Using GPS and Self-Report Data to Examine the Relationship Between Community Mobility and Community Participation Among Autistic Young Adults

IMPORTANCE

Community participation of autistic adults is important for health and well-being. Many clinical efforts and interventions aim to enhance community participation in this population.

OBJECTIVE

To empirically examine the relationship between community participation and community mobility.

DESIGN

A randomized controlled trial using data from baseline and 4- to 6-wk follow-up.

SETTING

Community organizations serving autistic adults in Philadelphia.

PARTICIPANTS

Sixty-three autistic young adults with data on community mobility and participation from a prior study on public transportation use.

OUTCOMES AND MEASURES

Participants were tracked with GPS-enabled cell phones over a 2-wk period. A spatiotemporal data mining algorithm was used to compute the total number of destinations, nonhome destinations, unique destinations, percentage of time spent outside the home, and median daily activity space area from the GPS data. The Temple University Community Participation measure was used to collect self-report data in 21 different areas, and total amount, breadth, and sufficiency of participation were calculated.

RESULTS

Moderate and statistically significant associations were found between community mobility and participation variables at baseline and follow-up. However, changes in community mobility were not related to changes in community participation.

CONCLUSION

Health policymakers and providers should consider community mobility as a factor that can affect community participation in autistic individuals. Plain-Language Summary: Lower levels of community participation among autistic young adults affect health outcomes and overall quality of life. Community mobility is often a barrier to community participation. An understanding of the relationship between community mobility and community participation can lead to occupational therapists tailoring specific interventions and policies that support autistic young adults to engage in important life activities within the community.

Community Participation Challenges for Young Adults with Autism Spectrum Disorders During COVID-19 A Photovoice Study

Autistic Individuals with or without co-occurring Mental Health Conditions Experience Challenges with Community Participation that can Affect Quality of life. These Challenges Involve, but are not Limited to, Transportation, Finances, Accessibility, Attitude towards Participation, and Infrastructure Issues. COVID-19 Added a new Layer of Community Participation Barriers for all Individuals, Especially Autistic Individuals. The purpose of this study is to understand the perceived community participation barriers and facilitators encountered by autistic individuals during a public health crisis using the Photovoice methodology. The study will compare these perceptions of autistic individuals with and without co-occurring mental health conditions during a public health crisis to determine if any distinctions can be determined. Photovoice, an established qualitative outreach methodology, was the foundation for the methods. Participants completed a narrative answering the question "what is a barrier or facilitator to your community participation?" Data were analyzed using grounded theory. Seventeen autistic participants with a mean age of 23 completed the Photovoice study. Eleven (65%) reported at least one co- occurring mental health condition. Data analysis resulted in two major themes COVID-19 and Transportation; and six subthemes access, safety, technology, leisure, shared experiences, and sensory. Autistic individuals with and without co-occurring mental health conditions chose to identify barriers more than facilitators. Participants without co-occurring mental health conditions viewed COVID-19 as a facilitator almost twice as often as those without. Participants with co-occurring mental health conditions reported transportation more as a barrier than those without. In this study conducted during COVID-19 regulations, autistic individuals identified COVID-19 and transportation as the primary barriers to community participation. COVID-19 was identified as both a barrier and a facilitator. Autistic individuals identified that COVID-19 enabled more on-line participation. Autistic individuals with co-occurring mental health conditions can experience a greater increase in symptoms when daily routines and participation are affected. Disruption and changes in participation for the autistic community during the COVID-19 pandemic can have future implications on this population's ability to reintroduce themselves into community participation. Identified facilitators; technology, shared experiences, and leisure are useful tools to combat the participation barriers.

Developing and evaluating a toolkit of strategies to support remote inclusive research teams

Research teams must collaborate with people with intellectual and developmental disabilities to identify effective and inclusive responses to the COVID-19 pandemic and other public health emergencies. Collaborating remotely requires telecommunication and other technologies. We designed and evaluated a digital "Toolkit for Remote Inclusive Research" to provide research teams with evidence-informed strategies to make remote research accessible to and inclusive of people with intellectual and developmental disabilities. First, we completed a rapid scoping review to identify technology used by people with intellectual and developmental disabilities on collaborative research teams. Second, we designed a digital toolkit featuring 23 strategies identified in the review. Third, six inclusive researchers evaluated the toolkit. We illustrate how our team used these evidence-informed strategies during the past year to develop this and other tools to support inclusive research.

Interventions for Work/Employment Participation for Autistic Adults (2013-2020)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings on work/employment interventions and participation outcomes for autistic1 adults.

Interventions for Social Participation for Autistic Adults (2013-2020)

Systematic Review Briefs provide a summary of the findings from systematic reviews developed in conjunction with the American Occupational Therapy Association's Evidence-Based Practice Program. Each Systematic Review Brief summarizes the evidence on a theme related to a systematic review topic. This Systematic Review Brief presents findings on social participation interventions and participation outcomes for autistic1 adults.

Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry

AIMS

The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry.

METHODS AND RESULTS

1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients.

CONCLUSION

Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.

Psychometric Evaluation of the Parent Effort Scale

Objective

The Parent Effort Scale (PES) is a parent report questionnaire designed to quantify the level of effort required of caregivers to assist their children in developmentally appropriate home- and community-based activities. This manuscript describes the psychometric evaluation of the PES.

Method

Data collected from 304 parents of children ages 2–7 years (167 parents of a children with autism spectrum disorder and 137 parents of neurotypical children) were factor analyzed, calibrated using item response theory, and evaluated for construct validity.

Results

The final PES scales are reliable and valid measures of the level of parental effort required to assist children in dressing, personal hygiene, sleep, socialization at home, participation in community events, and access to healthcare. A total score reflects overall parental effort.

Conclusion

The PES can be used to plan and evaluate the effectiveness of interventions that aim to help parents enhance children's participation opportunities and thus, support their cognitive and social development.

Does age influence follow-up after alcohol septal ablation in hypertrophic obstructive cardiomyopathy?

Introduction

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Since its introduction in 1995 alcohol septal ablation (PTSMA) was discussed as treatment option only in elderly patients with symptomatic obstructive HCM (HOCM). We report on long-term follow-up after PTSMA with respect to patient's age.

Methods and results

Between 5/2000 and 6/2017 we treated 952 consecutive symptomatic HOCM patients (pts) with first PTSMA in our center. 132 (13.9%) pts were &lt;40 years of age (Group A; mean age 30.3±7.7), 421 (44.2%) pts between ≥40 to &lt;60 years of age (Group B; mean age 50.5±5.9) and 399 (41.9%) pts ≥60 years of age (Group C; 69.6±6.3). Family history (FH) of HCM was more often seen in Group A (50% vs. 25.7% (B) and 13.3% (C); p&lt;0.ehab724.17611) as FH of sudden cardiac death (SCD) (17.4% vs. 11.2% (B) and 7.0% (C); p&lt;0.01). Pts in Group C were more often in NYHA class III/IV (80.7%; p&lt;0.001 each) compared to Group A (68.2%) and B (67.9%). At the time of PTSMA an ICD for primary SCD prevention had been more often implanted in Group A (19.8%; p&lt;0.0001) compared to Group B (10.1%) and C (5.9%).

Echocardiographic measurements showed higher maximal septal thickness in Group A (23.9±5.7 mm; p&lt;0.ehab724.17611 each) compared to Group B (20.9±4.0 mm) and C (20.1±3.5 mm). Pts of Group B had lower resting gradients (60.0±35.3 mmHg; p&lt;0.01 each) compared to Group A (69.5±34.8 mmHg) and C (66.4±41.6 mmHg). Total heart block at PTSMA was less often seen in Group A (28.8%; p&lt;0.05 each) compared to Group B (39.4%) and C (43.4%). Due to persistent total heart block need of permanent pacemaker implantation was lowest in Group A (3.8%, p&lt;0.01 each) compared to Group B (9.3%) and C (14.0%) during hospital stay. One patient in Group A and C died during hospital stay, each.

Follow-up was longer in Group A (6.7±5.2 years) compared to Group C (5.5±4.8 years; p&lt;0.05) and was comparable to Group B (6.2±5.1 years). Re-PTSMA was more often performed in Group A (22.7%; p&lt;0.01 each) compared to Group B (12.8%) and Group C (10.5%). Reported clinical improvement at latest follow-up was comparable (93.3% Group A, 93.8% Group B, and 95.5% Group C). Mortality was highest in Group C (12.5%; p&lt;0.0001 each) compared to Group A (1.5%) and B (4.0%). In Group A no pt died from cardiac reason, whereas 5 pts died from cardiac reasons in Group B and C, each. SCD was not observed in Group A, whereas 2 pts in Group B and 1 pt in Group C suffered SCD.

Conclusion

PTSMA is feasible even in young pts with symptomatic HOCM. Mortality after PTSMA is mainly due to non-cardiac reasons and more often seen in elderly pts. Especially, SCD could be observed in younger pts &lt;40 years of age.

Funding Acknowledgement

Type of funding sources: None.

How people with intellectual and developmental disabilities on collaborative research teams use technology: A rapid scoping review

BACKGROUND

We conducted a rapid scoping review to identify how inclusive research teams use technology during the research process that could support remote collaboration during public health emergencies like the COVID-19 pandemic.

METHOD

We searched three databases and conducted a hand search. Two independent reviewers screened 1498 abstracts and titles for inclusion criteria; 81 full text articles were further reviewed; 47 were included. We extracted information about each type of technology, categorised technology used during the research process, and documented described accommodations.

RESULTS

We identified 47 articles and 94 examples of technologies used by people with intellectual and developmental disabilities throughout the research process: team formation and team function (38), data collection (19), data analysis (17) and dissemination (20).

CONCLUSIONS

Technology use by team members with intellectual and developmental disabilities demonstrates promise for remote research collaborations during public health and climate emergencies and teams with members living in diverse locations.

Initial Evaluation of a Public Transportation Intervention Program for Individuals With Developmental Disabilities (DD)

Date Presented 03/27/20

People with DD often face transportation challenges that impede community participation. The purpose of this study was to examine the impact of a comprehensive intervention program on the travel skills of individuals with DD to increase community mobility.

Primary Author and Speaker: Beth Pfeiffer

Additional Authors and Speakers: Katherine Bevans

Primary-Care Health Encounters for Adults With Autism Spectrum Disorder (ASD): Perceptions of Adults with ASD, Caregivers, and Providers

Date Presented 03/28/20

Primary-care encounters can be challenging for adults with ASD. The purpose of this presentation is to identify challenges experienced by this population as well as strategies to mitigate these difficulties.

Primary Author and Speaker: Leah Stein Duker

Additional Authors and Speakers: Beth Pfeiffer

Contributing Authors: Amber Pomponio, Sadie Kim

Reliability and Factor Structure of the Parent Effort Scale–Community Version (PES-C)

Date Presented 03/28/20

The purpose of this study was to examine internal consistency, factor structure, test–retest reliability, and scale distribution of the PES-C in children between the ages of two and seven. The PES-C measures a parent’s effort to support their child’s participation in daily activities in natural community environments.

Primary Author and Speaker: Beth Pfeiffer

Additional Authors and Speakers: Katherine Bevans, Aimee Piller

Feasibility & Proof of Concept for an Individualized Community Mobility Intervention

Date Presented 03/27/20

Individuals with intellectual or developmental disabilities have unmet transportation needs, which limits their community mobility. Access to transportation is linked to community participation and independence in adult outcomes. The purpose of this study was to examine the implementation feasibility of Community Mobility Plans, an individualized OT intervention.

Primary Author and Speaker: Beth Pfeiffer

Psychometric Evaluation of the Participation and Sensory Environment Questionnaire-Home Scale (PSEQ-H)

IMPORTANCE

The impact of sensory processing challenges on occupational participation is underrepresented by existing measurement tools even though these outcomes are highly prioritized by families. The Participation and Sensory Environment Questionnaire-Home Scale (PSEQ-H) is a parent-report assessment designed to evaluate the impact of the sensory environment on young children's participation in home-based activities.

OBJECTIVE

To describe the psychometric evaluation of the PSEQ-H, including the tool's structural validity; item difficulty, discrimination, and bias; reliability; and construct validity.

DESIGN

Psychometric field study.

SETTING

Community.

PARTICIPANTS

Three hundred four parents of children ages 2-7 yr (167 parents of children with autism spectrum disorder).

METHOD

Parent-report PSEQ-H data were factor analyzed, calibrated using Item Response Theory, and evaluated for construct validity.

RESULTS

The final PSEQ-H is a reliable and valid 15-item parent-report measure of the sensory environment's impact on children's dressing, self-care, sleep, and social and play activities.

CONCLUSIONS AND RELEVANCE

The PSEQ-H can be used to plan and evaluate the effectiveness of interventions for reducing the impact of the sensory environment on children's participation in home-based tasks and activities.

WHAT THIS ARTICLE ADDS

The PSEQ-H measures how young children's sensory environments influence their participation at home. The measure can be used to plan and evaluate occupational therapy interventions that aim to reduce sensory processing-related barriers to children's completion of developmentally salient activities.

Community mobility plans for individuals with developmental disabilities: A feasibility study

Introduction

Individuals with intellectual and/or developmental disabilities have unmet transportation needs, which limits their community mobility. Access to transportation is linked to community participation and independence in adult outcomes. The purpose of this study is to examine the implementation feasibility of individualized community mobility plans.

Methods

A pre-test post-test one group design was used to determine if methodology and implementation procedures were feasible. Outcome measures were evaluated to determine if appropriate for future effectiveness research. Participants were six adults with intellectual and/or developmental disabilities who received the community mobility plans intervention over a period of 3–8 sessions. Community mobility plans use a cyclical process where the individual first develops self-determined community mobility goals, followed by a comprehensive assessment process, and individualized environmental and person-centered travel interventions.

Results

Participants demonstrated significant improvement between pre- and post-test scores on the measures of the Progressive Evaluation of Travel Skills ( t(5) = –4.481, p = .007) and Goal Attainment Scaling ( t(5) = –7.457, p =.001).

Conclusion

Community mobility plans may provide a feasible option to improve community mobility for individuals with intellectual and/or developmental disabilities, although further research is needed to determine effectiveness.

Effectiveness of Noise-Attenuating Headphones on Physiological Responses for Children With Autism Spectrum Disorders

Objective: The purpose of this study was to evaluate the proof of concept of an intervention to decrease sympathetic activation as measured by skin conductivity (electrodermal activity, EDA) in children with an autism spectrum disorder (ASD) and auditory hypersensitivity (hyperacusis). In addition, researchers examined if the intervention provided protection against the negative effects of decibel level of environmental noises on electrodermal measures between interventions. The feasibility of implementation and outcome measures within natural environments were evaluated.

Method: A single-subject multi-treatment design was used with six children, aged 8–16 years, with a form of Autism (i.e., Autism, PDD-NOS). Participants used in-ear (IE) and over-ear (OE) headphones for two randomly sequenced treatment phases. Each child completed four phases: (1) a week of baseline data collection; (2) a week of an intervention; (3) a week of no intervention; and (4) a week of the other intervention. Empatica E4 wristbands collected EDA data. Data was collected on 16–20 occasions per participant, with five measurements per phase.

Results: Separated tests for paired study phases suggested that regardless of intervention type, noise attenuating headphones led to a significance difference in both skin conductance levels (SCL) and frequency of non-specific conductance responses (NS-SCRs) between the baseline measurement and subsequent phases. Overall, SCL and NS-SCR frequency significantly decreased between baseline and the first intervention phase. A protective effect of the intervention was tested by collapsing intervention results into three phases. Slope correlation suggested constant SCL and NS-SCR frequency after initial use of the headphones regardless of the increase in environmental noises. A subsequent analysis of the quality of EDA data identified that later phases of data collection were associated with better data quality.

Conclusion: Many children with ASD have hypersensitivities to sound resulting in high levels of sympathetic nervous system reactivity, which is associated with problematic behaviors and distress. The findings of this study suggest that the use of noise attenuating headphones for individuals with ASD and hyperacusis may reduce sympathetic activation. Additionally, results suggest that the use of wearable sensors to collect physiological data in natural environments is feasible with established protocols and training procedures.

Examining Primary Care Health Encounters for Adults With Autism Spectrum Disorder

OBJECTIVE

Our objective was to identify perceived barriers and strategies to improve primary care encounters, as reported by adults with autism spectrum disorder (ASD), caregivers of adults with ASD, and primary care providers (PCPs) treating adults with ASD.

METHOD

As part of a larger mixed-methods design, adults with ASD, caregivers, and PCPs (N = 78) in Los Angeles and Philadelphia completed surveys examining barriers to care and strategies to improve care.

RESULTS

Multiple barriers to care were reported by adults with ASD and caregivers, including communication and sensory challenges. Adults with ASD and caregivers reported minimal use of strategies during primary care visits but indicated that those used were helpful during care. Expert PCPs reported using strategies more frequently than novice PCPs. All respondent groups endorsed that strategies had the potential to improve care in the future for adults with ASD.

CONCLUSION

Opportunities exist for occupational therapy collaboration in primary health care and primary care education to improve care for adults with ASD.

Reliability of the Participation and Sensory Environment Questionnaire: Community Scales

BACKGROUND

The Participation and Sensory Environment Questionnaire (P-SEQ): Community Scales is a parent report questionnaire designed to examine the impact of the sensory environment on participation within community activities for children with autism spectrum disorder (ASD).

METHODS

This study used a cross sectional quantitative design to establish the reliability and discriminate validity of the P-SEQ: Community Scales.

RESULTS

This study established the initial reliability of the questionnaire including internal consistency of 0.98 test-retest reliability of 0.76. The P-SEQ: Community Scales demonstrated significant differences in item distribution for children without ASD as compared to those with ASD, an essential aspect of construct validity.

CONCLUSIONS

The results of this study indicate that the questionnaire is a reliable tool that can be used to assess the impact of sensory environment's impact on participation in community activities. Identified barriers can be modified to support participation in community tasks.

Reliability and Factor Structure of the Parent Effort Scale Home Version (PES-H)

Date Presented 04/06/19

The purpose of this study was to examine internal consistency, factor structure, test-retest reliability, and scale distribution of the Parent Effort Scale Home Version (PES-H) in children between the ages of two and seven. The PES-H measures a parent’s effort to support their child’s participation in daily activities in natural environments. Additionally, this study examined differences in parental effort between children with and without autism spectrum disorders.

Primary Author and Speaker: Beth Pfeiffer

Additional Authors and Speakers: Aimee Piller, Katherine Bevans

Reliability and Factor Structure of the Participation and Sensory Environment Community Questionnaire (PSEQ-C)

Date Presented 04/06/19

The purpose of this study was to examine internal consistency, factor structure, and test-retest reliability of the Participation and Sensory Environment Questionnaire Community Version (PSEQ-C). The PSEQ-C is intended to assess parent and caregiver perceptions of the degree to which the sensory environment impedes young children's participation in community activities. Additionally, this study examined differences in participation between children without and with autism spectrum disorders (ASD).

Primary Author and Speaker: Beth Pfeiffer

Additional Authors and Speakers: Katherine Bevans, Aimee Piller

Impact of Noise-Attenuating Headphones on Participation in the Home, Community, and School for Children with Autism Spectrum Disorder

AIM

The purpose of this study was to conceptualize the benefits and limitations of using noise-attenuating headphones for children with autism spectrum disorder (ASD) on participation in home, community, and school environments from the perspective of parents and teachers.

METHODS

Grounded theory methodology was used to guide data collection and analysis. Ten parents and five teachers of children with ASD and auditory hypersensitivity aged 6-12 completed recorded interviews. Interviews were transcribed and crosschecked prior to analysis by two or more researchers. Constant comparison was used during open and axial coding followed by theoretical integration.

RESULTS

Participants identified that the use of noise-attenuating headphones increased participation in home, community, and school settings. Barriers and benefits were identified for both around-ear and in-ear headphones. Preparation for use was an identified strategy that reduced the barriers and increased use of the headphones. Additionally, many of the children learned to predict when they needed the headphones and requested their use.

CONCLUSION

Results of the study identified parental and teacher support for the use of noise-attenuating headphones to increase participation in natural environments for children with ASD, as well as suggestions to facilitate use for practicing physical and occupational therapists.

Parental Strategies to Support Participation in Home and Community Activities for Children With Autism Spectrum Disorder

Date Presented 4/20/2018

The purpose of this study was to identify strategies parents use to increase participation in home- and community-based activities for children with autism spectrum disorder. This research can empower occupational therapy practitioners to provide parents with evidence-based strategies to increase their child’s participation in the home and community.

Primary Author and Speaker: Nicole Schiavone

Additional Authors and Speakers: David Szczepanik, John Koutras, Beth Pfeiffer

Effectiveness of Noise-Attenuating Headphones for Children With Autism Spectrum Disorder

Date Presented 4/19/2018

Children with autism spectrum disorder often demonstrate atypical responses to auditory stimuli that impact stress and arousal levels. This study examined the efficacy of two types of noise-attenuating headphones on electrodermal responses in natural environments using an innovative measurement system.

Primary Author and Speaker: Beth Pfeiffer

Additional Authors and Speakers: Leah Stein Duker, Chengshi Amory Shiu

Caregiver Strategies to Enhance Participation in Children With Autism Spectrum Disorder

Participation is necessary for childhood development, however, children with disabilities participate in fewer activities than their nondisabled peers. This study identified strategies caregivers use to increase participation in home- and community-based activities for children with autism spectrum disorder. Survey responses of 44 caregivers were analyzed through open and axial coding to develop a central theme and five broad themes. Caregiver strategies which produce a participation outcome fell into five themes: (a) adapters/facilitators, (b) pragmatic considerations, (c) social reframing, (d) sensory adjustments, and (e) desperate measures. Nonproductive strategies were identified where the child did not participate in the activity. Adaptations/facilitators were more likely used in the home, whereas community-based strategies were more often pragmatic considerations. Nonproductive strategies occurred more frequently in the community. When evaluating a child's participation, occupational therapy (OT) practitioners should take into consideration the context of the activity to identify appropriate and helpful strategies.

State of the Science of Sensory Integration Research With Children and Youth

Many children and youth with and without disabilities are affected by challenges in processing and integrating sensations. Occupational therapy practitioners serve a pivotal role in the evaluation and treatment of this population. This special section of the American Journal of Occupational Therapy includes articles that elucidate the relationship between sensory processing and participation in valued occupations as well as articles that guide best practice, including systematic reviews on common occupational therapy interventions for children and youth with challenges in processing and integrating sensation. This editorial elaborates on key issues for future research.

Brief Report: Reliability of the Participation and Sensory Environment Questionnaire: Home Scales

The Participation and Sensory Environment Questionnaire: Home Scales (P-SEQ): Home Scales is a parent report tool designed to assess the impact of the sensory environment on participation in daily activities in the home of children with and without autism spectrum disorder. A cross-sectional study was completed to determine internal consistency, test-retest reliability, and examine item distribution. A total of 304 parents of children between the ages of 2 and 7 years of age completed the P-SEQ: Home Scales. Results identified excellent internal consistency (α = 0.96), moderate test-retest reliability (r = .62), and reasonable item distribution. Results suggest that the P-SEQ: Home Scales provides reliable estimates of the impact of the sensory environment on children's participation in home activities.

Effectiveness of Cognitive and Occupation-Based Interventions for Children With Challenges in Sensory Processing and Integration: A Systematic Review

This systematic review examines the evidence for the effectiveness of cognitive and occupation-based interventions to improve self-regulation in children and youth who have challenges in processing and integrating sensory information. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guided the methodology. Five studies identified through a comprehensive database search met the inclusion criteria and were separated into categories of cognitive and occupation-based interventions. Articles that did not specifically measure sensory integration (SI) or processing challenges were omitted. Synthesis of the articles suggests that self-regulation (e.g., sensory processing, emotional regulation, executive functioning, social function) improved with cognitive and occupation-based interventions. Because the number of studies that measured sensory processing or SI challenges was limited, researchers are encouraged to include these measures in future research to understand the impact of a broader range of cognitive and occupation-based interventions.

Development and Content Validity of the Participation and Sensory Environment Questionnaire

Qualitative methodology was used to develop items for a questionnaire designed to examine the perspectives of parents regarding the impact of the sensory environment on participation for children aged 3 to 5 who have autism spectrum disorders (ASD). A total of 34 parents/caregivers of children with ASD and 8 experts in ASD and/or measurement completed qualitative interviews for concept, content review, and cognitive interviewing. The result was a pool of 35 items for home/community domains for 3 scales. The outcome of this study was the development and content validation of the Participation and Sensory Environment Questionnaire (PSEQ).

The Sensory Environment and Participation of Preschool Children With Autism Spectrum Disorder

Sensory processing is recognized as impacting participation for preschool children with autism spectrum disorder (ASD). Little research exists to examine the impact of the sensory environment on the participation patterns of children with ASD, specifically from a contextual standpoint. The researchers in this study examined the viewpoint of teachers and occupational therapists on the sensory-related environmental barriers to participation within the preschool context. Qualitative descriptive methodology was used for data collection and analysis. Thirteen preschool teachers and occupational therapists were interviewed. Sensory aspects of the environment both inhibited and enhanced participation. Physical and temporal components of the environment are identified as being the most influential. Modifications of the environment are identified as increasing participation. It is important to consider the sensory aspects of the environment, in addition to the sensory processing patterns of the person in assessment and intervention planning within the preschool environment.

Reliability of the Participation and Sensory Environment Questionnaire: Teacher Version

The Participation and Sensory Environment Questionnaire-Teacher Version (PSEQ-TV) is a teacher-report questionnaire to assess the impact of the sensory environment on participation of preschool children with autism spectrum disorder (ASD). Many children with ASD have sensory processing differences, although these differences are frequently examined from the standpoint of the person. The PSEQ-TV provides a single assessment to examine both participation and the sensory environment for preschool aged children with ASD. This study established the reliability of the PSEQ-TV including internal consistency of 0.98 and test-rest reliability of 0.70. The results indicate initial reliability of PSEQ-TV as an instrument that can be used to identify sensory environmental barriers within the preschool setting to target during interventions to increase participation.

Using a Multifaceted Approach to Working With Children Who Have Differences in Sensory Processing and Integration

Pediatric occupational therapy practitioners frequently provide interventions for children with differences in sensory processing and integration. Confusion exists regarding how best to intervene with these children and about how to describe and document methods. Some practitioners hold the misconception that Ayres Sensory Integration intervention is the only approach that can and should be used with this population. The issue is that occupational therapy practitioners must treat the whole client in varied environments; to do so effectively, multiple approaches to intervention often are required. This article presents a framework for conceptualizing interventions for children with differences in sensory processing and integration that incorporates multiple evidence-based approaches. To best meet the needs of the children and families seeking occupational therapy services, interventions must be focused on participation and should be multifaceted.

The Impact of the Sensory Environment on Participation of Preschool Children With Autism Spectrum Disorder

Date Presented 3/31/2017

This qualitative study explores the sensory environment to determine the impact on participation in the preschool environment. The study presents information gathered from semistructured interviews of preschool teachers and occupational therapists.

Primary Author and Speaker: Aimee Piller

Contributing Authors: Beth Pfeiffer

The Effectiveness of the Size Matters Handwriting Program

Date Presented 3/31/2017

With school-based occupational therapists reporting up to 75% of their caseload related to handwriting, the urgency to identify a proven and efficient instructional program is paramount. Effective, embeddable, measurable, easy, and fast, the Size Matters Handwriting Program promotes collaboration in the natural environment and the Workload model.

Primary Author and Speaker: Beverly Moskowitz

Additional Authors and Speakers: Beth Carswell, Jennifer Kitzmiller, Moira Bushell, Laura Neikrug, Chaya Gottesman

Contributing Authors: Beth Pfeiffer, Gillian Rai, Tammy Murray

Noise-Attenuating Headphones and Participation in Children With Autism Spectrum Disorder

Date Presented 3/31/2017

The purpose of this study was to understand the perceived benefits and limitations of using noise-attenuating headphones for children with ASD for participation in home, community, and school environments to determine feasibility of use and guide intervention planning and future research.

Primary Author and Speaker: Beth Pfeiffer

Adverse Family Experiences Are Associated With Age of Diagnosis Among Children With Autism Spectrum Disorder

Date Presented 4/1/2017

Adverse childhood experiences (ACEs) may pose a significant barrier to timely diagnosis of autism spectrum disorder among U.S. children. By identifying ACEs early in a family’s history, occupational therapy practitioners have the opportunity to reduce family stress and support parents in meeting their children’s treatment needs.

Primary Author and Speaker: Kristin Berg

Additional Authors and Speakers: Beth Pfeiffer

Contributing Authors: Cheng-Shi Shiu, Kruti Acharya, Michael Msall, Elizabeth Pfeiffer

Supports and Barriers to Effective Job Matching for Persons With Intellectual Disabilities

Date Presented 3/31/2017

Several practices act as barriers, as supports, or as both to the job-matching process. Future research should focus on integrating these factors into a systematic procedure for matching persons with disabilities to long-term, competitive community employment.

Primary Author and Speaker: Andrew Persch

Additional Authors and Speakers: Beth Pfeiffer, Rebecca Weisshaar, Amy Darragh, Dennis Cleary

Exploratory Factor Analysis and Test–Retest Reliability of the Sensory Environment and Participation Questionnaire (SEP)

Date Presented 3/31/2017

The purpose of this study was to examine internal consistency, factor structure, and test–retest reliability of the Sensory Environment and Participation Questionnaire (SEP–Q) in children with ASD. The SEP–Q measures parents’ perspective of the impact of the sensory environment on participation.

Primary Author and Speaker: Beth Pfeiffer

Additional Authors and Speakers: Wendy Coster, Katherine Bevans

Contributing Authors: Cheenghee Kho

Caregivers' Perspectives on the Sensory Environment and Participation in Daily Activities of Children With Autism Spectrum Disorder

The purpose of this phenomenological study was to obtain caregivers' perspectives on the impact of the sensory environment on participation in daily activities of their young children with autism spectrum disorders (ASD). Interviews were completed with 34 caregivers of children with ASD ages 3-7 yr. Results strongly suggest that parents and caregivers were pivotal in enabling participation for their children through the implementation of specific strategies and a parental decision-making process. The decision-making process considered amount of effort necessary to support participation and whether participation in a given activity was perceived as essential or nonessential. Strategies enabled participation and reduced the effort required to support the child's participation. Strategies either directly related to the sensory factors of the environment or focused on reducing behavioral responses associated with sensory factors. In this study, we identified important considerations to enhance participation in the home and community environments for children with ASD.

Systematic Review of the Effectiveness of Frequency Modulation Devices in Improving Academic Outcomes in Children With Auditory Processing Difficulties

This systematic review describes the published evidence related to the effectiveness of frequency modulation (FM) devices in improving academic outcomes in children with auditory processing difficulties. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards were used to identify articles published between January 2003 and March 2014. The Cochrane Population, Intervention, Control, Outcome, Study Design approach and the American Occupational Therapy Association process forms were used to guide the article selection and evaluation process. Of the 83 articles screened, 7 matched the systematic review inclusion criteria. Findings were consistently positive, although limitations were identified. Results of this review indicate moderate support for the use of FM devices to improve children's ability to listen and attend in the classroom and mixed evidence to improve specific academic performance areas. FM technology should be considered for school-age children with auditory processing impairments who are receiving occupational therapy services to improve functioning in the school setting.

Effectiveness of a Handwriting Intervention With At-Risk Kindergarteners

OBJECTIVE. We examined the effectiveness of an occupational therapist–led handwriting intervention for special education and at-risk kindergarteners.

METHOD. We incorporated a two-group, pretest–posttest design. Both groups consisted of kindergarteners receiving individualized education program (IEP) or Response to Intervention (RtI) support. An occupational therapist provided biweekly group handwriting instruction using the Size Matters Handwriting Program to students in the intervention group (n = 23). The control group (n = 12) received the standard handwriting instruction.

RESULTS. Students in the intervention group demonstrated significantly greater gains in handwriting legibility than students in the control group. Students in the intervention group also demonstrated significantly greater gains in the prereading skills of uppercase letter recognition, lowercase letter recognition, and letter sound recognition.

CONCLUSION. This study provides preliminary support for an occupational therapist–led handwriting intervention to improve writing legibility and letter recognition in kindergarteners receiving RtI and IEP supports.