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.

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.

The impact of carer status on participation in healthy activity and self-reported health among Australian women over 50 years.

BACKGROUND/AIM: Occupational therapists frequently work with carers and their family member who requires direct services. In Australia, women provide the majority of informal care. Carer status is determined by the provision of informal help or supervision to an older person, or a person with a disability or long-term health condition. Caregiving responsibilities can impact mental and physical health and reduce women's participation in leisure activities and the labour force. The aim of the study was to examine differences in the participation of Australian women, aged 50 years and over, with and without caregiving responsibilities, in self-selected health promoting activities, self-reported mental health and participation in physical activity. METHODS: This cross-sectional study investigated Australian women (N = 157) who completed a survey comprising demographic questions, the Depression Anxiety Stress Scales-21 (DASS-21), International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Health Promoting Activities Scale (HPAS). Differences between carers and non-carers in participation in health promoting activities, mental health, physical activity and labour force participation were investigated using Mann-Whitney U and Kruskal-Wallis tests. RESULTS: Carers reported significantly lower participation in health promoting activities (P < 0.001), vigorous physical activity (P = 0.001) and moderate physical activity (P = 0.009). Carers also reported significantly higher responses than non-carers, in symptoms of depression, anxiety and stress (P < 0.001). Carers were significantly more likely than non-carers to be engaged in part-time employment, with 37% of carers employed part-time and 44% of carers not working. CONCLUSION: These findings indicate significant differences between women with and without caregiving responsibilities and their participation in health promoting activities, self-reported mental health, participation in physical activity and the labour force. Carers may benefit from occupational therapy that recognises the important role of carers in the life of their family member and supports carer's health and participation in health promoting activities.

iPad applications that required a range of motor skills promoted motor coordination in children commencing primary school.

BACKGROUND/AIM: Children are reported to spend less time engaged in outdoor activity and object-related play than in the past. The increased use and mobility of technology, and the ease of use of tablet devices are some of the factors that have contributed to these changes. Concern has been raised that the use of such screen and surface devices in very young children is reducing their fine motor skill development. We examined the effectiveness of iPad applications that required specific motor skills designed to improve fine motor skills. METHOD: We conducted a two-group non-randomised controlled trial with two pre-primary classrooms (53 children; 5-6 years) in an Australian co-educational school, using a pre- and post-test design. The effectiveness of 30 minutes daily use of specific iPad applications for 9 weeks was compared with a control class. Children completed the Beery Developmental Test of Visual Motor Integration (VMI) and observation checklist, the Shore Handwriting Screen, and self-care items from the Hawaii Early Learning Profile. RESULTS: On post testing, the experimental group made a statistically and clinically significant improvement on the VMI motor coordination standard scores with a moderate clinical effect size (P < 0.001; d = 0.67). Children's occupational performance in daily tasks also improved. CONCLUSION: Preliminary evidence was gained for using the iPad, with these motor skill-specific applications as an intervention in occupational therapy practice and as part of at home or school play.

Transition from early intervention program to primary school in children with autism spectrum disorder.

AIM: To evaluate the characteristics that are associated with successful transition to school outcomes in preschool aged children with autism. METHODS: Twenty-one participants transitioning from an early intervention program were assessed at two time points; at the end of their preschool placement and approximately 5 mo later following their transition to school. Child characteristics were assessed using the Mullen Scales of Early Learning, Vineland Adaptive Behaviour Scales, Social Communication Questionnaire and the Repetitive Behaviour Scale. Transition outcomes were assessed using Teacher Rating Scale of School Adjustment and the Social Skills Improvement System Rating Scales to provide an understanding of each child's school adjustment. The relationship between child characteristics and school outcomes was evaluated. RESULTS: Cognitive ability and adaptive behaviour were shown to be associated with successful transition to school outcomes including participation in the classroom and being comfortable with the classroom teacher. These factors were also associated with social skills in the classroom including assertiveness and engagement. CONCLUSION: Supporting children on the spectrum in the domains of adaptive behaviour and cognitive ability, including language skills, is important for a successful transition to school. Providing the appropriate support within structured transition programs will assist children on the spectrum with this important transition, allowing them to maximise their learning and behavioural potential.

Management strategies of mothers of school-age children with autism: implications for practice.

BACKGROUND/AIM: Mothering children with autism results in mothers spending more time on daily tasks as well as managing the disorder. The need for mothers to self-manage often increases when the child is school aged. Mothers develop strategies, and occupational therapists and other health professional rely on or expect mothers to be involved in meeting the extra needs of their children with autism and other family members. Little is known about the strategies adopted by the mothers. The aim of this study was to explore the strategies mothers used to manage their roles and emotions, and their child's behaviours. METHOD: In-depth individual interviews were conducted with seven mothers and data were analysed in this qualitative study using phenomenological analysis. RESULTS: Findings revealed that the mothers had adopted strategies to manage their roles, their emotions and their child's behaviour. However, the strategies were often shaped by the expectations of others or circumstances beyond their control and at times added further to their stress. CONCLUSIONS: Mothers of children with autism developed strategies to self-manage their lives and their child's disorder. However, even when these strategies were effective, they sometimes placed further stress on the mothers. The mothers provided insights to how they coped but need help to consider the support they require and therapists need to consider the pressures of expecting mothers to self-manage their child's disorder, their own lives and their family. Family-centred practice emphasising collaboration with mothers needs to be maintained with school-aged children.

Context influences the motivation for stereotypic and repetitive behaviour in children diagnosed with intellectual disability with and without autism.

BACKGROUND: Children are motivated to engage in stereotypic and repetitive behaviours for a number of reasons. Their motivation seems to change according to context, but little empirical evidence supports that observation. Interventions designed to reduce the behaviours may be improved by an increased understanding of the interaction between motivation and context. METHOD: Using Rasch analysis, we analysed data describing stereotypic behaviours from 279 Revised Motivation Assessment Scales (MAS:R). Data were gathered from two groups of children: Group 1 with intellectual disability (n = 37) and Group 2 with both intellectual disability and autism (n = 37). We examined behaviours in three contexts: free time, transition and while engaged in tasks. MAS:R distinguishes two intrinsic motivators: enhanced sensation and decreased anxiety and three extrinsic motivators: seeking attention or objects or escape. RESULTS: Significant differences in motivators were observed during free time and transition. No one motivator predominated while children were engaged in tasks. For both groups, sensory enhancement was a more likely motivator in free time and anxiety reduction was a more likely motivator during transition. Transition was the context most likely to influence extrinsic motivators, but there were significant differences between the groups. CONCLUSIONS: Context influences the motivation for stereotyped and repetitive behaviours. Transition has a particularly powerful effect.

Sensory processing and stereotypical and repetitive behaviour in children with autism and intellectual disability.

BACKGROUND: Sensory processing disorders have been linked to stereotypical behaviours in children with intellectual disability (ID) and autism spectrum disorders (ASD) and to anxiety in children with ASD. In earlier phases of this study with the same participants, we found that those with both ASD and ID were more motivated than those with ID alone to engage in stereotypical behaviour to alleviate anxiety. In this phase, we confirmed that children with both ASD and ID and those with ID alone process sensation differently than typically developing children. We asked: Do the sensory processing difficulties of children with ASD and ID differ significantly from those of children with ID alone in a way that would help explain the increased anxiety of the former group? METHOD: Parents of children with ASD and ID (n = 29; mean age 9.7 years) and with ID alone (n = 23; mean age 9.5 years) completed a Sensory Profile (SP) to provide information about their children's sensory processing abilities. SP quadrant scores for each group were compared with each other and with the published norms of typically developing children. RESULTS: Children with ASD and ID and with ID alone processed sensory information differently than typically developing children (P=0.0001;d= >2.00). Children with both ASD and ID were significantly more sensitive (P=0.007;d=0.70) and avoidant (P < 0.05;d=0.47) than the children with ID alone. CONCLUSION: We conclude that increased sensitivity and the tendency to avoid sensation may help explain anxiety in children with autism.

Intrinsic and extrinsic motivation for stereotypic and repetitive behavior.

This study provides evidence for intrinsic and extrinsic motivators for stereotypical and repetitive behavior in children with autism and intellectual disability and children with intellectual disability alone. We modified the Motivation Assessment Scale (MAS) (1988b); dividing it into intrinsic and extrinsic measures and adding items to assess anxiety as an intrinsic motivator. Rasch analysis of data from 279 MASs (74 children) revealed that the items formed two unidimensional scales. Anxiety was a more likely intrinsic motivator than sensory seeking for children with dual diagnoses; the reverse was true for children with intellectual disability only. Escape and gaining a tangible object were the most common extrinsic motivators for those with dual diagnoses and attention and escape for children with intellectual disability.

The motivation of stereotypic and repetitive behavior: examination of construct validity of the motivation assessment scale.

Construct validity of the Motivation Assessment Scale (MAS) (Durand, Crimmins, The Motivation Assessment Scale 1988) was studied using Rasch analysis data from 67 children (246 MASs), with dual diagnosis of autism and intellectual disability or with intellectual disability only. Results failed to support the proposed unidimensional construct or the original 4-factor structure. Some motivators appear to form a unidimensional construct: "to gain attention", "to gain a tangible object", and "to escape". There was evidence that sensory stimulation represents a different construct. Children with intellectual disability were more apt to be motivated by desire to gain a tangible item or attention. Children with the dual diagnoses were more apt to have sensory stimulation or escape from task demand as a motivator for stereotypic and repetitive behavior.