Longitudinal development of hand use in children with unilateral spastic cerebral palsy from 18 months to 18 years.

AIM: To describe the development of the use of the affected hand in bimanual tasks in children with unilateral cerebral palsy (CP) from 18 months to 18 years. Specifically, whether early development can be confirmed in a larger cohort and how development progresses during adolescence. METHOD: In total, 171 participants (95 males, 76 females; mean age 3 years 1 month [SD 3 years 8 months], range 18 months-16 years at inclusion) were classified in Manual Ability Classification System (MACS) levels I (n = 41), II (n = 91), and III (n = 39). Children were assessed repeatedly (median 7, range 2-16 times) with the Assisting Hand Assessment: in total 1197 assessments. Developmental trajectories were estimated using a nonlinear mixed effects model. To further analyse the adolescent period, a linear mixed model was applied. RESULTS: The developmental trajectories were different between participants in MACS levels (MACS I-II, II-III) in both rate (0.019, 95% confidence interval [CI] 0.006-0.031, p = 0.034; 0.025, 95% CI 0.015-0.037, p < 0.001) and limit (19.9, 95% CI 16.6-23.3, p = 0.001; 7.2, 95% CI 3.3-11.2, p < 0.003). The individual variations were large within each level. The developmental trajectories were stable over time for all MACS levels between 7 and 18 years (p > 0.05). INTERPRETATION: Children and adolescents with unilateral CP have considerable development at an early age and a stable ability to use their affected hand in bimanual activities from 7 to 18 years in all MACS levels.

Partnering for change (P4C) in Sweden- a study protocol of a collaborative school-based service delivery model to create inclusive learning environments.

BACKGROUND: Inclusive learning environments are considered as crucial for children's engagement with learning and participation in school. Partnering for change (P4C) is a collaborative school-based service delivery model where services are provided at three levels of intensity based on children's needs (class, group-, individual interventions). Interventions in P4C are provided universally to support all children with learning, not only children with special education needs (SEN), and as such are expected to be health-promoting. AIM: The aim of the study is to evaluate the effectiveness and cost-effectiveness of P4C as well as school staff members' and children's experiences after P4C. METHODS: In a parallel, non-randomised controlled intervention design, 400 children, aged 6-12 years, and their teachers, will be recruited to either intervention classes, working according to the P4C, or to control classes (allocation ratio 1:1). Data will be collected at baseline, post-intervention (4 months), and 11 months follow-up post baseline. The primary outcome is children's engagement with learning in school. Secondary outcomes include for example children's health-related quality of life and wellbeing, occupational performance in school, attendance, and special educational needs. The difference-in-differences method using regression modelling will be applied to evaluate any potential changes following P4C. Focus group interviews focusing on children, and professionals' experiences will be performed after P4C. A health economic evaluation of P4C will be performed, both in the short term (post intervention) and the long term (11-month follow-up). This study will provide knowledge about the effectiveness of P4C on children's engagement with learning, mental health, and wellbeing, when creating inclusive learning environments using a combination of class-, group- and individual-level interventions. TRIAL REGISTRATION NUMBER: NCT05435937.

Applying to a nursing home is a way to maintain control of life-Experiences from Swedish nursing home applicants.

BACKGROUND: Swedish social policy enables ageing in place with support from home-based care services despite high age and/or declining health. AIM: This study aims to describe the daily life experiences behind the decision to apply for a nursing home placement in older adults ageing in place. MATERIALS AND METHODS: A qualitative design was chosen, and 11 semi-structured interviews were conducted and analysed using inductive qualitative content analysis. RESULTS: The participants described a feeling of dependence in which they had to ignore their personal privacy when receiving home-based care. They reached a turning point when ageing in place was, for several reasons, no longer considered an acceptable option. This influenced their choice to apply to a nursing home where they expected that they could maintain control over their lives. DISCUSSION AND CONCLUSION: The results indicate that when enhancing ageing in place it is important to enable older adults to receive support to maintain autonomy in daily activities and to have the opportunity to age in the right place.

Residential care staff are the key to quality of health care for adults with profound intellectual and multiple disabilities in Sweden.

BACKGROUND: People with profound intellectual and multiple disabilities (PIMD) have combined severe intellectual and physical disability and need extensive health care support. They cannot communicate by spoken language and need around the clock support. The health care for people with PIMD is typically provided by a number of different health care services in collaboration with residential care staff and their managers. The quality of health care for people with PIMD are important due to their limited ability to communicate their needs. The aim of this study was to explore residential care staff and manager's experiences and views of health care services for adults with PIMD. METHODS: Thirteen semi-structured interviews with residential care staff (n = 7) and managers (n = 6) were conducted and analysed using qualitative content analysis. RESULTS: The informants expressed a variety of experiences, under the theme was Quality of health care is enhanced through residential care staff. The theme was comprised of four subthemes: (1) Individually tailored support promotes quality, (2) Accessibility requires adaptation and prioritization by healthcare providers, (3) Disability competence promotes quality and safety and (4) Complex collaboration conditions between the person with PIMD, residential care staff and disability health care. CONCLUSIONS: The residential care staff create quality of care in their role as representatives for adults with PIMD. The care situation is complex and requires adequate competence in the disability, the individual's needs and adaptations to ensure quality of health care. It is also important to build collaboration with other services that are involved in the care of people with PIMD.

Toward Control Over Time: Participant Experience of Attending the Let's Get Organized Group Intervention.

IMPORTANCE: Time management is crucial for managing daily activities but is difficult for many people with neurodevelopmental or mental disorders. Few sustainable interventions have addressed time management in daily life. OBJECTIVE: To describe the experiences and meaning of attending the Swedish version of the Let's Get Organized (LGO-S) group intervention. DESIGN: Qualitative design with interviews 1 to 4 mo after the completed intervention. SETTING: Outpatient psychiatric and adult habilitation clinics. PARTICIPANTS: Twelve adults with neurodevelopmental or mental disorders. INTERVENTION: LGO-S, a manual-based group intervention that focuses on time-management skills. Outcomes and Measures: Semistructured interviews analyzed with qualitative content analysis. All authors took an active part in the analysis process; consensus was reached. RESULTS: The overarching theme, "a roller-coaster process toward control over time in daily life," describes the participants' process during and after intervention. Four main categories describe the meaning of understanding why time management is difficult and how to use tools for improvement, a process of change that was facilitated by the learning environment. Participants described the process as a struggle to take control over time, but they noted that the positive changes in daily life made it worthwhile. CONCLUSIONS AND RELEVANCE: Participation had a positive impact on daily life. The opportunity for skills training with support over an extended period, a changed view on failure, and the group format appear to be important success factors. What This Article Adds: The LGO-S, with its structured training of time-management skills, contributes to occupational therapy practice with an intervention that clients experience as bringing meaningful and positive changes to daily life functioning.

Assessing and reporting patient participation by means of patient preferences and experiences.

BACKGROUND: Although patient participation is strongly associated with high quality of healthcare, valid means to measure and report a comprehensive notion of patient participation are scarce. The Patient Preferences for Patient Participation (4Ps) is a new healthcare practice and research tool, comprising patients' preferences as well as experiences. The 4Ps employs 12 items for the patient to conceptualise patient participation. The aim of this paper is to describe how the two perspectives of patient participation, namely preferences and experiences, can be combined to visualise and report preference-based patient participation. METHODS: With four response alternatives in each section, the 4Ps offers sixteen possible combinations of degree of match per item. Theoretical and clinical principles fostered a tentative order of six ranks and three levels of preference-based patient participation. To test the standard, statistical analyses for ordinal data were performed, using data from a randomised controlled trial evaluating an intervention aiming to improve patient participation. Further, structures for visualising the preference-based patient participation of individuals and groups were suggested. RESULTS: Data from the 4Ps demonstrated the individuals' preference-based patient participation, indicating either a match or a mismatch for each item. Mismatches represented either the experience of participation surpassing the patient's preferences, or the patient's preferences for patient participation not being established. At group level, the suggested approach for visualising and reporting the 4Ps demonstrated that the intervention group had a significantly higher proportion of sufficient preference-based patient participation for certain items than the control group. These results had not been identified earlier, when using the preferences and experiences of patient participation as separate measures. CONCLUSIONS: Ways to easily acquaint stakeholders with patients' preferences for patient participation are needed, in order for healthcare staff to better use resources to match the basic requirements of individuals and groups. While the 4Ps can guide professionals to patient participation as framed in legislations, concept analyses and by patients, a visualisation of the results is needed to capture preference-based patient participation. The proposed route to representing degree of match in preferences and experiences may also be relevant to other dimensions of quality of healthcare.

Pilot Study of Let's Get Organized: A Group Intervention for Improving Time Management.

IMPORTANCE: There is a need for evidence-based occupational therapy interventions to enhance time management in people with time management difficulties. OBJECTIVE: To pilot test the first part of the Let's Get Organized (LGO) occupational therapy intervention in a Swedish context by exploring enhancements of time management skills, aspects of executive functioning, and satisfaction with daily occupations in people with time management difficulties because of neurodevelopmental or mental disorders. DESIGN: One-group pretest-posttest design with 3-mo follow-up. SETTING: Outpatient psychiatric and habilitation settings. PARTICIPANTS: Fifty-five people with confirmed or suspected mental or neurodevelopmental disorder and self-reported difficulties with time management in daily life. INTERVENTION: Swedish version of Let's Get Organized (LGO-S) Part 1, with structured training in the use of cognitive assistive techniques and strategies using trial-and-error learning strategies in 10 weekly group sessions of 1.5 hr. OUTCOMES AND MEASURES: Time management, organization and planning, and emotional regulation were measured with the Swedish version of the Assessment of Time Management Skills (ATMS-S). Executive functioning was measured with the Swedish version of the Weekly Calendar Planning Activity, and satisfaction with daily occupations was assessed with the Satisfaction With Daily Occupations measure. RESULTS: Participants displayed significantly improved time management, organization and planning skills, and emotional regulation, as well as satisfaction with daily occupations. Aspects of executive functioning were partly improved. ATMS-S results were sustained at 3-mo follow-up. CONCLUSION AND RELEVANCE: LGO-S Part 1 is a promising intervention for improving time management skills and satisfaction with daily occupations and should be investigated further. WHAT THIS ARTICLE ADDS: This study shows that LGO-S Part 1 is feasible for use in psychiatric and habilitation outpatient services. The results are promising for improved time management skills, organization and planning skills, and satisfaction with daily occupations and need to be confirmed in further studies.

Promoting person-centred care in the perioperative setting through patient advocacy: An observational study.

AIMS AND OBJECTIVES: To examine the extent to which the findings from an integrative review regarding perioperative patient advocacy could be empirically supported, and to describe Swedish registered nurse anaesthetists' patient advocacy actions and interactions during the perioperative period. BACKGROUND: Patient advocacy is practiced by various healthcare professionals in promoting the well-being of patients. It is complex, and in a general healthcare context, it has been described as supporting the patients both physiologically and psychologically. During general anaesthesia, the patient enters an unconscious state, and the registered nurse anaesthetist safeguards patient privacy and autonomy. DESIGN: Qualitative descriptive. METHODS: Individual, nonparticipant observations (n = 16) with eight registered nurse anaesthetists. The observer followed the nurses unobtrusively by shadowing them during the perioperative phase on two separate occasions. The analysis was conducted with a directed content analysis in the light of four predetermined categories, identified in a previous integrative review of patient advocacy in the perioperative setting: protecting, value preserving, supporting and informing. RESULTS: The predetermined categories were empirically supported. They were further refined by identifying 11 new subcategories leading to a conceptual extension of the theoretical frame. The registered nurse anaesthetists interacted with the patient and all members of the surgical team when practicing perioperative patient advocacy and the actions were mostly initiated by the registered nurse anaesthetists themselves. CONCLUSIONS: The findings offer a new insight into the registered nurse anaesthetist's professional role. The observations deepen the understanding of the registered nurse anaesthetists' perioperative patient advocacy actions and can contribute to a more reflective and theory-oriented view of practice. RELEVANCE TO CLINICAL PRACTICE: The results from this study could be used to help registered nurse anaesthetists and their students understand practice in a more complete and insightful way.

Protective Nursing Advocacy: Translation and Psychometric Evaluation of an Instrument and a Descriptive Study of Swedish Registered Nurse Anesthetists' Beliefs and Actions.

PURPOSE: To translate and adapt the Protective Nursing Advocacy Scale (PNAS) into a Swedish version (PNAS-Swe), evaluate its psychometric properties, and describe registered nurse anesthetists' (RNAs) advocacy beliefs and actions from a protective perspective. DESIGN: A cross-sectional design was used. METHODS: First, the PNAS was translated into Swedish. Next, the content and construct validity of the PNAS four subscales was evaluated. Finally, the PNAS-Swe was used to describe Swedish RNA beliefs and actions regarding protective nursing advocacy. FINDINGS: The final PNAS-Swe has 29 items in four subscales. The RNAs reported that they feel that they should provide protective nursing advocacy for their patients. There were no differences in gender, or associations with age, or work experience regarding their advocacy beliefs or actions. CONCLUSIONS: The PNAS-Swe is valid for use in a Swedish context. Protective nursing advocacy is important to the RNAs, which is in congruence with earlier qualitative studies.

Psychometric properties of a revised version of the Assisting Hand Assessment (Kids-AHA 5.0).

AIM: The aim of this study was to scrutinize the Assisting Hand Assessment (AHA) version 4.4 for possible improvements and to evaluate the psychometric properties regarding internal scale validity and aspects of reliability of a revised version of the AHA. METHOD: In collaboration with experts, scoring criteria were changed for four items, and one fully new item was constructed. Twenty-two original, one new, and four revised items were scored for 164 assessments of children with unilateral cerebral palsy aged 18 months to 12 years. Rasch measurement analysis was used to evaluate internal scale validity by exploring rating-scale functioning, item and person goodness-of-fit, and principal component analysis. Targeting and scale reliability were also evaluated. RESULTS: After removal of misfitting items, a 20-item scale showed satisfactory goodness-of-fit. Unidimensionality was confirmed by principal component analysis. The rating scale functioned well for the 20 items, and the item difficulty was well suited to the ability level of the sample. The person reliability coefficient was 0.98, indicating high separation ability of the scale. A conversion table of AHA scores between the previous version (4.4) and the new version (5.0) was constructed. INTERPRETATION: The new, 20-item version of the Kids-AHA (version 5.0), demonstrated excellent internal scale validity, suggesting improved responsiveness to changes and shortened scoring time. For comparison of scores from version 4.4 to 5.0, a transformation table is presented.

Development of the Assisting Hand Assessment for adolescents (Ad-AHA) and validation of the AHA from 18 months to 18 years.

AIM: To develop and evaluate a test activity from which bimanual performance in adolescents with unilateral cerebral palsy (CP) can be observed and scored with the Assisting Hand Assessment (AHA), and to evaluate the construct validity of the AHA test items for the extended age range 18 months to 18 years. METHOD: A new test activity was developed and evaluated for its ability to elicit bimanual actions in adolescents with (n=20) and without (n=10) unilateral CP. The AHA scores of 126 adolescents (mean age 14y 3mo, SD 2y 6mo; 71 males, 55 females) and 157 children with unilateral CP (mean age 6y 1mo, SD 2y 10mo; 102 males, 55 females) were analysed using the Rasch measurement model. RESULTS: The test activity elicited bimanual actions in 100% of typically developing adolescents and in 96.8% and 57.9% of adolescents with unilateral CP (moderately and severely limited hand function respectively). The scale demonstrated good construct validity; thus the same scoring criteria can be used for the age range studied. INTERPRETATION: The new Assisting Hand Assessment for adolescents (Ad-AHA) activity is valid for use with 13- to 18-year-olds to elicit bimanual performance in adolescents with unilateral CP. The same AHA scoring criteria can be used both for children and for adolescents within the age range 18 months to 18 years.

Longitudinal development of hand function in children with unilateral spastic cerebral palsy aged 18 months to 12 years.

AIM: The aim of the study was to describe the development of hand function, particularly the use of the affected hand in bimanual tasks, among children with unilateral cerebral palsy aged 18 months to 12 years. METHOD: A convenience sample of 96 children (53 males, 43 females) was assessed with the Assisting Hand Assessment (AHA) at regular intervals from the ages of 18 months to 12 years. The children ranged from 17 to 127 months (median age 24mo) at recruitment. Subgroups were created to identify differences in development using the child's AHA at 18 months and the Manual Ability Classification System (MACS). A nonlinear mixed effects model was used to analyze data according to a 'stable limit' development model. RESULTS: The results were based on 702 AHA sessions. The children showed a rapid development at a young age and reached 90% of their stable limit between 30 months and 8 years. The subgroups, based on the 18-month AHA and the MACS levels respectively, had distinctly different patterns of development. INTERPRETATION: The AHA at 18 months may be used to make a crude prediction of future development.

Perioperative Patient Advocacy: An Integrative Review.

PURPOSE: The purpose of this review was to identify the characteristics and consequences of perioperative patient advocacy. DESIGN: An integrative review method was employed. METHODS: A database search to identify peer-reviewed articles that focused on perioperative patient advocacy was conducted in PubMed and CINAHL, followed by a manual search for additional articles. Studies were selected if they reported original empirical research findings with regard to perioperative patient advocacy. The data abstraction and synthesis were achieved with an inductive qualitative content analysis. FINDING: The analysis resulted in seven categories, two subthemes, and one main theme. The main theme, "Doing good for another human being-a balancing act between philanthropy and personal gratification," was the core of perioperative patient advocacy. CONCLUSION: Perioperative patient advocacy is part of the professional role of the perioperative nurse, and it affects the perioperative nurse emotionally. This advocacy shares similarities with descriptions of patient advocacy in general nursing.

The influence of early modified constraint-induced movement therapy training on the longitudinal development of hand function in children with unilateral cerebral palsy.

AIM: There is evidence that modified constraint-induced movement therapy (mCIMT) has a short-term positive effect on hand function in children with unilateral cerebral palsy (CP), but the long-term effect is unknown. The aim of this study was to investigate whether or not a single block of mCIMT (2h/d for 2mo) at age 2 to 3 years influences the course of development of bimanual hand function at around 8 years of age. METHOD: A convenience sample of 45 children (24 males, 21 females) with unilateral CP and mean (SD) age at first assessment 32 months (13mo) was included in this study. The participants were divided into the mCIMT group (n=26) and the reference group (no mCIMT; n=19). Brain lesion characteristics were available for 32 children. The children were measured repeatedly with the Assisting Hand Assessment (AHA) for a mean period of 4 years and 6 months. Development curves were created and compared with a non-linear mixed effects model. RESULTS: Children who were receiving mCIMT had an upper limit of development of bimanual hand function that was 8.5 AHA units higher than in the reference group (p=0.022). However, when controlling for brain lesion characteristics and baseline in a subgroup of 32 children, the difference was considerably smaller and no longer significant. CONCLUSION: mCIMT may have a positive impact on long-term development of bimanual hand function, but the results are inconclusive and further research is necessary.

Measurement properties of the 13-item sense of coherence scale using Rasch analysis.

PURPOSE: The sense of coherence (SOC) scale is widely used and has an extensive history in research. The psychometric properties of the SOC scale have been investigated using classic test theory, but modern test theory enables a more multifaceted investigation of the properties of the SOC scale. The aim of this study was to explore the measurement properties of the SOC scale using the Rasch measurement model. METHODS: SOC questionnaires from a sample of 623 healthy adults were analysed using Rasch analysis. Aspects analysed were rating scale functioning, item fit, unidimensionality, differential item functioning (DIF), targeting, and reliability. RESULTS: Rating scale analysis showed that the seven scale steps were not utilized in the intended manner and that a shortening to five categories would be beneficial. Twelve out of the 13 items showed acceptable goodness-of-fit and 43% of the variance was explained by the SOC dimension in the principal components analysis. There was no DIF between subgroups in the sample. The items were well targeted to the sample SOC level with no ceiling or floor effects. Item and person reliability were good and the person separation index was 2.05 indicating that the scale can separate three different levels of SOC, which corresponds well to its theoretical base. CONCLUSIONS: The SOC scale is generally well functioning; however, the three components of SOC seem to influence the PCA results. The scale would benefit from a reduction from seven to five scale steps, which would need to be investigated further.

Occupational therapist practice patterns in relation to clients with cognitive impairment following acquired brain injury.

UNLABELLED: Abstract Primary objective: To describe Swedish occupational therapist practice patterns for clients with cognitive impairment following acquired brain injury. RESEARCH DESIGN: A cross-sectional stratified random sample of 462 occupational therapists. METHODS: An online questionnaire was used to collect data. MAIN RESULTS: The predominant practice pattern was the use of ADL-activities for assessment and therapy regardless of whether limitations in occupational performance or cognitive function were assessed or whether the approach was remedial or compensatory. For assessment, general ADL-instruments were used more often than instruments that assessed cognitive function. Instruments were used less often within municipal rehabilitation facilities compared to regional, county and primary care facilities. The most common focus of the therapies was in regard to abilities related to executive functioning. Another prominent practice pattern was a collaborative approach involving clients, relatives and other staff. The theories used in practice were, to a large extent, general in nature and did not focus specifically on cognitive functioning. CONCLUSIONS: Swedish occupational therapy practice for clients with cognitive impairments following acquired brain injury focuses highly on occupational performance. Therapies targeting executive functioning seem particularly important in practice and a collaborative approach involving clients, relatives and other staff is a prominent feature in practice.

Therapeutic use of self as defined by Swedish occupational therapists working with clients with cognitive impairments following acquired brain injury: a Delphi study.

BACKGROUND/AIM: The concept therapeutic use of self has mainly been described theoretically. Empirical descriptions are few and empirical validation is needed to make the concept more useful for informing practice and explaining what occupational therapists do in the interaction with their clients to facilitate successful outcomes. The aim of this study was to empirically define the aspects that occupational therapists working with clients with cognitive impairments following acquired brain injury find are consistent with the concept of therapeutic use of self. METHOD: Thirteen expert occupational therapists participated. Reactive Delphi technique in three rounds was used where each round built on the results of the previous one. A questionnaire based on current literature was developed for the first round. RESULTS: Twenty of 33 statements reached a consensus level of 75% or more. These statements reflected the therapists' consciousness, self-awareness and use of personal characteristics. The statements also concerned the intentions of therapeutic use of self, including client group-specific intentions such as enhancing self-awareness. The results indicate that the content of the concept may be defined differently depending on the client group. CONCLUSIONS: The empirical descriptions generated from this study may help occupational therapists working with clients with cognitive impairments following acquired brain injury to describe how and with what intention they use themselves therapeutically in the rehabilitation process. In occupational therapy education, the results may be used to highlight how the concept may be understood in practice and to discuss it in relation to different client groups.

Use of the HESPER Web to Assess Perceived Needs Immediately After Multiple Disaster Events in Fiji.

OBJECTIVE: In January 2022, Fiji was hit by multiple natural disasters, including a cyclone causing flooding, an underwater volcanic eruption, and a tsunami. This study aimed to investigate perceived needs among the disaster-affected people in Fiji and to evaluate the feasibility of the Humanitarian Emergency Settings Perceived Needs Scale (HESPER Web) during the early stage after multiple natural disasters. METHODS: A cross-sectional study using a self-selected, non-representative study sample was conducted. The HESPER Web was used to collect data. RESULTS: In all, 242 people participated. The number of perceived serious needs ranged between 2 and 14 (out of a possible 26), with a mean of 6 (SD = 3). The top 3 most reported needs were access to toilets (60%), care for people in the community who are on their own (55%), and distress (51%). Volunteers reported fewer needs than the general public. CONCLUSIONS: The top 3 needs reported were related to water and sanitation and psychosocial needs. Such needs should not be underestimated in the emergency phase after natural disasters and may require more attention from responding actors. The HESPER Web was considered a usable tool for needs assessment in a sudden onset disaster.

Test-retest reliability of the assessment of time management skills (ATMS-S) in adults with neurodevelopmental disorders.

BACKGROUND: Time-management skills are essential in handling daily life, and adults with neurodevelopmental disorders often have difficulty with these skills. Therefore, interventions targeting such skills are common in occupational therapy. The Assessment of Time-Management Skills (ATMS) is a self-rated instrument for measuring time-management skills. AIM: This study aims to evaluate the test-retest reliability of the Swedish version of the ATMS (ATMS-S). MATERIALS AND METHODS: A total of 33 participants with neurodevelopmental disorders and difficulty with time management completed the test twice, approximately 1 week apart. The test-retest reliability for the three subscales in the ATMS-S was analyzed using intraclass correlation coefficients. The smallest detectable change was calculated to determine the precision of individual ATMS units. RESULTS AND CONCLUSION: The results showed overall moderate to good stability for the measures. The intraclass correlation coefficients were 0.79 (time management), 0.82 (organization and planning), and 0.50 (regulation of emotions) for the three subscales, and the smallest detectable changes were 9.5, 6.9, and 15.7 ATMS units for the respective subscales. These results suggest that the ATMS-S is a sufficiently stable tool for measuring time management and organization and planning skills in adults with neurodevelopmental disorders, but may be less reliable for measuring emotional regulation.