Item Analysis, Age Trends, and Internal Consistency Reliability of the Children's Occupational Performance Questionnaire (COPQ).

IMPORTANCE: Occupational performance measures are essential for guiding client-centered interventions for children and for measuring progress and program outcomes. OBJECTIVE: To evaluate and report on the psychometric properties of a new assessment tool, the Children's Occupational Performance Questionnaire (COPQ). DESIGN: Descriptive and correlational methods were used. PARTICIPANTS: A convenience sample primarily from the northeastern United States was recruited, consisting of the caregivers of 156 children and 25 older children who completed the COPQ as a self-report. Participants' ages ranged from 2 mo to 19 yr. Seventy-five percent of them identified as typically developing, and 25% had a medical condition or disability affecting development. OUTCOMES AND MEASURES: Data from completed questionnaires assessing children with and without disabilities were used to explore aspects of the COPQ's content validity, including age trends and item difficulty. Internal consistency reliability was also examined for each of the five domains: Personal Activities of Daily Living, Instrumental Activities of Daily Living, Social Participation, Play/Leisure, and Education/Work. RESULTS: Each COPQ domain showed strong internal consistency reliability (Cronbach's α = .96-.99). Age trends indicated increasing competency in occupational performance with age across domains and supported occupational performance as a developmental construct. CONCLUSIONS AND RELEVANCE: The COPQ shows promise as a reliable occupational performance measure for children for both clinical and research purposes. Potential items for modification or deletion were identified to reduce redundancy and increase efficiency. Further study of the tool's psychometrics and normative data collection are needed. WHAT THIS ARTICLE ADDS: The COPQ addresses all areas of occupational performance and is being developed as a valid, reliable assessment tool for children. It aims to assist in guiding occupational therapy interventions and detecting changes in occupational performance in response to treatment.

Validity of the Occupational Performance Scale of the Sensory Processing Three Dimensions Measure.

IMPORTANCE: The Sensory Processing Three Dimensions (SP3D) Occupational Performance Scale (OPS) is a new parent-report measure developed for use as part of a comprehensive occupational therapy evaluation for children with sensory processing and integration challenges. OBJECTIVE: To examine the internal consistency and discriminant validity of the SP3D OPS, examine relations between sensory processing subtypes and areas of occupational performance (OP), and determine the extent to which specific sensory processing challenges predict problems with OP. DESIGN: Nonexperimental, descriptive design using correlations, group comparisons, and stepwise regression. SETTING: Three outpatient clinic sites in the United States. PARTICIPANTS: Parents of 66 children (33 typically developing and 33 with clinical problems) ranging in age from 4 to 12 yr. OUTCOMES AND MEASURES: The SP3D OPS and SP3D Inventory were completed by parents to address psychometrics of the SP3D OPS and determine the association between sensory processing and integration challenges with OP. RESULTS: Internal consistency reliability and discriminant validity of the SP3D OPS were supported. Scores on the Dyspraxia and Sensory Overresponsivity subscales best predicted deficits in OP. Significant relations were found between sensory processing and integration and competency in multiple OP areas. CONCLUSIONS AND RELEVANCE: The SP3D OPS shows promise as a measure of OP. The OP deficits among children with sensory processing and integration challenges are in part due to subtype presentation. Further studies of the SP3D OPS's reliability and validity are needed. WHAT THIS ARTICLE ADDS: This new occupational performance measure shows associations between sensory processing and OP areas. It can provide information to support therapists in identifying family concerns relevant to goal setting and intervention.

Initial Studies of Validity of the Sensory Processing 3-Dimensions Scale.

AIMS: This study examined the validity of a new measure of sensory processing for children, the Sensory Processing 3-Dimensions Scale (SP-3D). The SP-3D is a performance-based measure for children ages three to thirteen years, designed to assess sensory processing abilities, and identify the three patterns of sensory processing disorder (SPD) and related subtypes, including sensory modulation, sensory discrimination, and sensory-based motor disorders. METHODS: Age trends were explored using descriptive statistics and graphing techniques with a sample of children with and without SPD. SP-3D scores were correlated with scores from the Sensory Processing Measure (SPM) to examine criterion-related validity. Discriminant validity was assessed by comparing SP-3D scores from children with and without SPD. RESULTS: Age trends of SP-3D scores supported sensory discrimination, praxis and postural functions as developmental constructs. Several mild to moderate correlations were found between the scores of the SP-3D and the SPM, indicating that the tools are measuring similar constructs, and supporting the SP-3D as a measure of sensory processing. Modulation and Motor Behavior Scores from the SP-3D discriminated typically developing children from those with SPD, while results from subtests measuring sensory discrimination, postural and praxis were mixed regarding capacity for discrimination suggesting revision to several items. CONCLUSION: The study provides preliminary evidence of the SP-3D as a valid measure of sensory processing abilities and dysfunction. Further research regarding the reliability and validity of the SP-3D are needed.

An examination of occupation-based, client-centered, evidence-based occupational therapy practices in New Hampshire.

This study surveyed occupational therapy practitioners to gain a better understanding of the nature of occupational therapy practices in the State of New Hampshire. A questionnaire was developed and distributed to a sample of practitioners working in New Hampshire to gather information regarding the extent to which occupation-based, client-centered, evidence-based services were being provided. Results suggested that practitioners highly value these service delivery attributes. However, day-to-day practice decisions regarding evaluation methods, where to conduct intervention sessions, goal writing, and choices of intervention activities suggest a stronger emphasis on the evaluation and remediation of specific performance skill and body function deficits, rather than on client performance of desired occupations. In light of the findings, the discrepancy between practitioner values and daily clinical practices is discussed, along with the challenges inherent in providing authentic, evidence-based occupational therapy.

Verification and clarification of patterns of sensory integrative dysfunction.

Building on established relationships between the constructs of sensory integration in typical and special needs populations, in this retrospective study we examined patterns of sensory integrative dysfunction in 273 children ages 4-9 who had received occupational therapy evaluations in two private practice settings. Test results on the Sensory Integration and Praxis Tests, portions of the Sensory Processing Measure representing tactile overresponsiveness, and parent report of attention and activity level were included in the analyses. Exploratory factor analysis identified patterns similar to those found in early studies by Ayres (1965, 1966a, 1966b, 1969, 1972b, 1977, & 1989), namely Visuodyspraxia and Somatodyspraxia, Vestibular and Proprioceptive Bilateral Integration and Sequencing, Tactile and Visual Discrimination, and Tactile Defensiveness and Attention. Findings reinforce associations between constructs of sensory integration and assist with understanding sensory integration disorders that may affect childhood occupation. Limitations include the potential for subjective interpretation in factor analysis and inability to adjust measures available in charts in a retrospective research.

Characteristics of Idiopathic Sensory Processing Disorder in Young Children.

This study described the developmental and behavioral characteristics of children identified with idiopathic sensory processing disorder (SPD) as well as the relations among specific types of SPD as proposed by the nosology presented by Miller et al. (2007), adaptive behavior profiles, and behaviors associated with mental functioning. A retrospective, non-experimental design applying descriptive and correlational analyses was used. Data were obtained from clinic medical records of 78 children ages 2 to 7 years who were identified with sensory processing problems affecting daily life, but who did not meet criteria for any other neurodevelopmental or mental disorders following a comprehensive diagnostic evaluation. Results revealed that all SPD types as described by current typologies were well represented with the most common being the over-responsivity sensory modulation subtype. Within the sample, 53% of the children displayed more than one SPD type. Atypical externalizing and internalizing behavior scores associated with various mental disorders as measured by the child behavior checklist (CBCL) fell in the borderline dysfunctional range. Adaptive behavior for all developmental domains was below average, and the severity of SPD symptoms moderately and positively correlated with behaviors associated with mental disorders, and with lower adaptive behavior performance. It was concluded that symptoms characteristic of the various types of idiopathic SPD overlap substantially suggesting that current typologies may include more types/subtypes than are necessary or clinically useful. Children with SPD share similar, but often less severe pathological behaviors associated with other mental or related neurodevelopmental disorders. Psychometrically sound measures of SPD are needed, and further study of the neural mechanisms involved in sensory processing deficits is vital for validating idiopathic SPD as its own diagnostic entity.

Initial Studies of Validity of the Children's Occupational Performance Questionnaire.

Studies of validity of a new caregiver report measure, the Children's Occupational Performance Questionnaire (COPQ) designed to address children's performance in the domains of personal and instrumental activities of daily living (IADLs), social participation, play/leisure, and education/work are presented. I examined criterion-related and discriminant validity of the COPQ. Criterion-related validity was addressed by correlating children's COPQ scores with those from the Vineland Adaptive Behavior Scale (VABS-II). Quasi-experimental methods were used to compare COPQ scores from a heterogeneous group of children with disabilities with those from neurotypical children matched by age. COPQ scores correlated highly with scores from the VABS-II including social interaction, communication, daily living skills, and motor skills. Capacity of the COPQ to discriminate between children with and without disabilities varied dependent on age, and the occupational domain being considered. Preliminary support for the validity of COPQ as a measure of occupational performance for children was provided. Further study of the tool's psychometrics and with larger samples is needed.

An examination of the relationships between motor and process skills and scores on the sensory profile.

OBJECTIVE: This quasi-experimental study sought to determine whether children with possible sensory processing deficits, as measured by the Sensory Profile, performed less well on an occupational performance measure compared to children with typical Sensory Profile scores. METHOD: Sixty-eight children were administered both the Assessment of Motor Process Skills (AMPS) and the Sensory Profile. After the assessments were completed, children were divided into two groups based on their Sensory Profile scores. RESULTS: Independent t tests indicated statistically significant differences between groups on the AMPS ADL [Activities of Daily Living] Motor and ADL Process measures (p < .05), with the children with atypical Sensory Profile scores showing more functional difficulties. Correlations revealed significant relationships among the measures. CONCLUSION: The results suggest that children identified with sensory processing deficits on the Sensory Profile are likely to experience some challenges in performing everyday occupations.

Identification of Sensory Processing and Integration Symptom Clusters: A Preliminary Study.

RATIONALE: This study explored subtypes of sensory processing disorder (SPD) by examining the clinical presentations of cluster groups that emerged from scores of children with SPD on the Sensory Processing 3-Dimension (SP-3D) Inventory. METHOD: A nonexperimental design was used involving data extraction from the records of 252 children with SPD. Exploratory cluster analyses were conducted with scores from the SP-3D Inventory which measures sensory overresponsivity (SOR), sensory underresponsivity (SUR), sensory craving (SC), postural disorder, dyspraxia, and sensory discrimination. Scores related to adaptive behavior, social-emotional functioning, and attention among children with different sensory modulation patterns were then examined and compared. RESULTS: Three distinct cluster groups emerged from the data: High SOR only, High SUR with SOR, and High SC with SOR. All groups showed low performance within multiple domains of adaptive behavior. Atypical behaviors associated with social-emotional functioning and attention varied among the groups. IMPLICATIONS: The SP-3D Inventory shows promise as a tool for assisting in identifying patterns of sensory dysfunction and for guiding intervention. Better characterization can guide intervention precision and facilitate homogenous samples for research.

Behavioral and physiologic response measures of occupational task performance: a preliminary comparison between typical children and children with attention disorder.

OBJECTIVE: To compare performance on the Assessment of Motor and Process Skills (AMPS), a measure of functional task performance and physiological responses (salivary cortisol levels) during AMPS administration, between typically developing children and children diagnosed with attention deficit hyperactivity disorder (ADHD). METHOD: In this quasi-experimental study, independent t tests, and mixed, repeated measures analysis of variance were conducted to compare a group of typically developing children (n = 21) with a group of children with ADHD (n = 12) on two dependent measures: (a) the AMPS and (b) salivary cortisol. Salivary cortisol, a stress hormone, was taken at three time points, baseline, mid-way through AMPS administration, and 20 min following AMPS administration. RESULTS: Significant differences were found on the activities of daily living (ADL) process ability measure of the AMPS (p = .001) and the ADL motor ability measure (p = .04), with the ADHD group performing more poorly than typical children. There was no significant group (ADHD vs. control) by time period interaction effect on cortisol levels. Overall, the cortisol levels of the ADHD group were higher than the levels of those in the control group (p = .02). Cortisol levels tended to drop significantly over time (p = .01) for both groups, however the patterns differed somewhat between groups. Cortisol levels of the typical children dropped at the final time period (20 min post-AMPS administration) whereas the levels of the children in the ADHD remained higher during this time period. This interaction effect approached, but did not reach, statistical significance (p = .15). CONCLUSION: The results of this investigation suggest that the AMPS is sensitive to detecting functional performance concerns, and both motor and process skill deficits, associated with ADHD, and therefore may be a useful assessment tool with this population. Data also suggests that cortisol expression to a well-known ADL task may be lower if the task is not overly challenging for the individual, and provides support for further study of the role of cortisol with disorders of attention.

Sensory and motor behaviors of infant siblings of children with and without autism.

We compared the sensory and motor behaviors of typically developing infants with those of infant siblings of children with autism spectrum disorders (ASD), who are considered high risk for the disorder, to explore potential sensory and motor markers for use in early diagnosis of ASD. We compared frequencies of sensory and motor behaviors during 10-min, videotaped, infant-mother play sessions and during 5 min of spoon-feeding between groups of 12-mo-old infants. Data from standardized measures of development, sensory processing, and behaviors commonly associated with ASD were also analyzed descriptively for the high-risk group. The results indicated that high-risk infants demonstrated fewer movement transitions (t [23] = -2.4, p = .03) and less object manipulation (t [23] = -2.4, p = .03) than low-risk infants. The sensory and motor differences found between typical and high-risk infants suggest that early screenings for ASD should include the examination of sensory and motor behaviors.