A Psychometric Evaluation of the Dysphagia Handicap Index Using Rasch Analysis.

Background/Objectives: The Dysphagia Handicap Index (DHI) is commonly used in oropharyngeal dysphagia (OD) research as a self-report measure of functional health status and health-related quality of life. The DHI was developed and validated using classic test theory. The aim of this study was to use item response theory (Rasch analysis) to evaluate the psychometric properties of the DHI. Methods: Prospective, consecutive patient data were collected at dysphagia or otorhinolaryngology clinics. The sample included 256 adults (53.1% male; mean age 65.2) at risk of OD. The measure's response scale, person and item fit characteristics, differential item functioning, and dimensionality were evaluated. Results: The rating scale was ordered but showed a potential gap in the rating category labels for the overall measure. The overall person (0.91) and item (0.97) reliability was excellent. The overall measure reliably separated persons into at least three distinct groups (person separation index = 3.23) based on swallowing abilities, but the subscales showed inadequate separation. All infit mean squares were in the acceptable range except for the underfitting for item 22 (F). More misfitting was evident in the Z-Standard statistics. Differential item functioning results indicated good performance at an item level for the overall measure; however, contrary to expectation, an OD diagnosis presented only with marginal DIF. The dimensionality of the DHI showed two dimensions in contrast to the three dimensions suggested by the original authors. Conclusions: The DHI failed to reproduce the original three subscales. Caution is needed using the DHI subscales; only the DHI total score should be used. A redevelopment of the DHI is needed; however, given the complexities involved in addressing these issues, the development of a new measure that ensures good content validity may be preferred.

Exploring Environmental Barriers and Facilitators to Inclusion on a University Campus for Autistic Students.

Background: Attending university allows individuals to build independence, develop social networks, and attain valuable qualifications, contributing to enhanced outcomes in adulthood. However, autistic people have poorer participation rates and outcomes in university than those with all other disabilities or without disabilities. Most research conducted with autistic young adults in the university environment focuses on their social and communicative challenges and supports rather than on how the physical environment impacts an autistic student's university experience. Therefore, there is a need for research into how the sensory aspects of the university environment can affect the well-being and outcomes of autistic students. Methods: This qualitative study explored the experiences of seven autistic university students in the physical spaces of an Australian university. Using a semi-structured interview guide, and photo-elicitation, we collected data in one-on-one interviews with seven autistic undergraduate students. Results: We found that sensory aspects of physical spaces on university campuses are both enabling and challenging for autistic students. These aspects not only impact how students navigate and utilize aspects of the campus, but they also influence how students engage and participate at university. Autistic students need the space and resources to manage sensory overload on campus, and universities that seek to support autistic students need to consider the physical and sensory needs of this cohort. Conclusions: Inclusive university education requires attention to the physical aspects of campuses that support the mental and physical well-being of autistic students.

Why was this study done?: Autistic people are less likely to enroll in and complete further education than those with all other disabilities or without disabilities. Most research conducted with autistic young adults in the university environment focuses on their social and communication challenges, rather than the enabling and disabling aspects of the physical university environment. What was the purpose of this study?: This study aimed to capture and understand autistic students' experiences in navigating and participating in the physical spaces in an Australian university. What did the researchers do?: We interviewed seven undergraduate university students about the places and spaces on the university campus that they found challenging and enabling. Participants took photographs of these spaces before the interview and brought the photographs with them for discussion. What were the results of the study?: We found that the participants readily identified places on the campus that were both enabling and challenging. Physical aspects that were challenging included noisy spaces, crowded areas, and spaces with bright artificial lights. These spaces impacted on their ability to participate and succeed in their studies. They also impacted on their ability to interact with other students, their enjoyment of university, and their physical and emotional well-being. Comfortable spaces that allowed them to recharge were those that were quiet, less busy, had lower levels of sensory input, and allowed them to unmask. What do these findings add to what was already known?: Previous research on the university experience of autistic students has focused primarily on social and educational supports. Research on sensory-friendly education settings has typically focused on primary and secondary education. This study provides evidence of the importance of physical and sensory environments in the educational experience of autistic students in a postsecondary environment. What are potential weaknesses in the study?: The main weakness of the study is the small number of participants (n = 7) and that they were all drawn from one university. While this limits the generalizability of the findings, this was an exploratory study and an important first step in developing our understanding of barriers and facilitators to inclusion on a university campus. How will these findings help autistic adults now or in the future?: While this is a small-scale exploratory study, and there is a need for more research in this area, there are some simple takeaways that could be implemented by universities at minimal cost to support the inclusion of autistic students. For example, sensory input could be reduced by lowering the volume of piped music or reducing the number or brightness of lights. Simple supports for students experiencing sensory overload could include quiet times in cafeterias and access to sensory retreat rooms. At a minimum, our findings could serve as a starting point for discussions between university administrators and autistic students about necessary environmental adjustments to create more inclusive campuses.

Occupational therapy with patients in forensic solitary confinement: A qualitative study.

INTRODUCTION: Occupational therapists work with forensic mental health patients in solitary confinement to counter impacts of mental illness and occupational deprivation, to promote well-being and support transition to less restricted environments. There is little literature describing occupational therapy in this context. This study aimed to explore and describe the work, context and professional reasoning of occupational therapists working in solitary confinement settings within a large forensic mental health service in Victoria, Australia. METHODS: A qualitative design used semi-structured interviews with 11 occupational therapists and reflexive thematic analysis. FINDINGS: Three central organising themes, it's all about risk, the work we do and why we do what we do, provided rich description of the context and work of occupational therapists in solitary confinement settings, including approaches used to engage patients in occupation and how the Model of Human Occupation and recovery principles informed their professional reasoning. Despite the setting restrictions, participants engaged in core elements of the occupational therapy practice process and described creative work that offered patients choice and meaningful occupation. They described occupational enrichment to address occupational deprivation and create opportunities for change within the highly restrictive and risk-focussed environment of solitary confinement. Assessment was mainly unstructured, and the need for better evaluation of therapy outcomes acknowledged. Goal setting often focussed on immediate needs. Working in a risk-focussed environment influenced participants' professional reasoning and work with patients, and while they advocated for occupational opportunities for patients, frustration was experienced in response to limits to occupational therapy involvement in risk assessment. CONCLUSION: The findings address a gap in the literature about the work of occupational therapists in forensic solitary confinement. Though participants' reasoning was informed by occupational and recovery principles, and they described working in occupation-based ways, they did not always articulate explicit connections between theory and practice.

An Exploratory Study: Undergraduates' Perspectives on how Threshold Concepts Influence Professional Identity.

Background. Threshold concepts are key to professional identity development, transforming the way individuals think, act, and perceive the world. Purpose. To understand how occupational therapy students describe their professional identity, its importance, and how threshold concepts contribute to identity. Method. Mixed-method survey of final-year occupational therapy students (n = 58) at an Australian University. Findings. (i) High agreement on most identity and threshold questions; but up to 24% uncertain about confidence/competence in understanding specific concepts; (ii) occupation-focus is unique to our professional identity; (ii) identity develops over time; (iii) occupation-based, client-centered, and evidence-based practices are central to thinking like and becoming an occupational therapist; and (iv) practice education provides context for threshold concepts to be transformative. Implications. Identity is defined by a focus on occupation and its relationship to health. Traversing threshold concepts through academic and practice education is essential to developing professional identity.

'Exploring the perspectives of young adults with developmental disabilities about sexuality and sexual health education'.

BACKGROUND: Sexuality is important in everyday lives; it contributes to a sense of self. Everyone has a right to access sexual experiences, form relationships, and obtain sexual health education. There is limited literature from the perspective of people with developmental disabilities about their sexuality and particularly how, or if, societal attitudes influence their sexuality and their opinions about sexual health education. The aim of this study was to explore the experiences of young adults with developmental disabilities about their sexuality, their perceptions about how their sexuality was viewed by the community, and about the sexual education that is required and how it should be delivered. METHOD: A qualitative interpretative phenomenological approach using a purposive sample was used to explore the perspectives of young adults, aged between 18 and 32 years old with developmental disabilities, to explore their perspectives on their sexuality, societal attitudes, and access to sexual health education. Seven semi-structured interviews were conducted and analysed using an interpretative phenomenological approach. RESULTS: Five main themes were developed from the data: (1) sexuality is multidimensional and important, (2) the challenges and fear of expressing sexuality, (3) societal views need to change, (4) close support enables sexuality, and (5) sexual health education needs to be individualised. CONCLUSION: Participants suggested that sexuality was important to them, and they had the same expectations about sexuality and relationships as many young adults. However, their autonomy and self-determination to set sexuality goals were constrained by societal attitudes. Supportive family and friends enabled opportunities, but they believed the knowledge and attitudes about disability, and about disability and sexuality, of community members, service providers, funders, and educators needed to change to enable increased opportunity to express their sexuality. Participants reported a need for individualised sexual health education provided by professionals with expertise.

Evaluating the feasibility, fidelity, and preliminary effectiveness of a school-based intervention to improve the school participation and feelings of connectedness of elementary school students on the autism spectrum.

In My Shoes is a peer supported, teacher-led, school-based intervention that aims to improve the school participation and connectedness of students on the autism spectrum. The aim of this study was to explore the feasibility, fidelity, and preliminary effectiveness of In My Shoes in mainstream elementary schools. Ten Grade 3 and 4 students on the autism spectrum and 200 of their typically developing peers across eight classrooms and six schools participated. The following aspects of feasibility were explored: recruitment capability and sample characteristics, data collection procedures and outcome measures, appropriateness, implementation, and practicality of the intervention. Fidelity was explored by evaluating the delivery of intervention components against set criteria. Preliminary effectiveness was investigated by evaluating changes in intervention outcomes pre-post intervention using a range of outcome measures. Study findings are encouraging, suggesting In My Shoes is a feasible and appropriate intervention, and shows promise in improving the self-report school engagement of all student participants, as well the classroom participation and subjective school experiences of students on the autism spectrum. Useful insights into ways the intervention and the design of future research can be improved are discussed.

Benefits and Challenges of Assistance Dogs for Families of Children on the Autism Spectrum: Mothers' Perspectives.

Assistance dogs are a potential intervention for families of children on the autism spectrum to support participation. However, the lived experience of families with new assistance dogs has not previously been explored. This study described the expectations, benefits, and challenges of assistance dog ownership for families of children on the autism spectrum. Data were collected from four mothers through semi-structured interviews and photovoice prior to assistance dog placement and following 6 months of ownership. Findings indicated assistance dog ownership enhanced the child's self-regulation and socialization, and increased participation in daily routines. Having an assistance dog also enhanced participation in family outings and activities. Challenges included the adjustment period and the lack of public awareness of autism assistance dogs.

Closing the Gap Between Theory and Practice: Conceptualisation of a School-Based Intervention to Improve the School Participation of Primary School Students on the Autism Spectrum and Their Typically Developing Peers.

Limited interventions exist that support student's school participation. This paper describes a theoretical model of school participation and the iterative process that led to the development of an intervention that aims to improve the school participation of students on the autism spectrum and their typically developing peers. Literature on autism, school participation and intervention research were integrated to develop a theoretical model. Focus groups, a Delphi study, online surveys, and reference group consultation helped to develop and refine the intervention. A novel school-based intervention was developed. The impetus to develop interventions with a strong theoretical rationale is discussed.

Scoping review on noticing concerns in child development: a missing piece in the early intervention puzzle.

BACKGROUND: Between 13 and 32% of children in developed nations are at-risk for developmental delays. In order to identify concerns, there is a need to understand the mechanisms that facilitate becoming aware of it. AIM: A scoping review was conducted to understand this process of "noticing", through existing literature on parent experiences. METHODS: Records from major academic databases and grey literature sources were searched using key terms. Thematic analysis was then conducted to synthesise findings. RESULTS: Twenty papers meeting inclusion were identified. Noticing a delay was found to be an interplay between who notices - parents or other - and how they do so. How concerns are noticed was through two mechanisms: knowledge of child development, and comparison with other children. CONCLUSIONS: This review highlights the nuanced complexity of noticing concerns with a child's development. Understanding how this process occurs and the key ingredients that enable it is vital to supporting early detection of developmental delays.Implications for rehabilitationNoticing developmental delays is a complex process that evolves over time, derived of 'who' notices and 'how' this occurs.When asking parents about child development, professionals need to listen for both bolder "aha moments" as well as more subtle "niggling" comments as indicators of parental concerns.Building baseline parental knowledge of developmental milestones may facilitate noticing of atypical development.Encouraging parents to engage in social opportunities with other children promotes both positive child development and enables developmental monitoring through use of comparison.

Mind the gap: Comparing perspectives of service providers to the needs of people with dementia living in the community.

INTRODUCTION: Research with West Australian people with dementia and their carers living in the community identified that they have a diverse range of needs. However, little is known about the needs of people with dementia and their carers from the perspectives of service providers who provide formal support. This study aimed to investigate the needs of people with dementia and their carers living in the community from the perspectives of service providers, and compare this to service recipients. METHOD: This interpretive descriptive study used focus groups to collect qualitative data from service providers (N = 10). Data were analysed using a hybrid inductive-deductive approach to compare the needs identified by service providers to those identified by people with dementia and their carers. RESULTS: Three major themes were identified: (i) services and supports required by people with dementia and their carers should be flexible, tailored, and equitable; (ii) building capacity to support carers and people with dementia; and (iii) systems designed to care were fragmented and difficult to navigate. Service providers prioritise needs that are limited to their current capacity to provide in contrast to the holistic needs of people with dementia and their carers. CONCLUSION: There was poor alignment between the perceived needs of people with dementia and their carers and the needs prioritised by service providers in the West Australian community. This gap may reduce the ability of services to effectively support people with dementia to remain living in the community.

Can I Learn to Play? Randomized Control Trial to Assess Effectiveness of a Peer-Mediated Intervention to Improve Play in Children with Autism Spectrum Disorder.

Play is often used in interventions to improve social outcomes for children with autism spectrum disorders (ASD). Play is a primary occupation of childhood and, therefore, an important outcome of intervention. The Ultimate Guide to Play, Language and Friendship (PLF) is a peer-mediated intervention for 6-11-year-old children with ASD. A total of 68 dyads were randomized to either a 10-week treatment first or waitlist control group. Results revealed a significant moderate intervention effect from pre- to post-intervention, which was maintained to the 3-month follow-up clinic session and generalized to the home environment. The findings support that the PLF intervention can be used to positively improve play in 6-11-year-old children with ASD.Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ (ACTRN12615000008527; Universal Trial Number: U1111-1165-2708).

Can We Play Together? A Closer Look at the Peers of a Peer-Mediated Intervention to Improve Play in Children with Autism Spectrum Disorder.

Peer-mediated interventions (PMIs) are often used to support children with autism spectrum disorder (ASD) to develop social skills. However, more investigation is needed to better understand the role of peers as both intervention recipients and models. Sixty-five typically developing peers who participated in a PMI for children with ASD were investigated using a randomised control trial. Play sessions of the dyads were scored using the Test of Playfulness. Results showed a significant moderate intervention effect for the peers from pre- to post-intervention; outcomes for children with ASD were not influenced by peer characteristics; and, the children demonstrated a similar pattern of play interaction. Implications for practice are discussed.Clinical Trials Registry Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ (ACTRN12615000008527; Universal Trial Number: U1111-1165-2708).

Peer's pragmatic language outcomes following a peer-mediated intervention for children with autism: A randomised controlled trial.

BACKGROUND: Peer-mediated pragmatic language interventions can be of benefit to children with autism as they simultaneously target an individual child's pragmatic language skills and contextual factors related to social interactions. However, little is known about peer outcomes following peer-mediated interventions. AIMS: This study evaluated the pragmatic language outcomes for typically-developing (TD) playmates who participated in a peer-mediated intervention for children with autism. METHODS: Dyads (child with autism and TD-playmate; n = 71) were randomised to a treatment-first or waitlisted-first comparison group. Dyads attended 10 clinic play-sessions with a therapist and parents mediated home-practice. The Pragmatics Observational Measure 2nd edition (POM-2), and Social Emotional Evaluation (SEE) evaluated pragmatics before, after and 3-months following the intervention. RESULTS: Changes in both outcomes measures were equivalent for intervention-first and waitlisted TD-playmates, but all TD-playmates made significant gains in pragmatics following the intervention. Treatment effects maintained for 3-months (p < 0.001-0.014, d = 0.22-0.63), were equivalent in different environments (clinic and home). Peer relationship type and therapist profession mediated POM-2 scores across the study, while expressive language ability moderated SEE scores. CONCLUSIONS: This peer-mediated intervention had a positive impact on TD-playmate's pragmatic language capacity and performance.

Can I join in? Multiple case study investigation of play performance generalisation for children with autism spectrum disorder from dyad to triad.

INTRODUCTION: Children with autism spectrum disorder (ASD) have difficulties with play, social interaction with peers and generalisation of intervention outcomes. The Ultimate Guide to Play, Language and Friendship (PLF) has demonstrated effectiveness in improving play performance of children with ASD and their typically developing (TD) peers. The aim of this investigation was to examine the changes in play performance when an additional TD child is added to an existing dyad of a child with ASD and a TD playmate to inform future delivery and adaptations of the intervention. METHODS: Participants in this multiple case study design were five children with ASD and their TD peer who completed a dyad intervention as part of a randomised control trial investigation of the PLF and an additional TD peer who joined the play dyad. A trained occupational therapist delivered an adapted version of the PLF to the triad over four clinic sessions. An independent rater scored each child (N = 15) on The Test of Playfulness at pre- and post-triad intervention. Line graphs were used to examine case data and compare to dyad play performance and patterns of interaction. RESULTS: Four of the five children with ASD generalised their play performance from the dyad to the triad social environment. However, the triad intervention did not demonstrate improvements in play performance. The play performance scores for the children with ASD and their TD peers were variable and demonstrated changes in their play pattern from the dyad to the triad. CONCLUSION: This investigation delivered preliminary evidence of play performance generalisation from a dyad to a triad with TD peers for children with ASD. Careful consideration of characteristics of all playmates is recommended for delivering the intervention to support play performance of children with ASD.

School participation: The shared perspectives of parents and educators of primary school students on the autism spectrum.

BACKGROUND: An international focus on the inclusion of students with disabilities in mainstream schools and the increased prevalence of autism spectrum disorder (ASD) has contributed to increasing numbers of students with ASD enrolling in mainstream schools. The school participation restrictions of adolescent students with ASD is widely researched, but less is known about the challenges faced by primary school students with ASD and how early in their schooling these challenges arise. METHODS: Focus groups were used to explore the perspectives of parents and educators on the school participation of primary school students with ASD. Focus group data were analysed thematically. RESULTS: Four themes were derived from the data: (1) more than just being there; (2) meeting in the middle; (3) consistency of supports; and (4) embrace difference. CONCLUSIONS: Findings from this study highlight that students aged between 6 and 11 years experience school participation restrictions due to a range of intrinsic (e.g., sense of self and school belonging) and extrinsic factors (e.g., school culture, educator knowledge and skills). It is imperative school based interventions are developed and implemented in the early primary years, that not only target students' skills, but the range of environmental enablers and barriers impacting student school participation.

A Randomized Controlled Trial of a Play-Based, Peer-Mediated Pragmatic Language Intervention for Children With Autism.

PURPOSE: This randomized controlled trial evaluated the effectiveness of a play-based pragmatic language intervention for children with autism. METHODS: A sample of 71 children with autism were randomized to an intervention-first group (n = 28 analyzed) or waitlist-first (n = 34 analyzed) group. Children attended 10, weekly clinic play-sessions with a typically developing peer, and parents mediated practice components at home. The Pragmatics Observational Measure (POM-2) and the Social Emotional Evaluation (SEE) evaluated pragmatics before, after and 3-months following the intervention. RESULTS: POM-2 gains were greatest for intervention-first participants (p = 0.031, d = 0.57). Treatment effects were maintained at 3-month follow-up (p < 0.001-0.05, d = 0.49-0.64). POM-2 scores were not significantly different in the clinic and home settings at follow-up. CONCLUSION: Findings support the combination of play, peer-mediation, video-feedback and parent training to enhance pragmatic language in children with autism.

A Play-Based, Peer-Mediated Pragmatic Language Intervention for School-Aged Children on the Autism Spectrum: Predicting Who Benefits Most.

This study explored characteristics of children with autism with large intervention effects following a peer-mediated pragmatic language intervention, to devise algorithms for predicting children most likely to benefit. Children attended a 10-week intervention with a typically-developing peer. Data from a pilot study and RCT formed the dataset for this study. The POM-2 measured intervention outcomes. Children completed the EVT-2, TACL-4, and Social Emotional Evaluation at baseline, and parents completed the CCC-2 and CCBRS. High CCC-2 Use of Context and CCBRS Separation Anxiety scores and comparatively lower EVT-2, CCC-2 Nonverbal Communication and Cohesion scores predicted children with large intervention effects. Results can be used by clinicians to predict which children within their clinics might benefit most from participating in this intervention.

Preparing Children with Autism for Transition to Mainstream School and Perspectives on Supporting Positive School Experiences.

School readiness is important to a positive start and success in school but children with Autism Spectrum Disorder (ASD) are at risk of not being school-ready. This study aimed to explore parent and therapist perspectives on school readiness skills of children with ASD and factors impacting on a positive mainstream school experience. A mixed methods design was used. Key findings were that school readiness depends on child and school factors, with social skills the most important child factor. The child's experience was largely reliant on teacher and education assistant attitudes and highlighted a need for further training and support. This study identified areas of focus for early intervention as well as school-aged intervention and the need for collaborative practice.

Applying Item Response Theory (IRT) Modeling to an Observational Measure of Childhood Pragmatics: The Pragmatics Observational Measure-2.

Assessment of pragmatic language abilities of children is important across a number of childhood developmental disorders including ADHD, language impairment and Autism Spectrum Disorder. The Pragmatics Observational Measure (POM) was developed to investigate children's pragmatic skills during play in a peer-peer interaction. To date, classic test theory methodology has reported good psychometric properties for this measure, but the POM has yet to be evaluated using item response theory. The aim of this study was to evaluate the POM using Rasch analysis. Person and item fit statistics, response scale, dimensionality of the scale and differential item functioning were investigated. Participants included 342 children aged 5-11 years from New Zealand; 108 children with ADHD were playing with 108 typically developing peers and 126 typically developing age, sex and ethnic matched peers played in dyads in the control group. Video footage of this interaction was recorded and later analyzed by an independent rater unknown to the children using the POM. Rasch analysis revealed that the rating scale was ordered and used appropriately. The overall person (0.97) and item (0.99) reliability was excellent. Fit statistics for four individual items were outside acceptable parameters and were removed. The dimensionality of the measure showed two distinct elements (verbal and non-verbal pragmatic language) of a unidimensional construct. These findings have led to a revision of the first edition of POM, now called the POM-2. Further empirical work investigating the responsiveness of the POM-2 and its utility in identifying pragmatic language impairments in other childhood developmental disorders is recommended.

Needs of people with dementia and their spousal carers: A study of those living in the community.

OBJECTIVE: To identify care and support needs, as reported by people with dementia and their spousal carers living in the community in metropolitan Western Australia. METHODS: An interpretive description approach was utilised. Semi-structured interviews were conducted with 10 dyads of spousal carers and people with dementia. Comparative analysis was used to develop themes regarding need, which were reviewed using two focus groups of spousal carers. RESULTS: Three major themes were developed through analysis of data from the interviews and were refined by the focus groups: (a) environmental enablers to support care; (b) strong caring relationships; and (c) adaptation of daily life roles. CONCLUSIONS: As dementia progresses, continued support to maintain participation in meaningful activity is needed. Strong caring relationships, knowledge and an understanding of dementia among health professionals, service providers and family members were key to maintaining support for the needs of people with dementia and their spousal carers.