Assessing functioning for individuals with neurodevelopmental conditions: Current clinical practice in Australia

BACKGROUND

In the disability sector globally, and specifically in Australia, assessments of functioning have become key to diagnostic processes, and accessing therapy and funding. Over half of all individuals accessing support through Australia's National Disability Insurance Scheme have a neurodevelopmental condition diagnosis. Little is known about assessments of functioning for this population.

METHODS

A mixed methods online survey was designed to understand the current assessment of functioning practices (including clinical contexts, concepts being assessed, and assessment methods) and barriers and facilitators to clinicians using best practice. Results were analysed descriptively, and differences between professions calculated where possible. Content analysis was used to explore qualitative comments.

RESULTS

Clinicians from various medical and allied health backgrounds completed the survey (n = 93), with varying ranges of age, experience, and education. Clinicians reported that they assessed functioning across age, setting, sector, funding body, and individuals with a wide variety of diagnoses. Missing from current practice is a clear transdisciplinary conceptualisation of functioning. The largest barriers to best practice were limited time, large caseloads, availability of appropriate tools, and lack of clarity from funding bodies.

CONCLUSIONS

Missing from current practice is a clear transdisciplinary conceptualisation of functioning.These results will help inform steps forward to improve assessment of functioning practices to ensure that all individuals receive appropriate and sufficient support.

New Graduates' Experiences in Paediatric Private Practice: Learning to Make Intervention Decisions

Background. Challenges with clinical decision-making are common among new graduate occupational therapists. There is limited research exploring their experiences of learning to make intervention decisions. Purpose. To explore new graduates' experiences of learning to make intervention decisions in pediatric private practice. Method. A case study approach, involving a range of data sources, explored the experiences of 11 new graduates and three experienced occupational therapists working in Australian private practices. Data were analyzed using inductive thematic analysis. Findings. Themes pervading new graduates' decision-making experiences were: "being seen as capable and competent," "similar and familiar," and "specialist versus generalist positions." Contextual influences contributed to new graduates utilizing their support networks and personal experiences in addition to workplace supports. Implications. It is vital to balance private practice business demands with opportunities for new graduates to engage with experienced occupational therapists and professional communities of practice to assist their learning to make intervention decisions.

Content validation of common measures of functioning for young children against the International Classification of Functioning, Disability and Health and Code and Core Sets relevant to neurodevelopmental conditions

LAY ABSTRACT

Young children who have developmental delay, autism, or other neurodevelopmental conditions can have difficulties doing things in different areas of their life. What they can and cannot do is called their level of functioning. There are lots of assessment measures that aim to assess functioning. But, we are not sure if these measures assess all the things we need to know about these children's functioning. Other research has identified lists of items (codes) that need to be assessed to understand functioning for young children with different neurodevelopmental conditions fully. These lists include body functions (the things a child's body or brain can do), activities and participation (the activities and tasks a child does) and environmental factors (parts of the environment that can influence functioning). In this study, we looked at the items from these lists assessed by different functioning measures to see how they compared to what should be assessed. The measures that we looked at covered 21%-57% of all the codes and 19%-63% of the codes for lists specific to different conditions. Most of the measures focused on activity and participation codes, and they rarely assessed environmental factors. Knowing which codes and how much of the lists the measures assess can help researchers, clinicians and policymakers to choose measures that are more appropriate for young children with neurodevelopmental conditions.

Movement difficulties in children with ADHD: Comparing the long- and short-form Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2)

AIMS

Up to 50% of children with attention deficit hyperactivity disorder (ADHD) also present with difficulties with motor proficiency. Several assessments of motor proficiency are available for occupational therapists, though the validity of these measures in an ADHD population requires further exploration. The aim of this paper was to evaluate the consistency of scores obtained using the long-form and short-form of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2) in a school-age ADHD sample.

METHOD

The BOT-2 long-form was administered to 84 school-age children (78 males) with ADHD; short-form scores were extracted from the relevant long-form items.

RESULTS

Long-form and short-form total scores were highly correlated (r = .87), though the average short-form score was significantly higher. As a categorical measure, 52 children were classified as "at-risk" for movement difficulties by the long-form; but only 36 by the short-form, yielding a false-negative rate of 30.77%. The sensitivity of short-form could be improved by raising the cut-off thresholds of short-form scores as identified by receiver operating characteristic curve analysis but did not yield practical utility.

INTERPRETATION

As a continuous indicator (i.e. total scores), the short-form is comparable to the long-form. However, the short-form overestimates the child's motor proficiency relative to the long-form and yields an unacceptably high rate of false negatives as a categorical measure. The current revision of the short-form is therefore not recommended as a screening nor diagnostic instrument in an ADHD population. In the absence of ADHD-specific norms, use of the long-form provides greater opportunity for occupational therapists to identify those at-risk for movement difficulties. However, any assessment of motor proficiency should be accompanied by a broader comprehensive assessment to best understand a child's motor functioning.

How Well Can Family Childcare Providers Report on Preschoolers' Motor Skill Competence?

Background

Assessing children's movement skill competence objectively is resource and time intensive. Family childcare providers (FCCPs) are with young children for most of a normal weekday and may have an understanding of their motor skill competence.

Objective

This study examined how well FCCPs can report on preschoolers' motor skills.

Method

Seventy-eight 3-5 year olds (53.1% girls) from 26 FCCPs participated. The Test of Gross Motor Development-2 assessed actual motor skill competence and a survey assessed preschoolers' motor competence as reported by FCCPs. Bivariate correlations examined associations between actual and FCCPs' proxy-report of preschoolers' motor skill competence. Regression models tested the predictive power of FCCPs' proxy-report on actual preschoolers' motor skill competence, accounting for age and sex.

Results

There were moderate significant correlations for locomotion (r = .30), object control (r = .38), and overall motor skill competence (r = .36). The regression models showed proxy report was statistically associated with preschoolers' object control skills (β = .78, p = .011) and overall motor skills (β = .72, p = .022), but not locomotor skills (β = .52, p = .084). FCCPs' proxy-report of preschoolers' motor skill competence explained 20.9, and 20.1% of preschoolers' variance in object control, and overall motor skill competence, respectively after adjusting for biological sex and age (increasing).

Conclusions

FCCPs may be used as an alternative source of information in reporting young children's actual motor skill competence, at least for the object control domain. There is an opportunity for education of FCCPs regarding children's locomotor skill development.

Perceptions of a multidisciplinary team regarding a pediatric rehabilitation modified needs assessment

BACKGROUND

Efficient service delivery models that optimize processes and human resources are required in the current health care climate. A family-centered care approach is recognized as a model that can improve the effectiveness and efficiency of pediatric rehabilitation. The objective of this study was to explore the perceptions of a multidisciplinary health care team regarding the use of the Préparation au plan d'intervention (PAPI), a modified needs assessment tool designed to facilitate a family-centered care approach among children with cerebral motor deficits (CMD) and their families.

METHODS

One focus group was conducted with the multidisciplinary team (n = 10) of the CMD program at a pediatric rehabilitation center. It was audio recorded and transcribed verbatim for content analysis.

RESULTS

Three overarching themes were identified from the analyzes: (1) a facilitator of open communication, (2) a way to gain the unique sense of the child and family and (3) parents as the experts of their child.

CONCLUSIONS

Health care professionals value the use of the PAPI as a way of facilitating a family-centered care plan process, specifically with children with cerebral motor deficits.

Convergent validity of two motor skill tests used to assess school-age children

BACKGROUND

Motor skills allow children to interact with their surrounding environment, making the progression of competent motor skills crucial to development. The most common form of motor skill assessment is through the use of performance-based tests. Performance measures need to be both reliable and valid to ensure they are of high quality. Two examples of performance-based motor skill tests often used to assess children are the Bruininks-Oseretsky Test of Motor Proficiency--2nd edition (BOT-2) and the Movement Assessment Battery for Children--2nd edition (MABC-2).

AIM

This study investigated the convergent validity between the BOT-2 and MABC-2 when completed by typically developing school-aged children aged 7-16 years.

METHOD

A convenience sample of 50 children aged 7-16 years with no history of motor or intellectual impairments was recruited. Scores from the BOT-2 and MABC-2 were analysed using Spearman's rho correlation.

RESULTS

The study found that the MABC-2 11- to 16-year-old group (age band 3) was significantly associated with the BOT-2; however, there were no significant relationships between the MABC-2 7- to 10-year-old group (age band 2) and the BOT-2.

CONCLUSION

The MABC-2 and BOT-2 appear to assess associated motor skill abilities in children aged 11-16 years but not in children aged 7-10. This study adds to the body of convergent validity evidence regarding the MABC-2 and BOT-2.

Are performance-based and self-report measures of children's motor skill abilities linked?

Traditionally, children's motor skills were assessed using standardized performance-based tests; however, practitioners are now being encouraged to utilize client-centered and child-centered assessment approaches (such as self-report scales). The purpose of the study was to investigate the association between standardized performance-based and child-report measures of children's motor skill abilities using a convenience sample of 93 typically developing school-age children (52 boys and 41 girls with a mean age of 10.3 years [standard deviation = 1.4]). Data obtained from the Bruininks-Oseretsky Test of Motor Proficiency-second edition (BOT-2) and the Physical Self-Description Questionnaire (PSDQ) were analyzed using Spearman's rho correlations. Of the eight BOT-2 subscales, the three that significantly correlated with 8 or more of the 11 PSDQ subscales were the BOT-2 Balance, Running Speed and Agility, and Strength subscales. The PSDQ Body Fat and Flexibility subscales did not correlate with any of the BOT-2 subscale scores. This suggests that children offer a unique perspective of their motor skill performance relative to other sources of assessment information. The PSDQ is recommended for inclusion as part of the motor skill assessment repertoire that practitioners use with children.

Top-down and bottom-up approaches to motor skill assessment of children: are child-report and parent-report perceptions predictive of children's performance-based assessment results?

BACKGROUND/ AIM: Therapists use different types of tests, scales, and instruments to assess children's motor skills, including those classified as being top-down and bottom-up. The aim of the study was to investigate the ability of measures of children's motor skill performance from the perspectives of children and parents (a type of top-down assessment) to predict children's performance-based motor ability test results (a type of bottom-up assessment).

METHODS

A convenience sample of 38 children and parents was recruited from Victoria, Australia. Motor skill performance was evaluated from a top-down perspective using the Physical Self-Description Questionnaire (PSDQ) and the Movement Assessment Battery for Children--Second Edition (MABC-2) Checklist to measure children's and parents' perspectives respectively. Motor skill performance was also evaluated from a bottom-up approach using the Bruininks-Oseretsky Test of Motor Proficiency--Second Edition (BOT-2). Data were analyzed using multiple linear regression analysis to determine whether the PSDQ or MABC-2 Checklist was predictive of the children's BOT-2 performance results.

RESULTS

Two predictive relationships were identified based on parents' perspectives, where the total score of the MABC-2 Checklist was found to be a significant predictor of the BOT-2 Manual Coordination motor composite score, accounting for 8.35% of its variance, and the BOT-2 Strength and Agility motor composite score, accounting for 11.6% of its variance. No predictive relationships were identified between the children's self-report PSDQ perspectives and the BOT-2 performance scores.

CONCLUSIONS

Therapists are encouraged to utilize a combination of top-down and bottom-up approaches and purposefully to seek parents' and children's perspectives when evaluating children's motor skill performance.

Motor skill assessment of children: is there an association between performance-based, child-report, and parent-report measures of children's motor skills?

Client-centered practice requires therapists to actively seek the perspectives of children and families. Several assessment tools are available to facilitate this process. However, when evaluating motor skill performance, therapists typically concentrate on performance-based assessment. To improve understanding of the information provided by the different approaches, the study investigated correlations between performance-based, child-report, and parent-report measures of children's motor skill performance. A sample of convenience of 38 children 8-12 years of age with no history of motor or intellectual impairments and their parents was recruited from Victoria, Australia. Scores for the Bruininks-Oseretsky Test of Motor Proficiency (performance-based, administered by a therapist), Physical Self-Description Questionnaire (child report), and Movement Assessment Battery for Children Checklist (parent report) were analyzed using Spearman's rho correlation. Several significant moderate-to-large correlations were found between scores for parent-report and scores for performance-based assessments, while few significant correlations were found between scores for child report and scores for the other two measures. The results suggest that children offer a unique perspective which should be integrated with other sources of information to gain a more holistic perspective of their motor skill performance.