Screening Tools: They're So Quick! What's the Issue?

Screening tools are needed in occupational therapy practice to determine which clients require formal evaluation. Because screening tools also tell us who does not require formal evaluation, they are key to improved clinical efficiency. Screening tools are brief, easy to administer, and often freely available. These qualities also lead to misuse of screening tools, including using them to measure progress over time or to serve as a confirmatory assessment on which to base treatment planning. We present additional common missteps of screening tool use, including a lack of consideration for a tool's psychometric properties, and exemplars of these common misuses in adult and pediatric practice. Finally, we offer solutions to address these concerns.

Sensory Processing in the General Population: Adaptability, Resiliency, and Challenging Behavior.

Sensory processing is a personal trait that can contribute to challenging behavior. Protective factors, such as resiliency, can support children in managing their behavior, yet little research has addressed the contribution of sensory processing to protective factors. Therefore, in this cross-sectional study we aimed to determine the contribution of sensory processing (using the Sensory Profile-2) to challenging behavior and protective factors (using the Behavior Assessment System for Children, 2nd ed., Parent Rating Scales) in a sample of 51 children ages 6-11 yr from the general U.S. POPULATION: The results indicated that sensory avoiding predicts externalizing behaviors, depression, resiliency, and adaptability. In addition, sensory seeking is related to depression and resiliency, whereas sensory sensitivity is related to externalizing behaviors. Implications for occupational therapy research and practice are discussed.

Occupation-Based Coaching by Means of Telehealth for Families of Young Children With Autism Spectrum Disorder.

OBJECTIVE: We investigated the efficacy of Occupation-Based Coaching delivered via telehealth for families of young children with autism spectrum disorder (ASD). METHOD: Participants were 18 families of children with ASD ages 2-6 yr. We used descriptive statistics to understand intervention characteristics and paired-sample t tests to examine changes in parent efficacy and child participation. RESULTS: Parents identified many areas of child adaptive behavior as intervention goals. Results showed that parent efficacy and various domains of child participation significantly increased postintervention (both ps < .05). Additionally, children showed significant gains in parent-identified goals. CONCLUSION: Occupation-Based Coaching delivered via telehealth appears to be an effective method of intervention to increase parent efficacy and child participation among families of children with ASD. Occupational therapists may consider how telehealth may be used to provide intervention to an increased number of families, in particular those in underserved areas.

Sensory Processing Patterns in Autism, Attention Deficit Hyperactivity Disorder, and Typical Development.

AIMS: The purpose of this study was to examine sensory processing in children ages 3-14 years with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and typical development (TD) using the Sensory Profile 2nd Edition (Dunn, 2014). METHODS: Participants included 239 children (ASD = 77; ADHD = 78; TD = 84) matched on age and gender. Multivariate analysis of covariance was used to compare the extent to which the three grsoups differed on sensory processing patterns (i.e., sensitivity, avoiding, registration, seeking) and sensory systems (i.e., auditory, visual, touch, movement, body position, oral, conduct, attention, social). We also examined the effect of chronological age. RESULTS: Children with ASD and ADHD did not differ in sensory processing patterns which were elevated as compared to a TD group. Children with ASD showed the highest rate of oral processing differences, followed by ADHD and TD. Children with ADHD had higher visual processing scores than children with ASD and TD. Older children had lower scores for seeking, auditory, visual, movement, touch, and conduct than younger children, regardless of diagnosis. CONCLUSIONS: Findings suggest that sensory features may be an area of overlap of behaviors in ASD and ADHD, which may have implications for intervention approaches for children with these conditions.

Sensory Pattern Contributions to Developmental Performance in Children With Autism Spectrum Disorder.

Sensory processing differences in preschool-age children with autism spectrum disorder (ASD) affect their engagement in everyday activities, thereby influencing opportunities to practice and develop skills such as social communication and adaptive behavior. The purpose of this study was to investigate the extent to which specific sensory processing patterns relate to aspects of development (i.e., adaptive behavior, expressive and receptive language, fine and gross motor skills, social behavior) in a sample of preschool-age children with ASD (N=400). A retrospective chart review was used to gather clinical data. Results suggest that sensory processing patterns differentially affect children's developmental skills and adaptive behavior. Certain sensory processing patterns predicted children's development of language, motor, and adaptive skills. These findings have clear implications for occupational therapy practice with young children with ASD. Practitioners should consider how sensory processing in ASD both supports and limits children's ability to engage in social communication and learning opportunities.

Measuring change in somatosensation across the lifespan.

OBJECTIVE: The study aim was to determine natural variability in somatosensation across age groups using brief measures. We validated measures in a community-dwelling population as part of the National Institutes of Health (NIH) Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox; http://www.nihtoolbox.org). METHOD: Participants included community-dwelling children and adults (N=367, ages 3-85 yr) across seven sites. We tested haptic recognition, touch detection-discrimination, and proprioception using brief affordable measures as required by the NIH Toolbox. RESULTS: Accuracy improved from young children to young adults; from young to older adults, the pattern reversed slightly. We found significant differences between adults and older adults. One proprioception test (kinesthesia; p=.003) showed gender differences (females more accurate). We provide expected score ranges for age groups as a basis for understanding age-related expectations for somatosensory perception. CONCLUSION: The age-related patterns of somatosensory perception from this study refine decision making about performance.

Role of occupational therapy in promoting self-determination through consumer-directed supports.

Consumer-directed services (CDS) are a type of support system designed to increase the quality of life and self-determination of clients, such as adults with developmental disabilities. Occupational therapists can play an important role in facilitating people's involvement in CDS supports. This paper describes CDS, evidence that supports their use, and ways that occupational therapists use their training in person-centered practice to enhance CDS supports and self-determination. A case study is used to illustrate the application.

Short report: Do parents use asynchronous materials in a hybrid coaching via telehealth intervention?

LAY ABSTRACT: Using telehealth to provide services to families and children with autism has grown since the start of the COVID-19 pandemic. Yet, we still know less about telehealth models that use both virtual sessions and online materials to support families. Research suggests it is important to make sure an intervention matches the characteristics of a child with autism, but fewer studies have examined the importance of matching an intervention to parent characteristics. In this study, we looked at parent characteristics (25 parents included in the study) before a parent coaching telehealth intervention for potty training in autism. We specifically looked at how parent competence (i.e. how confident and effective one feels with parenting) levels before the intervention influenced the usage of online education materials (i.e. podcasts/tip sheets). Results suggested that parents with lower competence used the online materials more often than parents with higher competence, and often made greater gains in parent competence during the intervention. Both parents with lower and higher competence found the intervention acceptable. Future research should study additional parent characteristics in a larger sample to better understand how to tailor interventions to meet both parent and child needs.

Partners in Care: Consumer Experiences With Professional Services.

Consumer experience is a key driver of successful health and education outcomes. Yet, the key factors influencing consumer experiences with care are not fully understood. The aim of this study was to understand, from the perspective of people receiving health care or education services, factors that determine positive and negative experiences with care. We interviewed people who received services, including occupational therapists, and analyzed recordings of the interviews using content analysis. Themes emerged from positive experiences with care on a continuum from "Acknowledges Me" to "Shares Problem Solving." Themes from negative experiences were also on a continuum from "Lacks Curiosity" to "Disregards." A fifth theme emerged from occupational therapists, describing "transformational insights" regarding how their personal experiences receiving care affected their practice. The findings from this study align with core OT constructs and advances understanding of authentic partnerships with people receiving professional services.

Partners in Care: Consumer Experiences with Professional ServicesThis study sought to understand, from the perspectives of people receiving services, factors that determine positive and negative experiences with care. We interviewed people who received health care or educational services, which are two settings where occupational therapists practice. We analyzed the interviews by identifying experiences participants had receiving care and grouping those experiences into common themes. Participants generally associated positive experiences with provider actions that recognized and validated their perspective and experiences or that partnered with the person in planning for their care. Participants associated negative experiences with provider actions that prioritized procedural care over individualization, or that actively disregarded the person which created feelings of shame, anger, and despondency. Occupational therapists in our study who received care shared similar experiences to people who were not trained as health care providers. Our findings highlight the importance of partnering with people receiving care, which is often at odds with training on expert models of care provision. We suggest that partnering in care is a skill set that providers need to cultivate through ongoing reflection and mentorship.

Coping with sensory changes after stroke: a qualitative study.

BACKGROUND: Coping strategies were found to predict success in rehabilitation. Research is lacking in identifying the specific coping strategies used to adjust to sensory changes after stroke. OBJECTIVE: This study utilized a qualitative descriptive method to understand how individuals handle sensory changes after stroke. METHOD: Researchers developed open-ended questions with probes to facilitate semi-structured interviews. Thirteen stroke survivors younger than 75 years old who were 1-5 years past their stroke were recruited. Researchers used an inductive content analysis approach to analyze the data gathered from the interviews. RESULTS: Two themes were identified; Coping strategies and the Amount of therapy received targeting sensory changes. CONCLUSION: Results from this study can inform occupational therapists about what strategies stroke survivors use to cope with sensory changes so that similar strategies can be implemented in therapy. Rehabilitation in the early stages of recovery can help stroke survivors identify adaptive strategies to cope with sensory changes.

Treatment of functional bowel disorders in an integrative medicine clinic resulting in improved digestive tract symptoms.

Background and Aim: Functional bowel disorders (FBDs), including irritable bowel syndrome (IBS) and others, are conditions without a physically identifiable etiology that, as a result, are difficult to treat. Alternatives to traditional medical interventions are needed because IBS patients require more of physician time and higher healthcare spending. The goal of this study was to determine the efficacy of alternative lifestyle interventions for patients with FBDs seen in an integrative medicine (IM) clinic at an academic medical center. Methods: We performed a retrospective chart review to determine whether patients with FBDs had improvement in symptoms following predominantly nutrition-based IM interventions that included recommendations for dietary supplements and elimination diets. We measured symptoms before and after intervention (average time between measurements 8.75 months) using a medical symptoms questionnaire (MSQ) commonly used to quantify symptom change in IM clinics. Results: Digestive tract symptoms, as measured by the MSQ, improved significantly in patients (n = 57) with FBDs following IM intervention. The MSQ Digestive Tract subtotal for FBD patients decreased from 10.2 (SD, 5.4) to 7.2 (SD, 5.2) (P < 0.001) after IM intervention. Conclusions: Patients in an IM clinic had improved digestive tract symptoms scores following IM intervention. Because nutrition-based interventions were the primary intervention recommended by IM providers, primary care physicians and gastroenterologists may wish to consider referring FBD patients to registered dietitian-nutritionists (RDNs) skilled in implementing elimination diets.

Coaching mothers of children with autism: a qualitative study for occupational therapy practice.

ABSTRACT The purpose of this study was to understand the perceptions of mothers of children with autism spectrum disorder (ASD) who participated in 10 one-hour coaching sessions. Coaching occurred between an occupational therapist and mother and consisted of information sharing, action, and reflection. Researchers asked 10 mothers six open-ended questions with follow-up probes related to their experiences with coaching. Themes were identified, labeled, and categorized. Themes emerged related to relationships, analysis, reflection, mindfulness, and self-efficacy. Findings indicate that parents perceive the therapist-parent relationship, along with analysis and reflection, as core features that facilitate increased mindfulness and self-efficacy. The findings suggest that how an intervention is provided can lead to positive outcomes, including increased mindfulness and self-efficacy.

Development of a Participation Focused Measure of Interoception for Adults.

Interoception is awareness of one's own internal bodily states. Currently, no participation-based measure of interoception exists. The purpose of this study was to identify items with adequate psychometric properties for a participation-based interoceptive measure grounded in Dunn's Sensory Processing Framework named the Sensory Profile: Interoception (SPI). Using a cross-sectional psychometric design, internal consistency was examined by calculating Cronbach's alpha for each of the four subscales of the SPI. Concurrent validity was studied using Pearson Product Moment Correlations to identify relationships between the SPI and the Adolescent Adult Sensory Profile (A/ASP) subscales. Interoception items correlating most strongly with their intended subscale were identified, maintaining 70 of the original 101 items (N = 55). The resulting subscales (sensitivity, avoiding, registration, and seeking) had good internal consistency (α = .63-.88) and correlated moderately with the corresponding A/ASP subscale. The findings provide preliminary support for the SPI's internal consistency and concurrent validity.

A Telehealth Delivered Toilet Training Intervention for Children with Autism.

BACKGROUND: Independence in toileting is a vital skill, yet toilet-training interventions for children with autism are limited. OBJECTIVES: We investigated the acceptability and preliminary efficacy of a hybrid telehealth intervention that used synchronous individualized coaching sessions and asynchronous online educational materials to support parents in toilet training their children with autism. METHOD: Participants included 34 families of children with autism ages 2 to 8 years. Measures were administered at pre- and postintervention (10-12 weeks) and included the Toileting Behavior Questionnaire, Goal Attainment Scaling, and Canadian Occupational Performance Measure. RESULTS: Twenty-five families completed all intervention procedures. Parents found the intervention highly acceptable and reported significant improvements in child toileting behaviors; however, families accessed the asynchronous intervention materials at a low rate. CONCLUSION: A parent coaching model delivered through telehealth may be a promising method to increase toileting independence among families of young children with autism.

Construct Validity of the Sensory Profile Interoception Scale: Measuring Sensory Processing in Everyday Life.

Scholars and providers are coming to realize that one's ability to notice and respond to internal body sensations (i.e., interoception) contributes to an overall sense of wellbeing. Research has demonstrated a relationship between interoceptive awareness and anxiety, for example. Currently, however, tools for evaluating one's interoception lack the conceptual foundation and clarity necessary to identify everyday behaviors that specifically reflect interoceptive awareness. Unlike existing interoceptive measures, the Sensory Profile Interoception (SPI) scale is participation-based and grounded in Dunn's Sensory Processing framework. In this study we investigated concurrent validity by correlating the SPI with the Adolescent/Adult Sensory Profile (A/ASP); we investigated construct validity by correlating the SPI with the Perth Alexithymia Scale (PAS), the Body Awareness Scale (BAS), and the State-Trait Anxiety Inventory (STAI). Using the REDCAP online platform, 74 college-aged participants completed the measures. Using Spearman rank order correlations there were statistically significant relationships between the corresponding sensory pattern subscales on SPI and A/ASP (r = 0.277 to r = 0.582). The PAS was only weakly related to the registration subscale of the SPI (r = 0.260). The BAS had significant relationships with seeking and avoiding on the SPI (r = 0.496 and r = 0.385). The STAI had significant relationships with sensitivity and registrations of the SPI (r = 0.266 and r = 0.361 for state; r = 0.403 and r = 0.321 for trait). Taken together, these findings provide evidence of construct validity of the SPI to identify participation patterns associated with both high and low interoception. With the more precise information the SPI provides, professionals can design tailored interventions to support everyday life goals and researchers can study interoception within authentic activities.

Corrigendum: Construct Validity of the Sensory Profile Interoception Scale: Measuring Sensory Processing in Everyday Life.

[This corrects the article DOI: 10.3389/fpsyg.2022.872619.].

Prevalence Models to Support Participation: Sensory Patterns as a Feature of All Children's Humanity.

Purpose: Research about children tends to consider differences from expected patterns problematic, and associates differences with disabilities [e.g., Autism, attention deficit hyperactivity disorder (ADHD)]. When we focus on disabilities and consider differences automatically problematic, we miss the natural variability in the general population. The International Classification of Functioning, Disability and Health (ICF 11) acknowledges that the experience of disability results from interactions between "environmental" and "personal" factors which determine the person's capacity to participate. The purpose of this study was to examine sensory patterns across a national sample of children in the general population and samples of children with disabilities to investigate the extent to which differences in sensory processing are representative of natural variability rather than automatically problematic or part of a disability. Materials and Methods: We employed descriptive statistics and chi-square tests to examine sensory processing patterns in children in the general population and autistic children and children with ADHD. We used standardization and validity data from the Sensory Profile 2 to conduct analyses. Results: Consistent sensory patterns exist across all groups. Children in all groups had different rates of certain patterns. Conclusion: Since children in all groups have certain sensory patterns, we cannot associate differences with problematic behaviors. Children participating successfully with all sensory patterns might provide insights for universal design that supports participation of all children.

Coaching-in-Context With Informal Maternal Care Partners of Children With Spinal Cord Injury.

BACKGROUND: Coaching-in-Context (CinC) is a conversation-based process for working with people that draws on the tenets of positive psychology, is solution-focused and strength-based, and uses evidence-informed coaching techniques that create opportunities for clients to be at their best when engaging in the roles and activities that are desired, required, or expected of them. OBJECTIVES: To explore the use of CinC with informal maternal care partners (mothers, grandmothers) of children with spinal cord injury (SCI). METHODS: This study was a multicenter, single group, pre-post treatment design. Participants received up to 10 sessions of CinC over a 10-week period. The Canadian Occupational Performance Measure (COPM), Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF), and Pediatric Measure of Participation Short Form (PMoP SF) were administered before and after coaching. The number of coaching sessions completed, missed, and rescheduled was recorded. Descriptive and nonparametric statistics were used to summarize sample characteristics and to evaluate changed COPM scores. PSI-4-SF stress percentiles were examined descriptively. Wilcoxon signed-rank test was used to determine whether there was a statistically significant change between baseline and postcoaching COPM and PMoP SF scores. RESULTS: Nine caregivers enrolled in the study; two had face-to-face coaching, five had phone coaching, and two dropped out. The seven who completed were mothers with an average age of 37.14 (range, 32-45; SD = 5.15) years, with children an average age of 10 (range, 7-13; SD = 2.89) years with paraplegia (n = 4) or tetraplegia (n = 3) sustained an average of 6.71 (range, 2-13; SD = 3.73) years prior to the study. Fifty-five (average = 7.86, mode = 9; range, 3-10) coaching sessions were provided; two sessions were missed and nine were rescheduled. After coaching, mean COPM performance scores increased by 2.48 (SD = 2.01) (Z = -4.057, p < .001), mean COPM satisfaction scores increased by 2.81 (SD = 1.33) (Z = -4.812, p < .001), and PMoP self scores increased (Z = -2.023, p < .043). CONCLUSION: This study provides preliminary support for CinC with informal care partners of children with SCI. It also highlights several factors that are important to consider when implementing a coaching program, namely mode of delivery and time commitment.

Preliminary examination of Coaching in Context with clients with spinal cord injury.

STUDY DESIGN: Repeated measures pilot study. OBJECTIVES: This study examined Coaching in Context when introduced to community-dwelling adults with spinal cord injury (SCI). SETTING: Urban community. METHODS: Three volunteers participated in up to ten, 45-60-min Coaching in Context sessions. Number of coaching sessions was recorded. Usefulness of Coaching in Context was examined by the Canadian Occupational Performance Measure (COPM), Goal Attainment Scaling (GAS), and the Moorong Self-efficacy Scale (MSES). Data were examined descriptively. RESULTS: Preliminary examination of Coaching in Context revealed successful implementation with adults with SCI living in the community. Mean COPM performance and satisfaction scores increased by 2.55 (SD = 2.25) and 4.27 (SD = 2.41), respectively. With the exception of one, each goal achieved or exceeded GAS expected level. Changed MSES scores ranged from +7 to +16. CONCLUSIONS: The ability to implement and evaluate Coaching in Context with three adults with SCI was demonstrated. Improvement in goals established for coaching was also documented.

Relationship between context and sensory processing in children with autism.

OBJECTIVE: The purpose of the study was to determine the relationship between sensory processing and context for children with autism. We examined home and school contexts using the Sensory Profile (Dunn, 1999) and the Sensory Profile School Companion (Dunn, 2006a) questionnaires. METHOD: Teachers of 49 students with autism completed the Sensory Profile School Companion, and parents completed the Sensory Profile. We conducted correlational analyses using the avoiding and seeking quadrant scores from the School Companion and corresponding avoiding and seeking quadrant scores from the Sensory Profile. RESULTS: The avoiding quadrant score coefficient (.59) and the seeking quadrant score coefficient (.45) were statistically significant (p = .01) with good and fair correlations, respectively, suggesting that sensory processing patterns have both universal qualities and context-specific qualities in children with autism. CONCLUSION: Findings from this study provide initial evidence that sensory processing and context for children with autism are related.