Exploring Self-Regulation Strategy Use in Adolescents with FASD

The experiences of occupational therapists supporting children with self-regulation needs: A qualitative descriptive study

INTRODUCTION

Occupational therapists support children with self-regulation needs to engage in meaningful occupations at home, school, and in the community. However, little is known about how Australian practitioners perceive their role working with children with self-regulation needs in the Australian healthcare context. Therefore, we explored the contemporary practice experiences of Australian occupational therapists working with children 4-12 years referred for self-regulation support, to better understand elements constituting efficacious service delivery to enhance occupational engagement.

METHODS

A qualitative descriptive design, underpinned by constructivism and relativism, was implemented to address the research aim. Occupational therapists were recruited online to participate in audio-recorded focus groups and interviews. The audio recordings were anonymised, transcribed verbatim, and analysed through reflexive thematic analysis.

CONSUMER AND COMMUNITY INVOLVEMENT

No consumers were involved in the study design or analysis.

FINDINGS

Four themes were generated, encapsulating the experience of 13 occupational therapists working with children with self-regulation needs: (1) navigating the complexities of self-regulation, (2) intervening to support the child and surrounding systems, (3) bringing the occupational therapy perspective to the self-regulation puzzle, and (4) working within an evolving practice context. Themes 1-3 describe specific processes that all occurred within the context of Theme 4. Overall, participants detailed successful practice to support children with self-regulation needs to participate in meaningful occupations that required person-centredness, collaboration, coaching, and adaptability of therapists responding to different stakeholder demands.

CONCLUSION

Self-regulation is a complex area of practice, and occupational therapists have a key role in supporting occupational engagement by balancing the child's needs with those of family, other stakeholders, and funding bodies. Findings support occupational therapists and decision-makers advocating for the unique role of occupational therapy in supporting self-regulation in childhood as part of a collaborative, multi-disciplinary approach. Specific consideration must also be given to ways that current funding schemes in Australia enable occupational therapy services for children with self-regulation needs.

PLAIN LANGUAGE SUMMARY

Controlling emotions and behaviours is sometimes called 'self-regulation'. Some children find this hard and need help from an occupational therapist, who knows a lot about the body and the systems within it. A lot of occupational therapists in Australia help children with their self-regulation. There is not much known about how these therapists see their role in working with these children. We wanted to understand what it is like for occupational therapists who help children, between 4 and 12 years old, with their self-regulation. We interviewed 13 occupational therapists from across Australia and analysed what they said. The data showed four main points: (1) understanding the challenges of self-regulation, (2) helping the child and their environment, (3) using an occupational therapy approach to solve self-regulation issues, and (4) working in a changing practice environment. The therapists described how important it is to focus on the child, work together with many people like caregivers and teachers, and being flexible. They talked about how they balance the needs of the child, family, and funding bodies, which could sometimes be tricky. The study shows the things that therapists are doing when working with children who need help with their self-regulation and the things that therapists find hard working in this space. The results of the study can be used by people who advocate for services that help children and by people who make decisions about Australia's healthcare. One way the study can be used is to think about how current funding schemes do or do not allow different people and professions to work together to support children's self-regulation. Even though there were some limitations, such as a low response rate due to the stress of the COVID-19 pandemic, we did interview therapists from different parts of Australia who work in different settings to each other.

Measurement of Self-regulation in Preschool and Elementary Children: A Scoping Review

AIMS

This scoping review sought to identify and characterize measurement of self-regulation in preschool and elementary aged children.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (ScR) guidelines were applied. Databases from the fields of allied health, education, medicine, and social sciences were searched including: CINAHL, Education Database (ProQuest), Education Research Complete, EMBASE, ERIC, iNFORMIT Combined, Medline, PsychINFO, Social Sciences (ProQuest), Teacher Reference Center, and Web of Science. Articles published between 2015 and 2020 were included. Dual review was utilized at all stages and a third reviewer resolved any conflicts.

RESULTS

Sixty-seven studies were included in this review. A range of observational, self-report, teacher report, caregiver report, and observational measures of self-regulation were identified. Included studies were primarily published in education and psychology disciplines, with no studies by occupational therapists identified.

CONCLUSIONS

Although a range of measures were identified in this scoping review, the results highlight the lack of consensus regarding self-regulation measurement that occupational therapists use to design and implement therapy programs to address child emotional and behavioral needs.

Adaptive behavior, sleep, and physical activity in adolescents with fetal alcohol spectrum disorder

BACKGROUND

Fetal alcohol spectrum disorder (FASD) is broadly associated with impairments to adaptive behavior and dysfunctional sleep. Associations between sleep, adaptive behavior, and physical activity are frequently drawn in discussions of typical development and other clinical conditions.

AIMS

In this study, we sought to characterize patterns of sleep, adaptive behavior, and physical activity in adolescents with FASD. We also investigated the associations between sleep, adaptive behavior, and physical activity within this population.

METHODS AND PROCEDURES

Twenty-seven adolescents aged 11- to 17-years with a diagnosis of FASD and their caregivers participated in this study. All participants completed parent and youth questionnaires on adaptive behavior, sleep, and physical activity.

OUTCOMES AND RESULTS

Adolescents with FASD displayed significant impairments to all domains of adaptive behavior and considerable sleep disturbance. Worse sleep was associated with older age and sleep-related breathing disturbances were associated with poorer social adaptive behavior. Participation in physical activity, particularly organized sport, was strongly associated with better adaptive behavior.

CONCLUSIONS AND IMPLICATIONS

Adolescents with FASD experience considerable challenges with regards to sleep and adaptive behavior. Physical activity, particularly organized sport, may provide opportunities for the improvement of adaptive behavior in this population.

Exploring offending characteristics of young people with foetal alcohol spectrum disorder in Western Australia

Neurodevelopmental impairments resulting from Foetal Alcohol Spectrum Disorder (FASD) can increase the likelihood of justice system involvement. This study compared offence characteristics in young people with FASD to demographically matched controls (n = 500) in Western Australia. A novel approach (i.e. association rule mining) was adopted to uncover relationships between personal attributes and offence characteristics. For FASD participants (n = 100), file records were reviewed retrospectively. Mean age of the total sample was 15.60 years (range = 10-24), with 82% males and 88% Australian Aboriginal. After controlling for demographic factors, regression analyses showed FASD participants were more likely than controls to be charged with reckless driving (odds ratio, OR = 4.20), breach of bail/community orders (OR = 3.19), property damage (OR = 1.84), and disorderly behaviour (OR = 1.54). Overall, our findings suggest justice-involved individuals with FASD have unique offending profiles. These results have implications for sentencing, diversionary/crime prevention programs and interventions.

Diminished culpability in fetal alcohol spectrum disorders (FASD)

There is a biological basis for diminished criminal responsibility in offenders with fetal alcohol spectrum disorders (FASD) just as there is in those with intellectual disability. Functional limitations affecting cognition in both neurodevelopmental conditions stem directly from structural brain damage at a gross and molecular level, which usually impairs executive functioning among other cognitive skills. Executive functioning, which includes reasoning and impulse control, is the only neural system in the brain that involves conscious thought. With respect to the law, impaired reasoning or rationality is an aspect of mens rea ("guilty mind"). When rationality is impaired by prenatal alcohol exposure, acts driven by strong emotion and urges can occur, which has obvious implications regarding criminal responsibility. The Atkins decision by the U.S. Supreme Court reflects the rationale that organically based brain dysfunction in executive skills reduces criminal culpability. We argue that people with FASD who have similar brain dysfunction likewise have reduced criminal responsibility.

Fetal alcohol spectrum disorder and confabulation in psycholegal settings: A beginner's guide for criminal justice, forensic mental health, and legal interviewers

Fetal alcohol spectrum disorders (FASD) are neurodevelopmental/neurobehavioral conditions caused by prenatal alcohol exposure (PAE). Impairments caused by PAE contribute to the over-representation of individuals with FASD in the United States juvenile and adult criminal justice systems. These same impairments can equally impact on individuals with FASD who are witnesses to or victims of crime who also have to navigate the complexities of the criminal justice system. Difficulties include increased susceptibility to confabulation throughout the legal process that, in turn, can contribute to increased rates of poor outcomes including false confessions and wrongful convictions. Individuals with FASD are particularity at risk of confabulation when they are subjected to tactics, such as stressful and anxiety-provoking situations, threats, and leading, suggestive, or coercive questioning. Many professionals in the forensic context are unfamiliar with FASD or related confabulation risk and may unintentionally utilize tactics that intensify impacts of pre-existing impairment. This article serves as a beginner's guide for professionals working in criminal justice settings by (a) providing research-based overviews of FASD and confabulation, (b) describing how FASD may lead to confabulation, and (c) suggesting ways that professionals can modify protocols when interacting with individuals with FASD. Suggestions in this article hold the potential to decrease the risk of confabulation in the criminal justice system and decrease problematic outcomes, such as false confessions and wrongful convictions among individuals with FASD.