Describing Outcomes in Autistic Young Adults One Year After High School Graduation

PURPOSE

Research documents poor outcomes for autistic adults in the domains of employment, independent living, and social relationships. Measurement and sample limitations in prior studies may have amplified past estimates of poor outcomes. The goal of the current study was to improve upon past approaches and to create and describe a measurement approach to capture adult outcomes that reflected the context of young adulthood and the perspectives of autistic individuals, pairing objective outcome indicators with subjective satisfaction indicators.

METHODS

Thirty-six autistic young adults (mean age 19.8 years) and a parent completed self-report surveys. Using these data, we defined an objective and subjective (i.e., satisfaction) outcome indicator in each of three domains: productivity (employment or post-secondary education), social well-being (frequency of contact with friends), and living situation (autonomy).

RESULTS

Three-quarters of young adults experienced at least 5 out of 6 positive outcomes. Over 90% were engaged in school, work, or a structured transition program, and an equal percentage were satisfied with their productivity activity. Over three-quarters of adults had a good amount of contact with friends and were satisfied with their social life. Most young adults had a moderate level of autonomy in their daily lives, and all were satisfied with their living situation.

CONCLUSION

Tailoring outcome measurement approaches specifically for autistic young adults provided a more optimistic portrayal of outcomes than previously noted in the literature. The approach used better reflects a neurodiversity approach and may be useful for evaluating the effectiveness of transition services or interventions.

Racial differences in legal socialization models across adolescence and emerging adulthood

OBJECTIVE

White and non-White adolescents report different experiences in the legal system. This disparity impacts their evaluations of, and attitudes toward, legal authorities such that non-White and older adolescents tend to perceive the legal system more negatively. Yet, many researchers assume that the process of legal socialization, which involves internalizing norms and information about the law and the legal system, is universal for all ages and races.

HYPOTHESES

We hypothesized that legal socialization models would change over the course of adolescent development and would differ by race.

METHOD

We used data from two longitudinal studies to examine racial differences in the integrated legal socialization model in early, middle, and late adolescence. Study 1 included 140 young adolescents (59% White, 41% non-White), and Study 2 included 296 midadolescents (82% White, 18% non-White) followed into late adolescence/emerging adulthood.

RESULTS

Study 1 identified differences in the integrated legal socialization model for young White and non-White adolescents. Normative status predicted rule-violating behavior for White participants, whereas no predictors or mediators related to rule-violating behavior for non-White participants. In Study 2, legal and moral reasoning during midadolescence became relevant in the model for both groups. Enforcement status predicted rule-violating behavior for non-White youth, whereas normative status continued to predict rule-violating behavior for White youth. In late adolescence/emerging adulthood, differences in the model shifted toward the relation between reasoning and legal attitudes.

CONCLUSIONS

Our findings suggest that legal socialization is a developmental process occurring and changing throughout adolescence and that this developmental process differs for White and non-White youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Breaking rules for moral reasons: Development and validation of the Prosocial and Antisocial Rule-Breaking (PARB) scale

OBJECTIVES

To determine whether prosocial rule-breaking exists as a separate construct from antisocial rule-breaking and to develop a valid rule-breaking scale with prosocial and antisocial subscales.

HYPOTHESES

We hypothesized that (a) rule-breaking would have prosocial and antisocial subfactors; (b) the prosocial rule-breaking subscale would positively associate with prosocial intentions, empathy, moral identity, and guilt proneness, whereas the antisocial rule-breaking subscale would negatively associate with these same factors; and (c) the two subscales would predict prosocial and antisocial cheating behaviors, respectively.

METHOD

We developed the Prosocial and Antisocial Rule-Breaking (PARB) scale using a sample of 497 undergraduates (Study 1) and 257 Amazon Mechanical Turk workers (Study 2). Participants completed all surveys (Studies 1 and 2) and took part in a between-subjects experiment (Study 2) in which cheating behavior was measured in two conditions-when cheating helps others (prosocial) or oneself (antisocial).

RESULTS

The final PARB scale demonstrated the expected factor structure (comparative fit index = .96, Tucker-Lewis index = .93, root-mean-square error of approximation = .064; χ² = 177, df = 88, p < .001), with the prosocial (α = .81) and antisocial (α = .93) subscales showing good reliability. Prosocial rule-breaking was positively associated with prosocial intentions, empathy, and guilt proneness, whereas antisocial rule-breaking was negatively associated with these same factors. Each additional point in prosocial rule-breaking PARB score predicted a 37% increased likelihood of participating in protest behavior in an exploratory investigation (p = .025) and predicted a 268% increase in actual prosocial cheating behavior (p < .001) but did not predict antisocial cheating behavior (p = .293). Conversely, each additional point in antisocial rule-breaking PARB score did not predict protest participation (p = .410) but did predict a 69% increase in actual antisocial cheating behavior (p = .025).

CONCLUSIONS

These findings suggest that our current understanding of rule-breaking is limited, as many types of rule-breaking are prosocially motivated and are not necessarily antisocial. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Preparation for Adulthood: Shifting Responsibility for Management of Daily Tasks From Parents to Their Children

Importance: Limited research has described the timing of acquisition of the broad range of skills required for the transition to adulthood.

Objective: To describe the timing of the shift of responsibility for daily tasks from parent to child.

Design: This study used an existing data set of parent responses to 49 items in the Responsibility domain of the Pediatric Evaluation of Disability Inventory Computer Adaptive Tests.

Participants: A U.S. nationally representative sample of 2,205 typically developing children and youth ages 0 to 20 yr.

Outcomes and Measures: Descriptive analyses focused on two ages: (1) starting age (when >50% of parents reported their child was taking at least some responsibility for a task) and (2) full responsibility age (when >50% of parents reported their child was taking full responsibility for the task).

Results: The process of shifting responsibility for daily life tasks from parent to child typically occurred over a long period. Many task items had an interval of 5 yr from starting age to full responsibility age; the longest interval was 15 yr. Youth began assuming responsibility for more complex tasks and tasks that involved more risk at ages 10 to 15.

Conclusions and Relevance: Results can serve as a reference for the timing of the transition to greater self-management of daily life tasks across childhood and adolescence. Timing of responsibility shifts may reflect a combination of development of underlying capacities and social transitions. Executive functioning may be especially relevant for management of the more complex tasks required in daily life in adulthood.

What This Article Adds: The transfer of responsibility for managing tasks of daily life from parents to children often extends over a period of many years. Clinicians may find the results helpful when discussing the future with parents of young people with disabilities and other chronic conditions and the tasks that their children must learn to manage for independent living as an adult.

Academic Correlates of Unwanted Sexual Contact, Intercourse, Stalking, and Intimate Partner Violence: An Understudied but Important Consequence for College Students

Sexual assault, partner abuse, and stalking are major problems on college campuses. Past research has demonstrated a host of physiological and psychological outcomes associated with victimization; however, there has been little research conducted on the potential academic outcomes associated with victimization. The purpose of this study was to measure the relation between academic outcomes and experiences of sexual violence, intimate partner violence, and stalking victimization among college students. A sample of 6,482 undergraduate students currently enrolled at one of eight universities in New England was surveyed using items from the subscales of the College Persistence Questionnaire (Academic Efficacy, Collegiate Stress, Institutional Commitment, and Scholastic Conscientiousness). All four types of victimization were associated with significant differences on academic outcomes after controlling for sex and year in school, with victimized students reporting lower academic efficacy, higher college-related stress, lower institutional commitment, and lower scholastic conscientiousness. Polyvictimization was also significantly correlated with outcomes, with the greater number of types of victimization experienced by students being associated with more negative academic outcomes. Implications for future research and campus response were discussed.

Variables Associated With Shift of Responsibility for Daily Tasks From Parents to Children With and Without Disabilities

Importance: No study has directly investigated which variables are associated with the shift of responsibility for managing daily tasks from parent to child in the transition to adulthood.

Objective: To examine characteristics associated with responsibility for managing daily life tasks in youth with and without disabilities.

Design: A secondary data analysis of parent-report data on typically developing (TD) youth and youth with disabilities.

Setting: An online panel that has regularly participated in online surveys.

Participants: A nationally representative sample of 2,205 TD U.S. children and youth, ages 0 to 20 yr, 11 mo (about 100 children per age year) and a sample of 617 children and youth with disabilities, ages 0 to 20 yr, 11 mo.

Outcomes and Measures: The dependent variable was the Responsibility domain scaled score (from the Pediatric Evaluation of Disability Inventory–Computer Adaptive Test), which reflects the extent to which responsibility for daily tasks has shifted from parent to youth.

Results: Youth with higher levels of responsibility were older in age, reported to be more focused, and youngest in birth order (TD, R² = .79; disability, R² = .35). Youth with developmental delay, intellectual disability, autism spectrum disorder, or orthopedic or movement impairments had assumed less responsibility.

Conclusions and Relevance: Other personal characteristics in addition to disability may have important influences on parents’ decision making as they prepare their children to manage daily life tasks.

What This Article Adds: Clinicians who work with adolescents in the process of transition to adulthood need to consider the potential influence of the personal characteristics, such as birth order and child temperament, on preparation for adulthood.

Asian Immigrant Parents' Role Enactment While Accessing and Using Services for Their Child With Developmental Disabilities in the United States: A Meta-Synthesis Study

We conducted a meta-synthesis to explore how Asian immigrant parents in the United States enact their perceived parental role while using health and educational services for their child with developmental disabilities. We identified 11 qualitative studies for analysis, and examined these studies using a constant comparative approach and thematic analysis informed by role theory and acculturation theory. Based on our analysis, five themes related to parents' role enactment emerged: (a) parents perceive a multifaceted parental role; (b) parents' individual factors influence their role enactment; (c) system factors influence parents' role enactment; (d) parents use coping strategies to address role dissatisfaction; and (e) parental role enactment is a continuously evolving process influenced by acculturation, which spirals them toward their ultimate goal of helping their child thrive. Findings can inform practitioners' and researchers' understanding of how to create a culturally safe environment to support Asian immigrant parents in realizing their parental role.

Stakeholder-driven approach to developing a peer-mentoring intervention for young adults with intellectual/developmental disabilities and co-occurring mental health conditions

BACKGROUND

Young adults with intellectual/developmental disabilities and co-occurring mental health conditions (IDD-MH) experience significant mental health disparities. Barriers to services include transportation and stigma associated with services. Peer mentoring (PM) may be one solution to these barriers.

METHODS

We conducted exploratory research to develop a PM intervention for young adults with IDD-MH by partnering with 3 young adults with IDD-MH and a seven-member advisory board. In addition, we conducted focus groups with mental health clinicians (n = 10), peer providers (n = 9), and transition specialists (n = 20) to identify the desired PM outcomes and features and content that may facilitate these outcomes.

RESULTS

Prioritized outcome: identifying and utilizing leisure activities as coping strategies. PM features: mentors should use relationship- and outcome-driven actions to operationalize a mentee-centred approach. Features and content considerations: safety, mentor matching, degree of structure, mentor training and support, and collaboration with mentees' support teams.

DISCUSSION

Findings are aligned with previous research on PM.

Asserting Our Competence and Affirming the Value of Occupation With Confidence

Throughout the years, leaders in the profession have challenged us to affirm the value of occupational therapy and to substantiate what we do. Occupational therapy practitioners have always focused on what most matters to clients in what is now called client-centered or patient-centered practice. We have also focused on client function to enable participation in everyday life. In a welcome shift, society's views about health and meaning-making are becoming more congruent with the long-standing ideals of occupational therapy. Now, more than ever, we have a powerful opportunity to communicate our competence. But how do we assert our competence and the complexity of occupation with confidence? This lecture draws on the conceptual foundations of theories about competence and confidence and provides examples from the research literature, and a practitioner and client narrative to illustrate the factors that enable us to effectively demonstrate the value of occupational therapy.

"That Felt Like Real Engagement": Fostering and Maintaining Inclusive Research Collaborations With Individuals With Intellectual Disability

People with intellectual disability (ID) are increasingly involved in stakeholder-engaged research, such as "inclusive research" (IR). To understand the processes that foster and maintain IR with individuals with ID, we used a narrative interview approach with co-researchers with ID (n = 6) and academic researchers (n = 8). We analyzed the data using grounded theory principles. We then developed a model describing how contextual factors and team-level factors and processes coalesce to foster and maintain IR collaborations. We observed that team members' values and characteristics are foundational to IR and drive a commitment to accessibility. Contextual factors, including funding and partnership duration, influence teams' processes and structures. These processes and structures influence the extent to which co-researchers perceive the IR team to be cofacilitated or academic-facilitated. Co-researcher involvement is partially maintained by perceived personal and societal benefits. Optimizing the relationship between these factors may support involvement of people with ID in stakeholder-engaged research projects.

Beyond Medication Adherence: The Role of Patients' Beliefs and Life Context in Blood Pressure Control

Objective

Despite numerous interventions to address adherence to antihypertensive medications, continued high rates of uncontrolled blood pressure (BP) suggest a need to better understand patient factors beyond adherence associated with BP control. We examined how patients' BP-related beliefs, and aspects of life context affect BP control, beyond medication adherence.

Methods

We conducted a cross-sectional telephone survey of primary care patients with hypertension between 2010 and 2011 (N=103; 93 had complete data on all variables and were included in the regression analyses). We assessed patient sociodemographics (including race/ethnicity), medication adherence, BP-related beliefs, aspects of life context, and used clinical BP assessments.

Results

Regression models including sociodemographics, medication adherence, and either beliefs or context consistently predicted BP control. Adding context after beliefs added no predictive value while adding beliefs after context significantly predicted BP control.

Practical Implications

Results suggest that when clinicians must choose a dimension on which to intervene, focusing on beliefs would be the most fruitful approach to effecting change in BP control.

Exercise adherence: beliefs of adults with knee osteoarthritis over 2 years

Exercise is an established treatment to alleviate pain and improve function among adults with knee osteoarthritis (KOA). However, long-term adherence to exercise is poor and effective approaches to support adherence are limited. Here, we report on an ancillary study to a randomized controlled trial (RCT) where the primary outcome was 2-year adherence to a home based strength-training program. The aims of this current study were to (i) explore experiences, feelings, and perspectives related to long-term adherence to exercise among adults with painful KOA participating in a 2-year RCT, and (ii) identify factors that influenced long-term adherence to exercise. Methods: We purposively recruited 25 subjects and conducted in-depth interviews at the 2-year RCT assessment. In the RCT participants completed a 6-week group exercise program followed by automated telephone calls. Findings: Three conceptual categories describing beliefs about exercise were identified: (1) monitoring; (2) knowledge of how to manage their exercise behaviors; and (3) benefits of exercise. Monitoring provided by peers and instructors during group exercise, and telephone technology were valued by participants. Participants who reported low adherence expressed ambivalence about the benefits of exercise and a desire for more social support. Those who reported high adherence exhibited self-determination and self-efficacy. Conclusions: A novel finding is the conceptual link of self-determination to high adherence to strength-training exercises over 2 years among adults with KOA. Implications for physical therapists include identifying patients' autonomy, competence, and relatedness needs to foster intrinsic control for exercise behavior.

Parents' future visions for their autistic transition-age youth: Hopes and expectations

Researchers have documented that young adults with autism spectrum disorder have poor outcomes in employment, post-secondary education, social participation, independent living, and community participation. There is a need to further explore contributing factors to such outcomes to better support successful transitions to adulthood. Parents play a critical role in transition planning, and parental expectations appear to impact young adult outcomes for autistic individuals. The aim of this study was to explore how parents express their future visions (i.e. hopes and expectations) for their autistic transition-age youth. Data were collected through focus groups and individual interviews with 18 parents. Parents' hopes and expectations focused on eight primary domains. In addition, parents often qualified or tempered their stated hope with expressions of fears, uncertainty, realistic expectations, and the perceived lack of guidance. We discuss our conceptualization of the relations among these themes and implications for service providers and research.

Exploring the Self-Disclosure Process in Peer Mentoring Relationships for Transition-Age Youth With Developmental Disabilities

The purpose of this study was to examine the role of the self-disclosure process in regard to connection development and relationship quality in peer mentoring relationships between transition-age youth (ages 15-20) and young adults (ages 18-36) with intellectual and/or developmental disabilities. Self-disclosure is defined as "the disclosure of inner feelings and experiences to another person" that "fosters liking, caring, and trust, thereby facilitating the deepening of close relationships" ( Reis & Shaver, 1988 , p. 372). Nine peer mentoring dyads with varied interpersonal connections were purposefully selected from a larger intervention study. Recorded mentoring conversations were analyzed for self-disclosure content and peer mentor response. The findings demonstrated trends related to connection development and differences across degree of connection. In relationships with stronger connections, there was a higher quantity of self-disclosure and more frequent disclosure of emotions, and peer mentors responded more frequently with advice and reciprocated self-disclosure. Implications of findings for promoting higher-quality peer mentoring relationships are discussed.

Revisiting Unwanted Sexual Experiences on Campus

The current study examines patterns of stability and change in reports of unwanted sexual experiences in one campus community in two similar cohorts of undergraduates studied 12 years apart. A sample of 417 women completed a questionnaire in 2000, and this sample is compared to a sample of 524 women who completed the same questionnaire in 1988. Results indicate a reported decrease in unwanted sexual contact but indicate stability in reported rates of unwanted intercourse. Across forms of unwanted sexual experiences, more patterns of similarity than difference in abuse characteristics, such as relationship to perpetrator and location of the experience, are noted.

The Distinctive Features of a Feasibility Study: Objectives and Guiding Questions

In this article, we highlight the distinctive features of a feasibility study, identify the main objectives and guiding questions of a feasibility study, and illustrate the use of these objectives. We synthesized the research methods literature related to feasibility studies to identify five overarching objectives of feasibility studies that focus on social and behavioral interventions. Feasibility studies are designed to answer the overarching question: Can it work? The main objectives of feasibility include the assessment of recruitment capability and resulting sample characteristics, data collection procedures and outcome measures, acceptability of the intervention and study procedures, resources and ability to manage and implement the study and intervention, and preliminary evaluation of participant responses to the intervention. For each objective, we identified follow-up questions designed to assist the researchers to understand barriers to the ultimate success of the research.

Linking Sensory Factors to Participation: Establishing Intervention Goals With Parents for Children With Autism Spectrum Disorder

Parents often focus on independence in activities of daily living and social participation when setting goals for their children with autism spectrum disorders. Occupational therapy practitioners use clinical reasoning to translate these goals to define occupation-based outcomes. This article describes an exploratory analysis of 160 parent-identified goals for children with autism. We identified sensory integrative factors hypothesized to influence each goal and then categorized the goals using the Occupational Therapy Practice Framework: Domain and Process and the International Classification of Functioning, Disability and Health (ICF). Most goals were at the ICF participation and activity levels. Activities of daily living were the most common area of occupation identified, followed by social participation and play. Sensory reactivity and somatopraxis were the most frequently occurring sensory integrative factors. The value of addressing parent goals using a systematic reasoning process to identify factors affecting participation and the importance of measuring participation outcomes are discussed.

Physical dating violence, sexual violence, and unwanted pursuit victimization: a comparison of incidence rates among sexual-minority and heterosexual college students

The purpose of this study was to estimate the 6-month incidence rates of sexual assault, physical dating violence (DV), and unwanted pursuit (e.g., stalking) victimization among sexual-minority (i.e., individuals with any same-sex sexual experiences) college students with comparison data from non-sexual-minority (i.e., individuals with only heterosexual sexual experiences) college students. Participants (N = 6,030) were primarily Caucasian (92.7%) and non-sexual-minority (82.3%). Compared with non-sexual-minority students (N-SMS; n = 4,961), sexual-minority students (SMS; n = 1,069) reported significantly higher 6-month incidence rates of physical DV (SMS: 30.3%; N-SMS: 18.5%), sexual assault (SMS: 24.3%; N-SMS: 11.0%), and unwanted pursuit (SMS: 53.1%; N-SMS: 36.0%) victimization. We also explored the moderating role of gender and found that female SMS reported significantly higher rates of physical DV than female N-SMS, whereas male SMS and male N-SMS reported similar rates of physical DV. Gender did not moderate the relationship between sexual-minority status and victimization experiences for either unwanted pursuit or sexual victimization. These findings underscore the alarmingly high rates of interpersonal victimization among SMS and the critical need for research to better understand the explanatory factors that place SMS at increased risk for interpersonal victimization.

Putting the "social" back in legal socialization: procedural justice, legitimacy, and cynicism in legal and nonlegal authorities

Traditionally, legal socialization theory and research has been dominated by a cognitive developmental approach. However, more recent work (e.g., Fagan & Tyler, 2005) has used procedural justice to explain the legal socialization process. This article presents 2 studies that expand this approach by testing a procedural justice model of legal socialization in terms of legal and nonlegal authority. In Study 1, participants completed surveys assessing the degree to which they perceived 3 authorities (police officers, parents, and teachers) as procedurally fair, the degree to which they perceived the authorities as legitimate, how cynical they were about laws, and the extent of their rule violation during the past 6 months. Across all 3 authorities, legitimacy and legal cynicism mediated the relation between procedural justice and rule violation. Study 2 examined the model with the same 3 authority types using experimental methods. Participants read 3 scenarios describing an interaction between an adolescent and an authority figure where a rule is enforced. Within each scenario, we manipulated whether the adolescent had a voice and whether the authority enforced the rule impartially. After reading each scenario, participants rated the authority's legitimacy, their cynicism toward the authority's rule, and the likelihood they would violate the rule. Again, legitimacy and rule cynicism mediated the relation between impartiality, voice, and rule violation. In addition, impartiality had a stronger effect in the parent and teacher scenarios, whereas voice had a stronger effect in the police scenario. Results are discussed in terms of expanding legal socialization to nonlegal contexts and applying legal socialization research to prevention and intervention strategies.

Rationalizing Delinquency

Multiple criminological theories predict that attitudes toward delinquency should affect an individual’s delinquent behavior. Criminological research, however, has not sufficiently incorporated social psychological theory predicting the reverse causal relationship, and tends to suffer from important methodological limitations. The present study addresses these issues using longitudinal data from the New Hampshire Youth Study (N = 626). After using latent variable models to demonstrate the discriminant validity of attitudinal and behavioral measures, it uses structural equation models to examine whether attitudes are stronger predictors of behavior or vice versa. Net of controls, results provide qualified support for a reciprocal relationship but suggest that behavior affects attitudes much more than attitudes affect behavior. We conclude by discussing the implications of these findings for future research and for interventions aimed at controlling delinquency.

Facilitated Learning Model to Teach Habits of Evidence-Based Reasoning Across an Integrated Master of Science in Occupational Therapy Curriculum

We describe an integrated master of science in occupational therapy curriculum and a coordinated sequence of evidence-based practice (EBP) courses that incorporate systematic, pragmatic teaching strategies to develop students’ EBP skills and habits of reasoning. The EBP courses focus sequentially on the occupational lives of clients and methods for gaining information about occupational performance and needs; appraising the internal, external, and statistical validity of intervention evidence; and generating evidence from one’s own practice to answer questions about individual or group client outcomes. All EBP courses use facilitated learning processes that encourage graduate students to take responsibility for their own learning, guided by a carefully structured series of assignments. The integrated curriculum scaffolds the translation and application of previously learned knowledge and skills, including EBP knowledge, into different contexts. Student survey data suggest that graduating students view EBP as an integral part of the clinical process and begin to internalize the habits necessary to be evidence-based practitioners.

Parents’ Explanatory Models and Hopes for Outcomes of Occupational Therapy Using a Sensory Integration Approach

PURPOSE. To describe parents’ concerns and hopes for their children who would be receiving occupational therapy using a sensory integration approach.

METHOD. Content analysis of 275 parental responses to three open-ended questions on developmental–sensory history intake forms.

FINDINGS. Parents’ descriptions of why they sought for their children were categorized into four overarching concerns about their children’s challenges: self-regulation, interacting with peers, participating in skilled motor activities, and self-confidence. Parents often linked these concerns together, revealing explanatory models of how they make sense of potential relationships among their children’s challenges and how these challenges affect occupational performance. Parents hoped occupational therapy would help their children develop self-understanding and frustration tolerance to self-regulate their behavior in socially acceptable ways.

IMPLICATIONS. Assessment and intervention should explicitly focus on links among self-regulation, social participation, skills, and perceived competence to address parents’ expectations.

The role of comorbidities in patients' hypertension self-management

OBJECTIVE

We sought to understand barriers to hypertension self-management in patients with hypertension and comorbidities.

METHODS

We conducted semi-structured, qualitative interviews with 48 patients with uncontrolled hypertension and at least one comorbidity to learn about beliefs and behaviors that might affect hypertension self-management. Using a grounded theory strategy, we analyzed interview transcripts detailing patients' hypertension self-management behaviors vis-à-vis a framework including Explanatory Models-a patient's understanding of the pathophysiology, cause, course, treatment, and severity of an illness, such as hypertension.

RESULTS

We identified four factors that interfered with hypertension self-management. (1) Interdependence: Participants saw hypertension as interconnected to their comorbidities and subsequently had difficulty separating information about their illnesses. (2) Low priority: Compared to other conditions, participants assigned hypertension a lower priority. (3) Conflicts: Participants struggled with conflicts between hypertension self-management practices and those for comorbidities. (4) Managing multiple medications: Polypharmacy led to patients' confusion and concern about taking medications as prescribed.

DISCUSSION

Participants did not experience hypertension as a discreet clinical condition; rather, they self-managed hypertension concurrently with other conditions, leading to a breakdown in hypertension self-management. We provide strategies to address each of the four barriers to better equip providers in addressing their clinically salient concerns.

Media use among adolescents with autism spectrum disorder

This study explores how adolescents with autism spectrum disorder (ASD) use media, and the factors associated with their media use. A total of 91 adolescents with ASD and their parents completed mail-based surveys. In all, 78% of the adolescents with ASD watched television (approximately 2 h/day), and 98% used computers (approximately 5 h/day) on any given day. They most frequently watched cartoons, played computer or video games that involved shooting, and visited websites that contained information on video games. Adolescents with ASD who watched television with parents reported more positive parent-child relationships. Adolescents with ASD who visited social networking websites or received emails from friends reported more positive friendships. The findings help us understand media-use habits of adolescents with ASD and suggest areas for future research.

The role of patients' explanatory models and daily-lived experience in hypertension self-management

BACKGROUND

Uncontrolled hypertension remains a significant problem for many patients. Few interventions to improve patients' hypertension self-management have had lasting effects. Previous work has focused largely on patients' beliefs as predictors of behavior, but little is understood about beliefs as they are embedded in patients' social contexts.

OBJECTIVE

This study aims to explore how patients' "explanatory models" of hypertension (understandings of the causes, mechanisms or pathophysiology, course of illness, symptoms and effects of treatment) and social context relate to their reported daily hypertension self-management behaviors.

DESIGN

Semi-structured qualitative interviews with a diverse group of patients at two large urban Veterans Administration Medical centers. PARTICIPANTS (OR PATIENTS OR SUBJECTS): African-American, white and Latino Veterans Affairs (VA) primary care patients with uncontrolled blood pressure.

APPROACH

We conducted thematic analysis using tools of grounded theory to identify key themes surrounding patients' explanatory models, social context and hypertension management behaviors.

RESULTS

Patients' perceptions of the cause and course of hypertension, experiences of hypertension symptoms, and beliefs about the effectiveness of treatment were related to different hypertension self-management behaviors. Moreover, patients' daily-lived experiences, such as an isolated lifestyle, serious competing health problems, a lack of habits and routines, barriers to exercise and prioritizing lifestyle choices, also interfered with optimal hypertension self-management.

CONCLUSIONS

Designing interventions to improve patients' hypertension self-management requires consideration of patients' explanatory models and their daily-lived experience. We propose a new conceptual model - the dynamic model of hypertension self-management behavior - which incorporates these key elements of patients' experiences.

Mothering when Mothers and Children Both have Sensory Processing Challenges

Introduction:

The aim of this study was to understand the perspectives of mothers when mother and child both have sensory processing challenges, and how the mother's coping strategies for managing her sensory needs influence mothering co-occupations and parenting ideals.

Method:

Four mothers with sensory processing challenges participated in semi-structured interviews. Data were analysed using grounded theory principles.

Findings:

Mothers described managing their sensory needs while negotiating the conflicting sensory preferences of their children. Coping strategies included understanding sensory processing patterns of behaviour and structuring daily activities and the environment. Some coping strategies had secondary consequences of a ripple effect, a reverberating impact that exacerbated the challenges of unmet sensory needs and interfered with co-occupations and parenting ideals.

Conclusion:

Implications for mothers include understanding how their sensory processing transacts with their children's sensory preferences. Implications for practitioners include attending to the sensory processing patterns and coping strategies of both children and parents.

Striving for Shared Understandings: Therapists' Perspectives of the Benefits and Dilemmas of Using a Child Self-Assessment

Pediatric client-centered intervention planning is particularly complex because children, parents, and professionals must form a “tridactic” partnership and reach a shared understanding for therapy. Therapists may use child self-reports to facilitate children's involvement in this process. The purpose of this study was to understand how therapists used and interpreted a child self-report to achieve a shared understanding in the context of a tridactic relationship, using the Children's Occupational Self-Assessment (COSA) as an exemplar. Thirty-three pediatric therapists participated in five focus groups and qualitative analysis was conducted in four iterative phases. Therapists' decision to use the COSA led to either “good” responses or unexpected tensions between the therapist's, child's, and parent's perspectives. Therapists used demonstration, negotiation, or reflection to shift beliefs to achieve a shared understanding for therapy. Findings suggest that although therapists valued children's voices, professional knowledge usually took precedence over child and parent self-knowledge during intervention planning.

Habits and routines in the daily management of hypertension

Two purposive case studies illustrate the role of habits and routines in illness management and how they are addressed in the clinical encounter. We argue habits and routines are related, but distinct constructs, and that by overlooking habits and routines, providers may be missing key opportunities to influence behaviour change. Utilization of ‘habit-changing’ professionals or health coaches who have the opportunity to communicate with patients on a regular basis in their daily living environment is proposed.

Friendship characteristics and activity patterns of adolescents with an autism spectrum disorder

This study compared perceptions of adolescents' friendships between adolescents with an autism spectrum disorder (ASD) and their parents, examined factors associated with friendship qualities, and investigated the adolescents' reports on the activities they did with friends and how activity patterns differed by gender. Ninety-one adolescents with an ASD and their parents completed mail-based surveys during the summer months. Adolescents with an ASD identified more friends than did their parents, but they agreed on the friends' characteristics. About half of the adolescents spent an average of 4 hours per day with friends during the summer months. Male adolescents with an ASD most frequently played video games with friends, whereas females most frequently had conversations with friends. The findings suggest that adolescents with an ASD and their parents identify different peers as the adolescent's friends. The findings also reveal similarities and differences in friendships between adolescents with an ASD and typically developing adolescents.

Don't trust anyone over 30: parental legitimacy as a mediator between parenting style and changes in delinquent behavior over time

Both law and society scholars and developmental psychologists have focused on the legitimacy of authority figures, although in different domains (police versus parents). The purpose of the current research is to bridge these two fields by examining the relations among parenting style (i.e., authoritarian, authoritative, permissive), the perception of parental legitimacy, and changes in delinquency over time. It is hypothesized that parental legitimacy mediates the relation between parenting style and future delinquent behavior. Middle school and high school students completed questionnaires three times over a period of 18 months. Parenting style and delinquent behavior were measured at time 1, parental legitimacy at time 2, and delinquency again at time 3. The results show that authoritative parenting was positively related to parental legitimacy, while authoritarian parenting was negatively associated with parental legitimacy. Furthermore, parental legitimacy was negatively associated with future delinquency. Structural equation modeling indicated that parental legitimacy mediated the relation between parenting styles and changes in delinquency over the 18-month time period. The implications for parenting style and parental legitimacy affecting delinquent behavior are discussed.

Development of a fidelity measure for research on the effectiveness of the Ayres Sensory Integration intervention

OBJECTIVE

We developed a reliable and valid fidelity measure for use in research on Ayres Sensory Integration (ASI) intervention.

METHOD

We designed a fidelity instrument to measure structural and process aspects of ASI intervention. Because scoring of process involves subjectivity, we conducted a series of reliability and validity studies on the process section. Raters were trained to score therapist strategies observed in video recordings of adult-child dyads. We examined content validity through expert ratings.

RESULTS

Reliability of the process section was strong for total fidelity score (ICC = .99, Cronbach's alpha = .99) and acceptable for most items. Total score significantly differentiated ASI from four alternative interventions. Expert ratings indicated strong agreement that items in the structural and process sections represent ASI intervention. CONCLUSION. The Ayres Sensory Integration Fidelity Measure has strong content validity. The process section is reliable and valid when scored by trained raters with expertise in ASI.

Ecological barriers and social forces in childhood asthma management: examining routines of African American families living in the inner city

OBJECTIVE

Asthma affects African American children at unprecedented rates. Researchers have examined the context in which African American families live and experience illness, and suggest that ecological barriers contribute to poor health. In this paper, the authors examine the social forces underlying these ecological barriers and what African American parents living in the inner city do to manage their children's asthma amidst these challenges.

METHODS

African American parents of children aged 5 to 12 years diagnosed with persistent asthma living in the inner city were interviewed using a semistructured interview guide. Grounded theory analysis identified recurrent themes in the interview data.

FINDINGS

Parents identified four adaptive routines they use to manage their children's asthma: ( 1 ) give young children with asthma responsibility for medication use; ( 2 ) monitor the availability of the school nurse; ( 3 ) manage air quality; and ( 4 ) frequently clean the home. These routines are described as adaptive because parents navigate ecological barriers and social forces within their daily context to manage their children's asthma.

IMPLICATIONS

The authors argue that the first step in reducing the impact of ecological barriers is understanding African Americans' sociohistorical context.

An integrated model of legal and moral reasoning and rule-violating behavior: the role of legal attitudes

Legal socialization theory predicts that attitudes mediate the relation between legal reasoning and rule-violating behavior [Cohn, E. S., & White, S. O. (1990). Legal Socialization: A Study of Norms and Rules. New York: Springer-Verlag]. Moral development theory predicts that moral reasoning predicts rule-violating behavior directly as well as indirectly [Blasi, A. (1980). Bridging moral cognition and moral action: A critical review of the literature. Psychological Bulletin, 88, 1-45]. We present and test an integrated model of rule-violating behavior drawing on both theories in a longitudinal study of middle school and high school students. Students completed questionnaires three times during the course of 1 year at 6-month intervals. Legal and moral reasoning, legal attitudes, and rule-violating behavior were measured at times one, two, and three respectively. Structural equation models revealed that while moral and legal reasoning were directly and indirectly related to rule-violating behavior among high school students, legal reasoning bore no direct relation to rule-violating behavior among middle school students. The implications for an integrated model of reasoning and rule-violating behavior are discussed.

Parasympathetic functions in children with sensory processing disorder

The overall goal of this study was to determine if parasympathetic nervous system (PsNS) activity is a significant biomarker of sensory processing difficulties in children. Several studies have demonstrated that PsNS activity is an important regulator of reactivity in children, and thus, it is of interest to study whether PsNS activity is related to sensory reactivity in children who have a type of condition associated with sensory processing disorders termed sensory modulation dysfunction (SMD). If so, this will have important implications for understanding the mechanisms underlying sensory processing problems of children and for developing intervention strategies to address them. The primary aims of this project were: (1) to evaluate PsNS activity in children with SMD compared to typically developing (TYP) children, and (2) to determine if PsNS activity is a significant predictor of sensory behaviors and adaptive functions among children with SMD. We examine PsNS activity during the Sensory Challenge Protocol; which includes baseline, the administration of eight sequential stimuli in five sensory domains, recovery, and also evaluate response to a prolonged auditory stimulus. As a secondary aim we examined whether subgroups of children with specific physiological and behavioral sensory reactivity profiles can be identified. Results indicate that as a total group the children with severe SMD demonstrated a trend for low baseline PsNS activity, compared to TYP children, suggesting this may be a biomarker for SMD. In addition, children with SMD as a total group demonstrated significantly poorer adaptive behavior in the communication and daily living subdomains and in the overall Adaptive Behavior Composite of the Vineland than TYP children. Using latent class analysis, the subjects were grouped by severity and the severe SMD group had significantly lower PsNS activity at baseline, tones and prolonged auditory. These results provide preliminary evidence that children who demonstrate severe SMD may have physiological activity that is different from children without SMD, and that these physiological and behavioral manifestations of SMD may affect a child's ability to engage in everyday social, communication, and daily living skills.

Friends of survivors: the community impact of unwanted sexual experiences

Since sexual assault survivors are most likely to disclose their experiences to a friend; prevention efforts increasingly focus on friends as informal helpers. The current study examined friends' perceptions of the disclosure experience. Undergraduates (N=1,241) at the University of New Hampshire completed a shortened version of the Ahrens and Campbell (2000) Impact on Friends measure. Results found that about 1 in 3 female undergraduates and 1 in 5 male students were told by a friend that they were a victim of an unwanted sexual experience. Gender differences were found in friends' responses to disclosure. Women reported greater emotional distress in response to a friend's disclosure, greater positive responses and lesser-perceived confusion/ineffectiveness as compared to men. Implications include the need to develop specific and clear educational material to help the community cope with and effectively respond to unwanted sexual experiences on college campuses.

Disclosure and service use on a college campus after an unwanted sexual experience

In order to continue to facilitate the disclosure of sexual assault to professional support services, the current study examined the extent to which survivors report using campus services and whether friends who had disclosed to participants used the services. We also compared knowledge of a campus sexual assault center and likelihood of using the center among college men and women. Surveys were completed by 1,230 students, including victims of unwanted contact (n = 127), victims of unwanted intercourse (n = 26), and friends of victims (n = 253). Students who reported being victims of unwanted sexual experiences were reluctant to use services, expressing concerns that they would not be believed and that they would be blamed for what had happened to them. College men were significantly less likely to know where the sexual assault center was located, to report that they would use the center, and to report that unwanted sexual experiences were a problem on campus. Results indicate that much needs to be done to educate the campus community about the value of using professional support services after a sexual assault.

A narrative of resistance: presentation of self when parenting children with asthma

Using a social constructivist perspective and narrative analysis, the purpose of this paper is to illustrate how an understanding of self-presentation in interactions may inform health care interventions. We examine how a single African American mother, living in poverty, presents her sense of self in the context of obtaining and providing asthma care for her children. By analyzing four separate encounters--two interviews with the children's mother, the clinical encounter between the mother and her children's doctor, and an interview with the doctor, we gain an understanding of the mother's self-presentation and identity and the doctor's view of the mother. The analyses reveal the mother's consistent desire to protect her children in an unpredictable social world. By examining self-presentation, behavior that is typically construed as non-adherence is reframed as resilience, one mother's attempt to assert control. We argue that an understanding of identity production may enable practitioners and patients to create collaborative interventions. The analysis presented in this paper points to the need for a co-constructed intervention that allows for choice and control and honors the mother's sense of self.

Factors associated with participation of children with and without ADHD in household tasks

Children's preparation for adult roles and independent living occur largely through participation with their families in home routines including household tasks. This preparation may involve learning related to family roles, socialization, and occupational performance. This study was designed to explore the extent to which child, environmental, and task factors are associated with household task participation by school-aged children, 9 to 11 years of age, with and without attention deficit/hyperactivity disorder (ADHD). Forty-four parents of children with and without ADHD completed a series of measures that examined family routine frequency and importance, parenting stress, parenting sense of competence, and a measure of their children's participation in household tasks. Child's age, the presence of an older sibling, and the importance of family routines were significant predictors of the number of household tasks performed by children. Diagnosis of ADHD, the presence of an older sibling, and parental stress were significant predictors of the amount of assistance the children required to do the household tasks.

Household task participation of children with and without attentional problems

Children with attention deficit/hyperactivity disorder (ADHD) often demonstrate problems in their participation in family occupations, such as household tasks, due to their needs for assistance and their behavior. Because participation in household tasks is part of family life and may be one way that families prepare children for adult roles, it is important to have a better understanding of the nature and extent of these difficulties. Forty-four parents of children in grades three through five (22 who had a child with ADHD and 22 whose child had no disabilities) completed the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES) measure to provide quantitative and qualitative information about their child's participation in household tasks. Children with ADHD did not differ significantly from the comparison group in their frequency of participating in household tasks. Children with ADHD, however, required significantly more assistance with the tasks than did the comparison group. The results have implications for family occupations and children's occupational development.

Patterns of concordance and non-concordance with clinician recommendations and parents' explanatory models in children with asthma

OBJECTIVE

Many children with asthma do not take medications as prescribed. We studied parents of children with asthma to define patterns of non-concordance between families' use of asthma controller medications and clinicians' recommendations, examine parents' explanatory models (EMs) of asthma, and describe relationships between patterns of non-concordance and EM.

METHODS

Qualitative study using semi-structured interviews with parents of children with persistent asthma. Grounded theory analysis identified recurrent themes and relationships between reported medication use, EMs, and other factors.

RESULTS

Twelve of the 37 parents reported non-concordance with providers' recommendations. Three types of non-concordance were identified: unintentional--parents believed they were following recommendations; unplanned--parents reported intending to give controller medications but could not; and intentional--parents stated giving medication was the wrong course of action. Analysis revealed two EMs of asthma: chronic--parents believed their child always has asthma; and intermittent--parents believed asthma was a problem their child sometimes developed.

CONCLUSIONS

Concordance or non-concordance with recommended use of medications were related to EM's and family context and took on three different patterns associated with medication underuse.

PRACTICE IMPLICATIONS

Efforts to reduce medication underuse in children with asthma may be optimized by identifying different types of non-concordance and tailoring interventions accordingly.

Fidelity in sensory integration intervention research

OBJECTIVE

We sought to assess validity of sensory integration outcomes research in relation to fidelity (faithfulness of intervention to underlying therapeutic principles).

METHOD

We identified core sensory integration intervention elements through expert review and nominal group process. Elements were classified into structural (e.g., equipment used, therapist training) and therapeutic process categories. We analyzed 34 sensory integration intervention studies for consistency of intervention descriptions with these elements.

RESULTS

Most studies described structural elements related to therapeutic equipment and interveners' profession. Of the 10 process elements, only 1 (presentation of sensory opportunities) was addressed in all studies. Most studies described fewer than half of the process elements. Intervention descriptions in 35% of the studies were inconsistent with one process element, therapist-child collaboration.

CONCLUSION

Validity of sensory integration outcomes studies is threatened by weak fidelity in regard to therapeutic process. Inferences regarding sensory integration effectiveness cannot be drawn with confidence until fidelity is adequately addressed in outcomes research.

Goal Attainment Scaling as a Measure of Meaningful Outcomes for Children With Sensory Integration Disorders

Goal attainment scaling (GAS) is a methodology that shows promise for application to intervention effectiveness research and program evaluation in occupational therapy (Dreiling & Bundy, 2003; King et al., 1999; Lannin, 2003; Mitchell & Cusick, 1998). This article identifies the recent and current applications of GAS to occupational therapy for children with sensory integration dysfunction, as well as the process, usefulness, and problems of application of the GAS methodology to this population. The advantages and disadvantages of using GAS in single-site and multisite research with this population is explored, as well as the potential solutions and future programs that will strengthen the use of GAS as a measure of treatment effectiveness, both in current clinical practice and in much-needed larger, multisite research studies.

Unwanted sexual contact on campus: a comparison of women's and men's experiences

While sexual victimization continues to be a problem on college campuses, recent attention has been drawn to understanding gender differences in victimization rates and consequences. To date, these studies remain relatively few in number. The current study surveyed 651 male and female undergraduate students about unwanted sexual experiences during 1 academic year. Comparison of men and women revealed expected differences in incidence rates, with women reporting higher rates of unwanted contact. Within the subsample of reported victims, however, there was gender similarity in terms of the context of unwanted sexual experiences. Analyses also revealed the negative consequences of these experiences for both men and women and low rates of disclosure regardless of gender. Across the full sample of students surveyed, there were interesting gender differences in knowledge of campus support services, with women more likely to have attended a prevention program and to have indicated greater knowledge of rape crisis services.

GENDER DIFFERENCES IN PREDICTING DELINQUENT BEHAVIOR: DO INDIVIDUAL DIFFERENCES MATTER?

The purpose of this study was to determine the role of individual differences (i.e., belief in a just world and authoritarianism), and attitude (i.e., attitudes toward the criminal legal system), in predicting delinquent behavior. High school students (412 males, 423 females) completed questionnaires that measured demographics, belief in a just world (BJW), authoritarianism (RWA), attitudes toward the criminal legal system (ATCLS), and delinquent behavior. Two models were assessed in this study. The first was a direct model, which assessed whether individual differences or attitude best predicted rule-violating behavior. The second was an integrating model, which assessed the role of both factors, individual differences and attitude, as predictors of rule-violating behavior. For male adolescents, the direct model best predicted delinquency, suggesting negative ATCLS was the sole significant predictor of rule-violating behavior. In contrast, for females, the integrating model best predicted delinquency, as negative ATCLS mediated the negative relation between BJW and delinquency, and partially mediated the negative relation between RWA and delinquency. The implications of gender differences in predicting delinquent behavior are discussed.

OTOF mutations revealed by genetic analysis of hearing loss families including a potential temperature sensitive auditory neuropathy allele

INTRODUCTION

The majority of hearing loss in children can be accounted for by genetic causes. Non-syndromic hearing loss accounts for 80% of genetic hearing loss in children, with mutations in DFNB1/GJB2 being by far the most common cause. Among the second tier genetic causes of hearing loss in children are mutations in the DFNB9/OTOF gene.

METHODS

In total, 65 recessive non-syndromic hearing loss families were screened by genotyping for association with the DFNB9/OTOF gene. Families with genotypes consistent with linkage or uninformative for linkage to this gene region were further screened for mutations in the 48 known coding exons of otoferlin.

RESULTS

Eight OTOF pathological variants were discovered in six families. Of these, Q829X was found in two families. We also noted 23 other coding variant, believed to have no pathology. A previously published missense allele I515T was found in the heterozygous state in an individual who was observed to be temperature sensitive for the auditory neuropathy phenotype.

CONCLUSIONS

Mutations in OTOF cause both profound hearing loss and a type of hearing loss where otoacoustic emissions are spared called auditory neuropathy.

Exploring parents' use of strategies to promote social participation of school-age children with acquired brain injuries

OBJECTIVE

To understand parents' perspectives about the strategies they use to promote social participation of their school-age children with acquired brain injuries (ABI) in home, school, and community life.

METHOD

A descriptive research design employing a semistructured interview format was used. Interviews were conducted in the homes of 16 families of school-age children with ABI discharged up to 7 years earlier from one inpatient rehabilitation program. Data were examined using content and constant-comparison analyses.

RESULTS

Parents needed time to allow the recovery process to unfold for themselves and their children and developed strategies that fit into or assisted with managing family routines. Over time parents developed insight into the activity demands and their child's potential success to participate in desired activities. Based on these insights, parents used "anticipatory planning," which involved previewing upcoming events and activities and using strategies to promote positive and prevent negative experiences for their children. Specific strategies that parents used to promote social participation were classified into three categories: Creating opportunities, teaching skills, and regulating cognitive and behavioral function.

CONCLUSIONS

Understanding how families use and integrate strategies within the context of their daily lives and what factors influence strategy use may provide practitioners with insights needed to support families in promoting their children's social participation.

Fine Motor Activities in Head Start and Kindergarten Classrooms

OBJECTIVE. The purpose of this study was to describe and compare the fine motor activities in Head Start and kindergarten classrooms in order to open a dialogue between the two contexts about the fine motor activities children in preschool will face in kindergarten.

METHODS. Children in 10 Head Start and 10 kindergarten classrooms were observed for 1 day each. Time spent in activities was categorized into four groups: fine motor activities with no academic purpose, fine motor activities with academic purpose, academic activities with no fine motor component, and nonacademic activities with no fine motor component. Percentages of time were calculated and t tests were used for comparison between contexts.

RESULTS. Children in Head Start spent 27%–46% (mean of 37%) of the in-class day in all fine motor activities whereas children in kindergarten spent 36%–66% (mean of 46%). For children in kindergarten, 42% of total fine motor activity time involved paper and pencil activities. In contrast, children in Head Start spent 10% of total fine motor activity time in paper and pencil activities.

CONCLUSION. The higher mean percent of time spent in fine motor activities in kindergarten classrooms suggests a developmentally appropriate increase in fine motor demands. The percent of paper and pencil activity time the children engaged in substantially increased from Head Start to kindergarten. The findings describe a difference between the two environments, informing Head Start of the fine motor demands their graduates face in kindergarten.