Play as Occupation: The State of Our Science and a Research Agenda for the Profession.

Occupational therapists view play through a unique lens. Considering play as a human occupation, and one to which all people have a right, places occupational therapists among a special group of professionals championing play. This State of the Science article seeks to increase awareness regarding the occupational therapy profession's contributions and to situate those contributions within the larger body of literature on play while also promoting further study of play as an occupation.

Father-Child Playfulness: A Secondary Analysis of a Multiple-Baseline Single-Subject Study of Three Children With Autism Spectrum Disorder.

IMPORTANCE: Ayres Sensory Integration® (ASI) is commonly used with children on the autism spectrum to promote sensory processing and improved occupational performance, including play. To date, there has been no explicit effort to examine improvements in playfulness through ASI. OBJECTIVE: To explore whether ASI, coupled with parent training, improves child playfulness and fathers' support of child playfulness. DESIGN: Single-subject A-B-BC design secondary analysis of a nonconcurrent multiple-baseline study. SETTING: Occupational therapy clinic. PARTICIPANTS: Three father-child dyads; children were ages 3 to 6 yr, with autism spectrum disorder (ASD) and documented sensory processing concerns. INTERVENTION: After a baseline phase, each child received at least 24 sessions of ASI, and fathers received parent training focusing on sensory processing issues and play via an online presentation. OUTCOMES AND MEASURES: The Parent/Caregiver's Support of Children's Playfulness and the Test of Playfulness. RESULTS: Visual analysis of the baseline phase, ASI phase, and ASI with parent training phase shows that all 3 fathers demonstrated an increase in the way they supported their child's playfulness; however, this change was not maintained. Children's playfulness fluctuated, reaching a peak after fathers received training, but none of the children maintained that change. CONCLUSIONS AND RELEVANCE: Additional support by the therapist is required for fathers to learn and use new strategies to promote consistent change in child playfulness during play. Pilot data can be used to inform future studies. What This Article Adds: Occupation- and family-centered frameworks may be useful in guiding practice when working with families of children with ASD.

Cognition Mediates Playfulness Development in Early Childhood: A Longitudinal Study of Typically Developing Children.

IMPORTANCE: Play, children's central occupation, and playfulness, its behavioral manifestation, are the foci of occupational therapy intervention. However, information about the development of playfulness behavior and the role of cognitive function is limited. OBJECTIVE: To explore the development of playfulness and its relation to cognitive functioning from infancy to toddlerhood. DESIGN: Longitudinal study with data collected at ages 6 mo, 18 mo, and 24 mo. SETTING: Laboratory (age 6 mo) and home (ages 12 and 18 mo). PARTICIPANTS: Eighty-six typically developing children drawn from a convenience sample of 109 low-risk families of middle to upper socioeconomic status. MEASURES: The Mullen Scales of Early Learning (MSEL) to assess cognitive functioning and the Test of Playfulness (ToP) to assess children's playfulness. RESULTS: ToP scores were significantly higher at age 24 mo than at age 6 mo, t(88) = -60.30, p < .001, 95% confidence interval (CI) [-1.47, -1.38]. Correlation analysis revealed that the more playful the infant was at age 6 mo, the higher their cognitive functioning was at age 18 mo and the more playful they were at age 24 mo. Toddlers with higher cognitive performance at age 18 mo demonstrated more playful behavior at age 24 mo (ß = 0.120, SE = 0.05, 95% CI [0.0377, -0.2276]). CONCLUSIONS AND RELEVANCE: Children's playfulness is evident as early as age 6 mo and continues to develop through toddlerhood, depending on their cognitive growth. Occupational therapists play a key role in working with families with young children, promoting cognitive development to further the development of playfulness behaviors. What This Article Adds: Understanding the development of playfulness and exploring its relationship with cognitive functioning in typically developing children fills important gaps in occupational therapy knowledge and contributes to delivery of early intervention, especially when cognition or playfulness are at risk. Our findings confirmed that cognitive functioning contributes to the development of playfulness.

Understanding Father-Child Joint Play Experience Using a Convergent Mixed-Methods Design.

IMPORTANCE: Research on the characteristics of father-child play is limited, and how fathers perceive this experience and its contribution to children's development and the parent-child relationship is insufficiently described. OBJECTIVE: To explore associations between fathers' own playfulness, their supportiveness of child playfulness, and child playfulness and fathers' perceptions of their joint play experiences. DESIGN: Convergent mixed-methods design. SETTING: Family homes. PARTICIPANTS: The participants were 57 father-child dyads who resided in a metropolitan area. Children were ages 2 to 5 yr. Interviews with 11 fathers (ages 25-56 yr) were included in the qualitative analysis. OUTCOMES AND MEASURES: Fathers completed a background questionnaire and the Short Measure of Adult Playfulness (SMAP) and participated in a semistructured interview. Fifteen minutes of video-recorded joint play were scored using the Parent/Caregiver Support of Children's Playfulness (PCSCP) and the Test of Playfulness (ToP). RESULTS: Fathers' own playfulness as measured with the SMAP was not related to their child's playfulness as measured with the ToP; however, their supportive behavior as measured with the PCSCP was associated with their child's playfulness. Fathers recognized the benefits of joint play for their child's development. CONCLUSIONS AND RELEVANCE: The current findings help fill the gap in research linking fathers' own playfulness and supportiveness during joint play and their child's playfulness with fathers' perceptions of this experience. What This Article Adds: Understanding fathers' perceptions and behaviors can further enhance service delivery to children and families through interprofessional work to benefit parent-child relationships as well as child development.

Fostering Inter-Professional Education through Service Learning: The Belize Experience.

Service-learning and interprofessional education are forms of experiential learning that instill confidence in students. This pilot study used a post-service learning survey to explore the benefits of interprofessional education in a service-learning experience with students. Findings indicated that this service-learning experience contributed to the development of cultural awareness, and professional skills, as well as increased team attitudes and perceptions related to the respective roles of occupational and physical therapy students. The following report describes students' perspectives and satisfaction concerning professional development, interprofessional education, and cultural awareness utilizing quantitative and qualitative descriptors.

Scoping review: Interventions that promote functional performance for adolescents and adults with Intellectual and Developmental Disabilities.

INTRODUCTION: Individuals with Intellectual and Developmental Disabilities (IDD) experience broad impairments that affect their functional performance and consequently result in the need for supervision and assistance on a daily basis. The literature contains effectiveness studies of functional interventions provided to adolescents and adults with IDD. However, existing differences in participant characteristics, study design, and type of functional intervention limit the ability to derive clinical evidence-based decisions. This scoping review sought to explore the breadth and depth of evidence related to interventions designed to promote everyday performance of adolescents and adults with IDD. METHODS: We conducted an electronic and hand search that yielded 1568 papers, after an extensive selection process reduced to a sample of 24 studies. RESULTS: A three-step extraction process of the 24 studies revealed 16 studies used functional training and technology-based approaches to teach individuals with IDD functional skills. Seven studies used functional training without a technology component, and two studies used functional training while comparing technology-based to non-technology based approaches. Overall, it appeared that functional training with the use of technology, especially Video Modelling (VM) and Prompting, were the most frequently and effectively used interventions to promote everyday performance. Gaps in research include limited studies on middle and older aged adults with moderate to severe IDD, minimal use of self-chosen goals or activities and use of technology as a continuous support. CONCLUSION: Our findings show a lack of studies for individuals age 30 and above with severe IDD. Additionally, this scoping review highlight that everyday functional performance of adolescents and adults with IDD can be enhanced with the usage of technology based functional interventions utilising VM and prompting methods.

Psychometric Properties of the Parents as Partners in Intervention (PAPI) Questionnaires.

This article describes two studies that focused on parents' expectations and satisfaction with occupational therapy intervention for their children (N = 208). The first study determined the psychometric properties of the Parents as Partners in Intervention (PAPI) Questionnaire set (n = 146). The 2nd study examined parental expectations, satisfaction, and perception of their child's functional gains from individual- (n = 30 parents) and group- (n = 32 parents) based interventions. Overall, the results of these studies further support the PAPI Questionnaire set's validity and reliability and suggest that parents' expectations are high and not necessarily in line with their actual satisfaction with the outcomes of their child's intervention and functional gains.

Playfulness and Interaction: An Exploratory Study of Past and Current Exposure to Domestic Violence.

Violence against women affects mother-child interactions, which may in turn affect their children's playfulness. We examined the effect of a history of violence against mothers on mother-child interactions and children's playfulness. This cross-sectional pilot study consisted of 36 mother-child dyads residing in family crisis shelters due to serious violence from an intimate partner. One subgroup had experienced violence during childhood, another had posttraumatic stress disorder (PTSD). Instruments included Posttraumatic Diagnostic Scale, Test of Playfulness, and Coding Interactive Behavior System. Mann-Whitney test and Spearman's rank correlation coefficients were calculated. Results indicated that children of mothers without PTSD were more playful than children of mothers with PTSD. Mothers who had not reported of childhood exposure to violence and who did not have PTSD had better interactions with more playful children.

Efficacy of a Crisis Intervention in Improving Mother-Child Interaction and Children's Play Functioning.

OBJECTIVE: We examined the efficacy of a crisis-based intervention in improving mother-child interaction and children's play functioning for families who had experienced domestic violence. METHOD: Using a pretest-posttest two-group control study design, we assigned the intervention group (n=20 mother-child dyads) to the Family Intervention for Improving Occupational Performance (FI-OP) program and the control group (n=17 dyads) to a playroom program. Both programs consisted of eight 30-min sessions. We videotaped dyads during free play and used standardized tools to assess interactions, play skills, and playfulness. RESULTS: After the intervention, mother-child interaction was significantly better in the FI-OP group than in the playroom group. The children in the FI-OP group also demonstrated significantly greater improvement in play skills, but not in playfulness. CONCLUSION: FI-OP is a promising program for improving aspects of mother-child interaction and children's play functioning among survivors of domestic violence.

Exploring the relationship between manual dexterity and cognition in people with multiple sclerosis: 9-hole peg and multiple cognitive functions.

AIM AND RATIONALE: Problems with manual dexterity and cognition impact the everyday performance of people with multiple sclerosis (PwMS). Accumulated findings point to the relationship between deficits in manual dexterity and auditory domains of cognition with a lack of evidence on visuospatial and verbal aspects of cognitive functioning. Therefore, this study explores the relationship between manual dexterity and cognition in a cohort of PwMS. METHOD: This cross-sectional study collected data from 63 PwMS aged 22 to 55 through a convenient sampling method. Participants were diagnosed with relapsing-remitting multiple sclerosis (RRMS). Cognition was measured using a multi-domain computerized cognitive testing, NeuroTrax, and manual dexterity was measured using a 9-hole peg assessment. Spearman correlation was used to identify the correlation among cognition subtests as well as with manual dexterity. Linear regression analysis was also conducted to identify whether manual dexterity predicts cognitive functioning. RESULTS: A significant negative correlation was found between 9-hole peg scores and global cognitive scores (GCS), r = -0.34, p = 006. The manual dexterity scores were also shown to predict GCS, R2= 0.165, p = 0.001. CONCLUSION: Manual dexterity was found to not only predict cognitive dysfunction but was also associated with multiple cognitive domains. Understanding the relationship between manual dexterity and cognition and the inferred progression of deficits can assist clinicians to provide interventions at earlier stages of disease progression to potentially increase daily functioning and quality of life (QoL).