Instructions for Administering the Canadian Occupational Performance Measure with Children Themselves.

AIMS: The Canadian Occupational Performance Measure (COPM) can be used to support children to clarify their needs themselves. However, for pediatric occupational therapists it is not sufficiently clear how to effectively use the COPM with children from 8 years of age.This study aimed to formulate specific instructions for using the COPM with children themselves, based on the experience of children, parents, and occupational therapists. In addition, professional consensus on the instructions was reached. METHODS: A multi-stage approach was used to develop the instructions. Triangulation of methods was used to gather knowledge of how the COPM with children themselves is performed in daily practice: interviews with 23 children, questionnaires completed by 30 parents, interviews with 13 therapists, and 10 video recordings of COPM administration. Specific instructions were derived from this knowledge and consensus for these instructions was reached by Delphi method. RESULTS: The data were analyzed and resulted in 40 specific instructions. Consensus of at least 80% amongst 10 occupational therapists, who regularly use the COPM with children, was achieved on each instruction. CONCLUSION: There is consensus on 40 specific instructions for administering the COPM with children. Following these instructions might help children to formulate their own goals for intervention.

How children and their parents value using the Canadian Occupational Performance Measure (COPM) with children themselves.

PURPOSE: Although the Canadian Occupational Performance Measure (COPM) is used with children, it is unclear how they and their parents experience this. This study aims to investigate the opinions of children and their parents about the COPM when it is used with children. METHODS: Semi-structured interviews were performed with 23 children varying in age between 8 and 18 years. The transcripts of the interviews were analysed using MAXQDA software to discover overarching themes. Parents' responses to an eight-item multiple-choice questionnaire were analysed using SPSS software. RESULTS: Five themes extracted from the interviews with the children show: My way of doing the COPM; The COPM shows my own problems and wishes for change; The COPM is important for identifying the support I need; The influence of my parents and my therapist; and The COPM is suitable for me. The children experienced the COPM as a valuable tool for determining and measuring the impact of an intervention. The parents experienced the COPM as suitable for their child and judged that the child's scores were useful for showing the outcome of an intervention. CONCLUSION: Both the children and their parents valued the COPM as an outcome measure for intervention.

Attention in 3-Year-Old Children with VLBW and Relationships with Early School Outcomes.

AIM: To compare attention skills of children with a very low birth weight (VLBW) with children with a normal birth weight (NBW) when entering primary school, and explore the association of attention skills with school career 2 years later. METHODS: Participants were 151 children with VLBW and 41 with NBW. Attention was assessed at 3 years and 8 months of corrected age (CA) and school career at 5½ years of CA. Children performed two tests, parents completed three questionnaires, and an assessor systematically observed children's attention. RESULTS: Children with VLBW had significantly lower mean scores on five of the six measures. Significantly more children with VLBW had scores in the clinical range on the Child Behavior Checklist completed by the parents (13% versus 0%) and scores representing dysfunction on assessor observations (19% versus 2%). At 5½ years of age, 36% of the children with VLBW followed special education or had grade retention. Dysfunctional attention as observed by the assessor was most strongly associated with need for learning support at 5½ years of age. CONCLUSIONS: At preschool age, children with VLBW have attention difficulties. Attentive behavior at preschool age is a predictor of school career 2 years later.

The relationship between multiple developmental difficulties in very low birth weight children at 3½ years of age and the need for learning support at 5 years of age.

This study investigated whether multiple developmental difficulties are more frequent in very low birth weight (VLBW) children than in those born full term. The association between multiple developmental difficulties assessed at 3½ years of age and educational provision for the child at 5½ years was also investigated, with 'educational provision' referring to the curriculum, school placement and the level of learning support. There were 143 VLBW children without cerebral palsy (CP) and 41 term-born peers assessed at 3½ years of age. The assessment included 6 measures of development: word comprehension, visual motor integration, visual perception, motor coordination, executive functioning and behaviour. Educational provision was determined at age 5½ years. A mildly abnormal score (score <1 standard deviation) was considered to indicate developmental difficulty. Scores from the six measures of development were analysed to determine the difficulty frequency and the presence of multiple difficulties (>1 difficulty score) in each child. This study showed that at 3½ years of age, the VLBW children had significantly more difficulty with motor coordination than their term-born peers. In addition, 27% of the VLBW children had multiple difficulties compared to 10% in the term-born group. Multiple logistic regression analyses showed that of the difficulties, impaired motor coordination was most strongly associated with the requirement for learning support two years later. Regression analyses showed that having multiple difficulties was significantly associated with the need for learning support (Odds Ratio of 3.4 (95% CI: 1.5-7.8). These results show that the presence of multiple difficulties in a VLBW child of preschool age, can impact the child's educational provision two years later.

Assessing independency in daily activities in very preterm children at preschool age.

This study investigates whether very low birth weight (VLBW) preschoolers experience disability in daily activities and what the risk factors for disability in daily activities are. The Dutch Pediatric Evaluation of Disability Inventory (PEDI-NL) was used to detect disability in daily activities in 143 VLBW children without cerebral palsy (CP) at 44 months of corrected age (CA). Data from the psychomotor-developmental index (PDI) and the mental developmental index (MDI) of the Bayley Scales of Infant Development II (BSID II) at 24 months CA, and data relating to perinatal and socio-economic status were available. Disability in daily activities was found in 27 (19%) VLBW children without CP. High frequencies of disability were found in 19 (13%) children on the mobility domain and in 12 (8%) children on the social functioning domain. The multiple logistic regression analyses showed that low BSID II outcomes (<2 SD) were risk factors for disability in the mobility domain, but not for disability in the social functioning domain. The predictive value of the BSID II outcomes is moderate, 46% of the VLBW children with a low PDI and 44% with a low MDI developed a disability in the mobility domain. This study showed a higher frequency of disability in daily activities in VLBW preschoolers compared to term born peers. Therefore, it is suggested to assess VLBW children's performance of daily activities before they start school.

The infant behavioral assessment and intervention program in very low birth weight infants; outcome on executive functioning, behaviour and cognition at preschool age.

BACKGROUND: The Infant Behavioral Assessment and Intervention Program (IBAIP©) improved motor function at 24 months, and mental and behavioural development in high risk subgroups of very low birth weight (VLBW) infants. AIM: To determine IBAIP's effects on executive functioning, behaviour and cognition at preschool age. STUDY DESIGN: Follow-up of a randomised controlled trial (RCT). SUBJECTS: At 44 months corrected age, all 176 VLBW infants were invited for follow-up. Forty-one term born children were assessed for comparison. OUTCOME MEASURES: Visual Attention Task (VAT), Gift delay, Peabody Picture Vocabulary Test III-NL (PPVT), Visual motor integration tests and Miller assessment for preschoolers. Parents completed Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P) and Child Behavior Checklist (CBCL). RESULTS: At preschool age, 76 (88%) children of the intervention group and 75 (83%) children of the control group participated. There were no significant differences between the intervention and the control group. However, positive interaction effects between intervention and infants with bronchopulmonary dysplasia, infants born at gestational age<28 weeks, and infants of low educated mothers were found on CBCL, CBCL and BRIEF-P, and PPVT respectively. Most interaction effects exceeded 1 standard deviation in favour of the intervention children. The 151 VLBW children performed significantly worse than the term born children on the VAT, BRIEF-P and CBCL. CONCLUSION: IBAIP effects in VLBW children did not sustain until preschool age on executive functioning, behaviour and cognition. However, the most vulnerable children had a clinical relevant profit from IBAIP. VLBW children performed worse than the term born children. This study is a follow-up at preschool age of the multi-centre RCT of IBAIP versus usual care in VLBW infants. The RCT was performed in Amsterdam, The Netherlands (IBAIP).

Infant behavioral assessment and intervention program in very low birth weight infants improves independency in mobility at preschool age.

OBJECTIVE: To evaluate the effects of the Infant Behavioral Assessment and Intervention Program(©) (IBAIP) in very low birth weight infants on sensory processing and daily activities at preschool age. STUDY DESIGN: Follow-up of children included in a randomized controlled trial. Eighty-six infants were enrolled in post-discharge IBAIP until 6 months corrected age, and 90 infants received standard care. At 3.5 years of age, the Sensory Profile-Dutch version (SP-NL) and Pediatric Evaluation of Disability Inventory-Dutch version (PEDI-NL) were administered. For comparison, parents of 41 term-born children also completed the SP-NL. RESULTS: Seventy-six children (88%) in the IBAIP group and 75 children (83%) children in the control group were examined at 44 months corrected age. After adjustment for pre-randomization differences in perinatal characteristics, the IBAIP group outperformed the control group significantly on SP-NL domains of oral sensory processing and sensory processing related to endurance/tone and PEDI-NL domains of mobility. The control group only scored significantly lower than the term group on the SP-NL domain endurance/tone. The very low birth weight groups performed significantly below the PEDI-NL's norm. CONCLUSION: In line with the positive developmental effects of the IBAIP until 24 months corrected age, independency in mobility in daily activities was improved at 3.5 years.

Visual function at 11 years of age in preterm-born children with and without fetal brain sparing.

OBJECTIVE: We have demonstrated earlier an accelerated maturation of the visual evoked potential in the first year of life in preterm infants with antenatal brain sparing. We have now assessed visual functioning at 11 years of age in the same cohort and compared the groups with and without brain sparing. DESIGN/METHODS: One hundred sixteen survivors included in a study on the outcome of preterm infants born at <33 weeks' gestation with and without fetal brain sparing and admitted to the NICU were followed extensively. Ninety-eight infants (85%) were again assessed at 11 years of age. Data were available for fetal Doppler measurements indicating brain sparing, neonatal cerebral ultrasound scanning, and developmental outcome in the first 5 years. Mean birth weight was 1303 g; mean gestational age was 29.8 weeks. The infants were divided into 2 groups with and without brain sparing. Visual functioning was estimated by measuring visual acuity, visual fields, eye position, and binocular function and by visual motor tests. RESULTS: Six percent of the children were found to have a visual acuity of <0.8, 12% had strabismus, and 14% to 46% showed abnormal results on the visual motor tests. No statistical differences were found between the 2 groups. However, children with severe cerebral ultrasound diagnoses in the neonatal period were found to have significantly more abnormalities on visual functioning and lower scores on visual motor tests than children without these morbidities. CONCLUSIONS: Children with fetal brain sparing do not demonstrate a different development of their visual functioning at late school age. However, an abnormal cerebral ultrasound in the neonatal period is associated with impaired visual function in later life.

The reproducibility and validity of the Canadian Occupational Performance Measure in parents of children with disabilities.

OBJECTIVE: To study the reproducibility (inter-rater agreement), the construct and criterion validity of the Canadian Occupational Performance Measure (COPM) in the parents of children with disabilities. DESIGN: The COPM was administered twice by two different occupational therapists. The inter-rater agreement of the content of the prioritized problems was explored. Data analysis of the reproducibility of the scores was based on the Bland and Altman method. Measures used: The construct validity was studied by comparing the results of the COPM with the Pediatric Evaluation of Disability Inventory, and a quality of life questionnaire. The criterion validity was verified with an open-ended question. SETTING: Occupational therapy departments of a university hospital and three rehabilitation institutes. SUBJECTS: One hundred and twenty-nine consecutive parents of children referred for occupational therapy. RESULTS: Data were obtained for 80 children with a mean age of 3.7 years (range 1-7.5). Of the prioritized problems identified in the first interview, 80% were also prioritized in the second interview. The limits of agreement were - 2.4 to +2.3 for the mean performance score and - 2.3 to + 2.6 for the mean satisfaction score. Assumptions about the construct and criterion validity were confirmed. CONCLUSIONS: The inter-rater agreement of the prioritized problems is good enough for client-centred occupational therapy. The reproducibility of the performance and satisfaction scores is moderate. The results support the construct and criterion validity. The COPM identifies many child-unique problems that are not assessed with existing standardized measurement instruments or with a simple open-ended question.