Children's Responses to Sensory Stimuli and their Behavior in the Dental Office.

OBJECTIVES: To evaluate children's behavior during dental examinations, their reactions to various selected sensory stimuli and the association between them. STUDY DESIGN: Sixty-three children (28 boys and 35 girls) aged 5-12 years (mean age 7.9 ± 1.6 years) participated in the study. Their parents were asked to complete a questionnaire while in the dentist's waiting room. The dentists evaluated the children's behavior in the dental office using Frankl's behavioral scale and noted the children's reactions to the sensory stimuli of touch, noise, smell and backward tilting of the examination chair. RESULTS: Most of the children cooperated during the dental examination. Lack of cooperation was associated with adverse reactions to all selected sensory stimuli. There was also an association between resistance to brushing teeth and adverse reaction to touch. Children who reacted negatively to sensory stimuli during dental examinations were more likely to have needed advanced management techniques during past dental treatment. CONCLUSIONS: Children's behavior during dental examinations is known to be affected by many factors, including age, previous experiences, anxiety and fear and others. This investigation demonstrates that it is also associated with their reactions to various sensory stimuli.

Effectiveness of a cognitive-functional group intervention among preschoolers with attention deficit hyperactivity disorder: a pilot study.

OBJECTIVE: To test functional improvement after a group cognitive-functional occupational therapy intervention for preschoolers with attention deficit hyperactivity disorder (ADHD). METHOD: Seventeen preschooler-parent dyads attended 11 weekly group sessions focused on acquiring executive strategies through occupational performance. Functional improvement was measured using the Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS); executive function, using the Behavior Rating Inventory of Executive Function-Pediatric; ADHD symptomatology, using Conners' Parent Rating Scale-Revised and Conners' Teacher Rating Scale-Revised; and social functioning, using the Social Participation scale of the Sensory Processing Measure. RESULTS: Significant improvement was found on the COPM and GAS measures, whereas mixed results were found on the other measures, with improvements found in children whose scores indicated impairment at baseline. CONCLUSIONS: Cognitive-functional group intervention appears to significantly improve daily functioning, executive function, and social functioning for children who demonstrate clinical impairment. Further research with a larger sample, a control group, and follow-up is required.

Social skills of kindergarten children with Global Developmental Delay (GDD), with and without Developmental Coordination Disorder (DCD).

AIM: A high prevalence of co-occurring Developmental Coordination Disorder (DCD) has been noted in the population of children with global developmental delays (GDD). The presence of developmental disabilities in general, and DCD in particular, constitute a risk factor for difficulties in social skills. However, to the best of our knowledge, no studies, have examined the unique contribution of DCD to social skills, over and above the effect of other general developmental impairments. The aim of this study was to compare the social skills of kindergarten children with Global Developmental Delay, with and without DCD. METHODS: Participants included 26 kindergarten children with Global Developmental Delay and DCD (Mage = 4.92, 61 % boys), and 26 children with Global Developmental Delay without DCD (Mage = 5.09, 69.25 % boys). All participants' parents and kindergarten teachers completed the Social Skills Improvement System Questionnaire (SSIS). RESULTS: Children with GDD only performed significantly better on social skills compared to children with GDD and DCD. Parents in general reported better social skills and less behavioral problems compared to kindergarten teachers. CONCLUSIONS: The findings contribute to the accumulating body of knowledge regarding social abilities of children with developmental disabilities and present new information as to the unique effect of DCD in this domain. Routine evaluation of social skills should be conducted among children with GDD and DCD, taking into account the negative influence that motor dysfunction has in this domain. Furthermore, children's social performance in different environments needs to be considered by relating to both parents and kindergarten teachers' perspective. Subsequent intervention programs should then address the unique profile of this population.

Sensory Modulation in Children Exposed to Continuous Traumatic Stress.

Preliminary evidence supports a possible association between post-traumatic stress disorder (PTSD) and sensory modulation disorder (SMD). Nevertheless, the research focusing on this relationship in children is notably limited. This study examined children with and without PTS symptoms, by comparing their mothers' perceptions of their responses to sensory events in daily life. Mothers of 134 non-referred children aged 5-11, exposed to continuous traumatic stress due to political violence, completed the UCLA-RI and the Short Sensory Profile questionnaires. Significant differences emerged between children with different levels of PTS symptoms in various sensory modalities. Furthermore, half of the symptomatic children had suspected clinically significant deficits in sensory processing. In addition, PTSD symptoms were significantly associated with most of the sensory processing scores. Logistic regression indicated that the overall sensory processing score was a significant predictor of group classification. The results indicate that children with PTS symptoms may be at increased risk for sensory processing deficits. Evaluation of sensory processing should be incorporated into the routine evaluation of this population in order to determine whether this is an additional factor contributing to a child's difficulties in participating in daily activities. Subsequent intervention programs should then address the multiple needs of these children.

Long-term impact of maternal posttraumatic symptoms on children's regulatory functioning: A four-year follow-up study.

BACKGROUND: The interrelation between exposure to trauma, posttraumatic stress disorder (PTSD), and regulatory functioning in children is gaining increasing attention. This study examines the effects of maternal posttraumatic symptoms (PTS) on child deficits in sensory regulation, behavior regulation, and executive functioning. METHOD: The sample at the first measurement (2011, T1) included 382 Israeli mothers and their young children (child's mean age = 3.89 years; SD = 1.26), and 240 of them were reassessed after 4 years (2015, T2). Mothers self-reported their trauma exposure and posttraumatic distress symptoms (PTSD) and filled out questionnaires on their children's sensory regulation (new version of the Short Sensory Profile including sensory processing and behavior regulation as well as their level of executive functioning (Dysexecutive Questionnaire). RESULTS: A path model showed that maternal PTS at T1 predicted maternal PTS at T2, which in turn was associated with problems in their children's sensory regulation, behavior regulation, and their level of executive functioning. These results highlight the relationship between mother's posttraumatic distress and her child's regulatory functioning. CONCLUSIONS: The study supports the construct of relational PTSD and broadens it to additional aspects of children's deficits in sensory regulation, behavior regulation, and executive functioning. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Development and psychometric properties of the Sensory Responsiveness Questionnaire (SRQ).

PURPOSE: Individuals with Sensory Modulation Disorder (SMD) are characterized by an inability to normally grade the degree, intensity and nature of their responses to sensory input and are limited in their ability to fully participate in daily life activities, and attain optimal quality of life. Most existing diagnostic tools are intended for paediatric populations. A questionnaire that assesses the intensity of the affective-emotive responsiveness of adults to stimuli in all sensory modalities and the frequency of such responses for diagnosing adults with disorders in sensory modulation is necessary. This article describes the development and assessment of the psychometric properties of a novel instrument, the Sensory Responsiveness Questionnaire (SRQ), for this purpose (see Appendix). METHOD: The SRQ evolved through three developmental phases (Pilot, Version-I, and the most recent Version-II). Each phase comprised several studies conducted to further refine the instrument and to examine its psychometric properties with adults with Sensory Modulation Disorder versus SMD-free individuals (n=39 for the pilot version, n=399 for Version-I, and n=48 for Version-II). RESULTS: The scales of Version-II indicated high test-retest reliability, moderate criterion validity and strong significant construct validity. CONCLUSION: There is strong indication that the SRQ can be used to diagnose adults with SMD.

The Participation in Childhood Occupations Questionnaire (PICO-Q): a pilot study.

There is a need, among practitioners and researchers, for a feasible, user-friendly assessment tool that evaluates overall participation and guides intervention. This paper describes the process of construction and development of the Participation in Childhood Occupations Questionnaire (PICO-Q) and the establishment of its primary psychometric properties. The 22-item instrument measures the level, enjoyment, and frequency of performance for children's participation in daily occupations in a variety of environments. The questionnaire was completed by the mothers of 41 children between the ages of 6 and 10 years (24 children with and 17 children without sensory modulation disorder). Cronbach's alpha varied from. 86 to. 89, indicating internal consistency of items. Test-retest reliability varied from. 69 to. 86, indicating that the instrument provides a stable measurement over time. The PICO-Q was found to differentiate between children with and without participation restrictions. The PICO-Q shows initial reliability and validity and has both research and clinical application potential.

Perceptuomotor functioning in preschool children with symptoms of attention deficit hyperactivity disorder.

Given limited research on perceptual-motor functioning of preschool children with symptoms of ADHD, the purpose of this study was to compare the fine motor, gross motor, visuomotor, and oral-motor functioning of 49 4- to 6-yr.-old children with symptoms of Attention Deficit Hyperactivity Disorder and 48 typically developing children. Analysis showed scores of the ADHD group were significantly lower than those of the control group on all perceptuomotor measures. In addition, scores on all measures yielded significant correlations with scores on the Hyperactive-Inattentive scale of the Preschool Behavior Questionnaire. Regression analyses indicated that the scores of gross motor and visuomotor functioning were significant predictors of group classification (with and without ADHD). These findings extend the well documented findings of perceptuomotor deficits among school-age children with ADHD into the preschool period and emphasize the importance of early assessment and treatment of these deficits in young children with symptoms of ADHD.

Responses of preschool children with and without ADHD to sensory events in daily life.

OBJECTIVE: The purpose of this study was to compare parents' perceptions of the responses of their preschool children, with and without attention deficit hyperactivity disorder (ADHD), to sensory events in daily life in Israel. In addition, the relationship between levels of hyperactivity and sensory deficits was examined. METHOD: The Sensory Profile Questionnaire (SP) was completed by mothers of forty-eight 4- to 6-year-old children with ADHD, and mothers of 46 children without disabilities. A matched group comparison design was used to identify possible differences in sensory processing. RESULTS: Based on the measure of mothers' perceptions, children with ADHD demonstrated statistically significant differences from children without ADHD in their sensory responsiveness as reflected in 6 out of 9 factor scores (p < .001-.05), and on their sensory processing, modulation, and behavioral and emotional responses, as reflected in 11 out of 14 section scores (p < .001-.05). Scores on the SP yielded statistically significant low to moderate correlations with scores on the hyperactive scale of the Preschool Behavior Questionnaire (r = .28-.66). CONCLUSION: The findings of the present study suggest that young children with ADHD may be at increased risk of deficits in various sensory processing abilities, over and above the core symptoms of ADHD. Early identification and treatment of sensory processing deficits from a young age may extend our ability to support the successful performance of children with ADHD in meaningful and productive occupations.

The use of the QNST-II as a measure for the identification of children with perceptual-motor deficits.

This study aimed to examine the ability of the Quick Neurological Screening Test QNST II) (Mutti et al., 1998) to discriminate between children with and without perceptual-motor deficits and to further clarify its psychometric characteristics. Ninety-four children aged six to seven years were tested on the QNST-II. Out of this pool of subjects, 63 children had perceptual-motor deficits and 31 were typical controls. The children with perceptual-motor deficits scored significantly lower than the control children on the total score and on each of the subtest' s scores of the QNST II. Inter-rater reliability indicated a high degree of correlation between both evaluators' total scores of the QNST II. In terms of the test' s sensitivity and specificity, QNST II scores correctly classified 97% of the children with perceptual-motor deficits and 84% of the children from the control group. The findings of this study support the capability of the QNST II to discriminate between children with perceptual-motor deficits and typical children; thereby suggesting its usefulness as a screening measure to identify children at risk for difficulties in school performance.

Differential diagnosis of sensory modulation disorder (SMD) and attention deficit hyperactivity disorder (ADHD): participation, sensation, and attention.

Differential diagnosis between sensory modulation disorder (SMD) and attention deficit hyperactivity disorder (ADHD) is often challenging, since these disorders occur at a high rate of co-morbidity and share several clinical characteristics. Preliminary studies providing evidence that these are distinct disorders have focused solely on body functions, using sophisticated laboratory measurements. Moreover, no studies have compared participation profiles of these populations. This study is the first to compare the profiles of these populations regarding both "body functions" (attention and sensation) and "participation," using measures applicable for clinical use. The study included 19 children with ADHD without SMD and 19 with SMD without ADHD (diagnosed by both pediatric neurologists and occupational therapists), aged 6-9, and matched by age and gender. All children underwent a broad battery of evaluations: the Evaluation of Sensory Processing, Fabric Prickliness Test (FPT) and Von Frey Test to evaluate sensory processing, and Test of Everyday Attention to evaluate attention components. The Participation in Childhood Occupations Questionnaire was used to evaluate participation. Results support significant group differences in all sensory components, including pain intensity to suprathreshold stimuli and pain "after sensation," as well as in tactile, vestibular, taste, and olfactory processing. No differences were found in attention components and participation. This study has both theoretical and clinical importance, inter alia, providing further evidence of two distinct disorders as well as indications of specific clinical instruments that might enable clinicians to implement differential diagnoses. In addition, results accord with other previous statements, which indicate that the clinical diagnosis of children with disabilities may not be a major factor in determining their participation profile.

The influence of environmental factors on the development of ultra-orthodox preschool boys in Israel.

The study objectives were: (a) to compare the prevalence of children at risk and/or with developmental delay (at risk/delayed) among the Ultra-Orthodox community with the prevalence reported in the literature and (b) to compare the performance of Ultra-Orthodox children in kindergarten versus that of children in preschool. To this end, motor, visual-motor integration and cognitive performance of 203 Ultra-Orthodox boys from low socio-economic status were assessed. We found a higher percentage of children who were at risk/delayed in gross motor and motor-cognitive skills as compared with the percentage reported in the literature. However, as opposed to expected, the results did not show that there was a higher percent of at-risk/delayed children among the kindergarten group as compared with those among the preschool group. Our findings are consistent with the research literature suggesting that children's cultural background and economic constraints can affect their motor and cognitive development. Thus, occupational therapists and other health professionals should be more culturally competent and more aware of the specific values and practices of families of children with whom they work, which can impact their development. However, in this study, it is difficult to distinguish between the influence of the cultural factors and the influence of socio-economic factors. Therefore, it is recommended to repeat this study among children from either low socio-economic status or other cultural backgrounds.

Co-occurrence of developmental delays among preschool children with attention-deficit-hyperactivity disorder.

The aim of this study was to provide a comprehensive profile of the sensory, motor, language, and intellectual functioning of a non-referred community sample of 49 preschool children with attention-deficit-hyperactivity disorder (ADHD; 39 males, 10 females; mean age 4y 7mo [SD 7mo]; range 3y 10mo-6y) and 48 typically developing children (38 males, 10 females; mean age 4y 8mo [SD 6mo]; range 3y 11mo-6y) matched by age, sex, and maternal education who underwent a broad battery of neurodevelopmental tests. The results showed that the scores of the ADHD group were significantly lower than the comparison group on all measures. In addition, 23 (47%) of the children with ADHD had clinically significant co-occurring deficits in two or more areas. Logistic regression indicated that the only significant predictors of group classification were scores of verbal intelligence and motor and sensory functioning, accounting for 44.1% of the variance. These findings suggest that preschool children with ADHD have multiple developmental deficits over and above the core symptoms of ADHD and emphasize the importance of evaluating the sensorimotor functioning of preschool children with ADHD symptoms.

Construct validity of the Miller assessment for preschoolers and the pediatric examination of educational readiness for children.

The purpose of this study was to investigate the construct validity of the Miller Assessment for Preschoolers (MAP) and the Pediatric Examination of Educational Readiness (PEER), two assessment tools that occupational therapists and physical therapists can use for early identification of children with developmental disabilities. The sample included 84 Israeli children who were tested on the MAP (42 children with pre-academic problems and 42 typically developing children), and 70 children who were tested on the PEER (35 children with pre-academic problems and 35 typically developing children). Out of this pool of subjects, 30 typically developing children and 30 children with pre-academic problems were tested on both tests and the results were used for additional data analysis. We found differences between the groups' MAP and PEER total scores as well as their developmental indices scores. Children with pre-academic problems scored lower. The supplementary behavioral observations of the tests yielded less definite results. A strong correlation existed between the total scores of the MAP and the PEER, and the total scores of the tests correlated significantly with each of the sub-scores of the other test. The findings support the construct validity of both tests, thereby suggesting that either test can be used to identify children with pre-academic problems.