To address this issue, we examined the extent to which child social-communication and sensory reactivity patterns (i.e., hyper- and hypo-reactivity) predicted parent responsiveness to 1-year-olds at-risk for ASD in a community sample of 97 parent-infant pairs. A combination of child social-communication and sensory hypo-reactivity consistently predicted how parents played and talked with their 1-year-old at-risk for ASD. Parents tended to talk less and use more play actions when infants communicated less and demonstrated stronger hypo-reactivity.

An occupation-centered discussion of development and implications for practice.

Children's learning to do everyday activities seems so obvious that the mechanisms bringing about the development of occupations remain essentially unstudied. Therefore, occupational therapy uses developmental models from other disciplines as foundation for practice. We specialists in childhood occupations need a theory-based and empirically tested body of knowledge about the processes leading to change to inform practice and guide interventions during efficacy studies. One body of knowledge about developmental mechanisms views change as originating from within the child and informs practice centered on changing the child. Given the inseparable nature of children and their social environments and daily activities, we introduce the philosophy of contextualism and outline a potential body of knowledge about a change process that is occupation centered. An intervention arising from a contextual perspective illustrates how this way of thinking leads to occupation-centered practice that uses multiple strategies and supports a child's occupation with social participation with peers.

Telerehabilitation position paper.

Though the use of telerehabilitation technologies is expanding quickly as a viable method of service delivery for many practitioners within the field of health care, there remain issues of efficacy, cost, reimbursement, legal and ethical ramifications, and practitioner competence. There is a significant need for occupational therapy practitioners to document, research, and publish on the efficacy of consultation, intervention, and follow-up services provided using telerehabilitation technologies. Further investigation of the use of telehealth technologies in professional development and supervision is needed to clarify effectiveness and efficiency, as demand for services, particularly in rural areas, threatens to exceed services available. Occupational therapy practitioners using telerehabilitation methods must adhere to the AOTA Occupational Therapy Code of Ethics (AOTA, 2000), maintain the AOTA Standards of Practice (AOTA, 2005), and comply with state regulations, ensuring both their proficiencies as practitioners and the well being of their clients.

Preliminary efficacy of adapted responsive teaching for infants at risk of autism spectrum disorder in a community sample.

This study examined the (a) feasibility of enrolling 12-month-olds at risk of ASD from a community sample into a randomized controlled trial, (b) subsequent utilization of community services, and (c) potential of a novel parent-mediated intervention to improve outcomes. The First Year Inventory was used to screen and recruit 12-month-old infants at risk of ASD to compare the effects of 6-9 months of Adapted Responsive Teaching (ART) versus referral to early intervention and monitoring (REIM). Eighteen families were followed for ~20 months. Assessments were conducted before randomization, after treatment, and at 6-month follow-up. Utilization of community services was highest for the REIM group. ART significantly outperformed REIM on parent-reported and observed measures of child receptive language with good linear model fit. Multiphase growth models had better fit for more variables, showing the greatest effects in the active treatment phase, where ART outperformed REIM on parental interactive style (less directive), child sensory responsiveness (less hyporesponsive), and adaptive behavior (increased communication and socialization). This study demonstrates the promise of a parent-mediated intervention for improving developmental outcomes for infants at risk of ASD in a community sample and highlights the utility of earlier identification for access to community services earlier than standard practice.