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Carrington L, Hale L, Freeman C, Smith D, Perry M. The effectiveness of play as an intervention using International Classification of Functioning outcome measures for children with disabilities - a systematic review and meta-synthesis. Disabil Rehabil 2024; 46:3827-3848. [PMID: 37750218 DOI: 10.1080/09638288.2023.2259305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/07/2023] [Accepted: 09/10/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Over 240 million children worldwide experience inequities due to disablement/disability. Play is important for children's global development, to enable participation in life, and has been used in therapeutic settings. The purpose of this systematic review is to determine the effectiveness of play used in therapy for children with disabilities, to explore ways that play is used in therapy, and to classify and map outcome measures used in play-based interventions to the International Classification of Functioning. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS The search yielded 22 articles eligible for inclusion. A meta-analysis found significant heterogeneity for play-based intervention outcomes, precluding estimates of effectiveness. Body function and structure outcomes accounted for 61% of reported outcome measures. CONCLUSION There is a trend towards a small positive effect of play used in therapy for children with disabilities, but certainty of the effect is poor, and replication difficult due to heterogeneous reports of how play is used. Research aims and outcome measures focusing on meaningful aspects of activity and participation in addition to body function and structure domains of the International Classification of Functioning should be considered for play-based interventions for children with disabilities.
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Affiliation(s)
- Lizz Carrington
- Centre of Health Activity and Rehabilitation Research, University of Otago, School of Physiotherapy, Dunedin, New Zealand
| | - Leigh Hale
- Centre of Health Activity and Rehabilitation Research, University of Otago, School of Physiotherapy, Dunedin, New Zealand
| | - Claire Freeman
- School of Architecture, Victoria University of Wellington Te Herenga Waka, Wellington, New Zealand
| | - Donna Smith
- Centre of Health Activity and Rehabilitation Research, University of Otago, School of Physiotherapy, Dunedin, New Zealand
| | - Meredith Perry
- Centre of Health Activity and Rehabilitation Research, University of Otago, School of Physiotherapy, Dunedin, New Zealand
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Kuhaneck H, Bundy A, Fabrizi S, Lynch H, Moore A, Román-Oyola R, Stagnitti K, Waldman-Levi A. Play as Occupation: The State of Our Science and a Research Agenda for the Profession. Am J Occup Ther 2024; 78:7804185150. [PMID: 38861551 DOI: 10.5014/ajot.2024.050824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Occupational therapists view play through a unique lens. Considering play as a human occupation, and one to which all people have a right, places occupational therapists among a special group of professionals championing play. This State of the Science article seeks to increase awareness regarding the occupational therapy profession's contributions and to situate those contributions within the larger body of literature on play while also promoting further study of play as an occupation.
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Affiliation(s)
- Heather Kuhaneck
- Heather Kuhaneck, PhD, OTR/L, FAOTA, is Professor and Program Director, Occupational Therapy Program, Recreation, Tourism, and Sports Management Department, Southern Connecticut State University, New Haven;
| | - Anita Bundy
- Anita Bundy, ScD, OT/L, FAOTA, FOTARA, is Professor and Department Head, Department of Occupational Therapy, Colorado State University, Fort Collins
| | - Sarah Fabrizi
- Sarah Fabrizi, PhD, OTR/L, FAOTA, is Associate Professor, Department of Rehabilitation Sciences, Florida Gulf Coast University, Fort Myers
| | - Helen Lynch
- Helen Lynch, PhD, MSc, Dip Montessori, Dip COT, is Co-Coordinator of P4Play and Senior Lecturer, Department of Occupational Science and Occupational Therapy, University College Cork, Ireland
| | - Alice Moore
- Alice Moore, PhD, MScOT, BSc(Hons.)OT, is Research and Impact Lead, The Crann Centre, Cork, Ireland
| | - Rosa Román-Oyola
- Rosa Román-Oyola, PhD, MEd, OTR/L, is Associate Professor, Occupational Therapy Program, University of Puerto Rico, San Juan, Puerto Rico
| | - Karen Stagnitti
- Karen Stagnitti, PhD, BOccThy, GCHE, is Emeritus Professor, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Amiya Waldman-Levi
- Amiya Waldman-Levi, PhD, OTR/L, FAOTA, is Clinical Associate Professor and Director of Scholarship and Research, Occupational Therapy Doctorate Program, Yeshiva University, New York
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Patten KK, Murthi K, Onwumere DD, Skaletski EC, Little LM, Tomchek SD. Occupational Therapy Practice Guidelines for Autistic People Across the Lifespan. Am J Occup Ther 2024; 78:7803397010. [PMID: 38758762 DOI: 10.5014/ajot.2024.078301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
IMPORTANCE Occupational therapy practitioners need evidence to support interventions that promote subjective well-being among autistic people and their families through optimal engagement and participation in occupations. OBJECTIVE These Practice Guidelines are informed by systematic reviews to expand knowledge of interventions that promote access, inclusion, engagement, and optimal participation in occupations that are meaningful to autistic people. Our intent was to foster occupational therapy practitioners' clinical decision-making and reasoning when working with autistic people and their care partners. METHOD These Practice Guidelines were developed on the basis of four systematic reviews, supporting evidence and literature, along with continued revisions and integration through an iterative and collaborative process. RESULTS A total of 98 articles were included in the systematic reviews, which are the foundation for practice recommendations in these guidelines. Forty-eight of the systematic review articles were used to inform the clinical recommendations included in these Practice Guidelines. CONCLUSIONS AND RECOMMENDATIONS Strong to moderate evidence indicates the need for multidisciplinary, goal-oriented interventions to support autistic people in different contexts. Although there is only emerging evidence in the inclusion of autistic people's strengths, interests, and perspectives to guide occupational therapy interventions, such practices can enhance the delivery of neurodiversity-affirming and trauma-informed practices. In addition, evidence is needed to support participation in activities of daily living (ADLs) for autistic youths. We recommend the use of strengths-based language to describe autistic people and the use of environmental adaptations, care partner education, and coaching to enhance occupational therapy service delivery. Plain-Language Summary: The literature is sparse regarding neurodiversity-affirming and trauma-informed practices for autistic youths, as well as for participation in activities of daily living (ADLs). These Practice Guidelines provide new information on positive mental health development; self-determination; ADLs, instrumental ADLs, play, and leisure occupations for children, adolescents, and adults; person-centered planning for adolescents and adults; and rest and sleep. Information on health management is also provided. Positionality Statement: This article uses the identity-first language autistic people. This nonableist language describes their strengths and abilities and is a conscious decision. This language is favored by autistic communities and self-advocates and has been adopted by health care professionals and researchers (Bottema-Beutel et al., 2021; Kenny et al., 2016). However, we respect the use of person-first language and have made a conscious decision to include research articles that have used this language.
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Affiliation(s)
- Kristie K Patten
- Kristie K. Patten, PhD, OT/L, FAOTA, is Counselor to the President and Professor, Department of Occupational Therapy, New York University, New York, NY
| | - Kavitha Murthi
- Kavitha Murthi, MSc(OT), FHEA(UK), OTR, is PhD Candidate, Department of Occupational Therapy, New York University, New York, NY
| | - Dora D Onwumere
- Dora D. Onwumere, MS, OTR/L, is PhD Candidate, Department of Occupational Therapy, New York University, New York, NY
| | - Emily C Skaletski
- Emily C. Skaletski, MOT, OTR/L, is PhD Candidate, Department of Kinesiology, University of Wisconsin-Madison
| | - Lauren M Little
- Lauren M. Little, PhD, OTR/L, FAOTA, is Associate Dean of Research, College of Health Sciences, and Associate Professor, Occupational Therapy, Rush University, Chicago, IL
| | - Scott D Tomchek
- Scott D. Tomchek, PhD, OTR/L, FAOTA, is Professor, Department of Pediatrics, Division of Developmental Behavioral Pediatrics, School of Medicine, University of Louisville, Louisville, KY
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Little LM, Cohen SR, Tomchek S, Baker A, Wallisch A, Dean E. Interventions to Support Participation in Play for Autistic Children and Youth (Dates of Review: 2013-2021). Am J Occup Ther 2023; 77:7710393170. [PMID: 37566777 DOI: 10.5014/ajot.2023.77s10017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
Abstract
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 to support participation in play for autistic1 children and adolescents (birth to 18 yr).
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Affiliation(s)
- Lauren M Little
- Lauren M. Little, PhD, OTR/L, is Associate Professor, Occupational Therapy, Rush University, Chicago, IL
| | - Samantha R Cohen
- Samantha R. Cohen, BA, OTS, is OTD student, Occupational Therapy, Rush University, Chicago, IL
| | - Scott Tomchek
- Scott Tomchek, PhD, OTR/L, FAOTA, is Professor, Pediatrics, University of Louisville, Louisville, KY
| | - Alissa Baker
- Alissa Baker, MS, OTR/L, is Instructor, Western Michigan University, Grand Rapids, MI
| | - Anna Wallisch
- Anna Wallisch, PhD, OTR/L, is Postdoctoral Research Associate, Juniper Gardens Children's Project, University of Kansas, Lawrence, KS
| | - Evan Dean
- Evan Dean, PhD, OTR/L, is Associate Director, Beach Center on Disability, University of Kansas, Lawrence, KS
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Briet G, Le Maner-Idrissi G, Seveno T, Le Marec O, Le Sourn-Bissaoui S. Peer mediation in play settings for minimally verbal students with autism Spectrum disorder. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2023; 8:23969415231204837. [PMID: 37869262 PMCID: PMC10588431 DOI: 10.1177/23969415231204837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Background and aims Peer-mediated interventions (PMIs) are effective strategies to foster socialization of children with autism spectrum disorder (ASD) in natural settings. However, research examining the efficacy of peer mediation for students with ASD who have the greatest cognitive and language impairments remains limited. Additionally, previous studies essentially targeted communicative abilities of participants. To address this gap, the present study evaluated the effects of a play-based PMI on three socio-communicative skills (play, social engagement and imitation) of minimally verbal students with ASD who also have a comorbidity of intellectual disability (ID). Methods Seven children with ASD attending ordinary school settings and 14 typically developing (TD) preschoolers participated. Seven single-sex groups were formed, and children played together during two 30 min weekly sessions. TD children were trained according to the principles of the integrated play group model. We used a multiple-baseline design across participants to measure the effects of the intervention on play skills, social engagement and motor imitation of students with ASD. Results Outcomes revealed an intervention effect for most of the participants, despite some variations across children. After the peer training, four children increased their duration of functional/symbolic play, six children improved their duration of interactive play and five children increased their rates of motor imitation. Concerning maintenance gains, inter-individual differences are also important. Conclusions and implications These findings suggest that a play-based PMI may be a feasible option for targeting inclusive education and improving socio-communicative skills of some minimally verbal students with ASD who also have an ID. However, variations across children invite further research to clarify how individual factors can moderate the effects of PMIs in children with ASD who are the most impaired.
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Affiliation(s)
- Gaëtan Briet
- University of NIMES, APSY-V, F-30021, Nîmes Cedex 1, France
| | - Gaïd Le Maner-Idrissi
- LP3C (Laboratoire de Psychologie, Cognition, Comportement, Communication), Université Rennes, Rennes, France
| | - Tanguy Seveno
- Centre Hospitalier Guillaume Regnier, Rennes, France
| | | | - Sandrine Le Sourn-Bissaoui
- LP3C (Laboratoire de Psychologie, Cognition, Comportement, Communication), Université Rennes, Rennes, France
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Carbone PS, Smith PJ, Lewis C, LeBlanc C. Promoting the Participation of Children and Adolescents With Disabilities in Sports, Recreation, and Physical Activity. Pediatrics 2021; 148:183444. [PMID: 34851421 DOI: 10.1542/peds.2021-054664] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The benefits of physical activity are likely universal for all children, including children and adolescents with disabilities (CWD). The participation of CWD in physical activity, including adaptive or therapeutic sports and recreation, promotes inclusion, minimizes deconditioning, optimizes physical functioning, improves mental health as well as academic achievement, and enhances overall well-being. Despite these benefits, CWD face barriers to participation and have lower levels of fitness, reduced rates of participation, and a higher prevalence of overweight and obesity compared with typically developing peers. Pediatricians and caregivers may overestimate the risks or overlook the benefits of physical activity in CWD, which further limits participation. Preparticipation evaluations often include assessment of health status, functional capacity, individual activity preferences, availability of appropriate programs, and safety precautions. Given the complexity, the preparticipation evaluation for CWD may not occur in the context of a single office visit but rather over a period of time with input from the child's multidisciplinary team (physicians, coaches, physical education teachers, school nurses, adaptive recreation specialists, physical and occupational therapists, and others). Some CWD may desire to participate in organized sports to experience the challenge of competition, and others may prefer recreational activities for enjoyment. To reach the goal of inclusion in appropriate physical activities for all children with disabilities, child, family, financial, and societal barriers to participation need to be identified and addressed. Health care providers can facilitate participation by encouraging physical activity among CWD and their families during visits. Health care providers can create "physical activity prescriptions" for CWD on the basis of the child's preferred activities, functional status, need for adaptation of the activity and the recreational opportunities available in the community. This clinical report discusses the importance of participation in sports, recreation, and physical activity for CWD and offers practical suggestions to health care providers.
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Affiliation(s)
- Paul S Carbone
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah
| | - Peter J Smith
- Section on Developmental and Behavioral Pediatrics, The University of Chicago, Chicago, Illinois
| | - Charron Lewis
- Division of Developmental-Behavioral Pediatrics and Psychology, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Claire LeBlanc
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
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Can I Learn to Play? Randomized Control Trial to Assess Effectiveness of a Peer-Mediated Intervention to Improve Play in Children with Autism Spectrum Disorder. J Autism Dev Disord 2021; 51:1823-1838. [PMID: 32870416 DOI: 10.1007/s10803-020-04671-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Play is often used in interventions to improve social outcomes for children with autism spectrum disorders (ASD). Play is a primary occupation of childhood and, therefore, an important outcome of intervention. The Ultimate Guide to Play, Language and Friendship (PLF) is a peer-mediated intervention for 6-11-year-old children with ASD. A total of 68 dyads were randomized to either a 10-week treatment first or waitlist control group. Results revealed a significant moderate intervention effect from pre- to post-intervention, which was maintained to the 3-month follow-up clinic session and generalized to the home environment. The findings support that the PLF intervention can be used to positively improve play in 6-11-year-old children with ASD.Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ (ACTRN12615000008527; Universal Trial Number: U1111-1165-2708).
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