Application of the Person-Environment-Occupation-Performance Model: A Scoping Review

The Person-Environment-Occupation-Performance (PEOP) Model is one of several occupation-based models in occupational therapy. The model describes the transactional nature of person, environment, and occupation factors that support performance (doing), participation (engagement), and well-being (health and quality of life). The purpose of this study was to explore the extent and nature of evidence on the PEOP Model. We used a scoping review to identify and analyze journal articles that used the PEOP Model as a framework for study. The PRISMA extension for scoping reviews (PRISMA-ScR) criteria were used to develop the research methods. We found 109 articles that adopted the PEOP Model as an organizing framework. The studies reviewed represent the breadth of occupational therapy practice and the transactional nature of person, environment, occupation, and performance in the PEOP Model. The PEOP Model is a useful international framework for research and practice across populations, conditions, life circumstances, settings, and areas of practice.

Assessment of Executive Functions in Children with Sensorineural Hearing Loss and in Children with Specific Language Impairment: Preliminary Reports

Executive functions (EFs) are related abilities, associated with the frontal lobes functions, that allow individuals to modify behavioral patterns when they become unsatisfactory. The aim of this study was to assess EFs in children with sensorineural hearing loss (SNHL) and in children with "specific language impairment" (SLI), compared with a control group of children with normal development, to identify specific skill deficits. Three groups of preschool children aged between 2 and 6 years were assessed: 19 children with normal hearing, cognitive, and language development, 10 children with SNHL, and 20 children with SLI. The FE-PS 2-6 Battery was used for the assessment of preschool EFs, supplemented with the Modified Bell Test for the analysis of selective attention. Statistically significant differences were found between the two experimental groups and the control one, regarding the investigated skills. Children with SNHL showed a clear deficit in flexibility, whereas children with SLI had greater problems in self-regulation and management of waiting for gratification. Selective attention was found to be deficient in all three groups, with no statistically significant differences. This study shows that the skills investigated were found to be deficient in both SNHL and SLI patients. It is essential to start targeted exercises based on specific deficient skills as part of the rehabilitation program. It is of great importance to understand the consequences of EF deficit in preschool children to achieve an accurate diagnosis and carry out customized rehabilitation programs.

Cognitive strategies utilised by early learners when writing alphabet-letters from memory

INTRODUCTION

Occupational therapy handwriting studies have shown cognitive instructional techniques are effective methods to assist beginning or challenged handwriters. However, information about how children's cognitive (thinking) skills impact their handwriting development is scarce. This study examined the cognitive strategy efficiency of early learners while writing the alphabet-letters from memory.

METHODS

Participants included 408 mainstream children in their first two years of formal schooling (Year 1 and Year 2). Children were asked to write the 26-lowercase alphabet-letters from memory. Data were collected using alphabet-letters generated by the children and observation of their cognitive strategy use while writing. The measurement tool employed was the Perceive, Recall, Plan, and Perform (PRPP) System of Task Analysis (Stage Two).

RESULTS

The results found that Year 1 and Year 2 children had difficulties applying cognitive strategies across all four PRPP quadrants while writing the lowercase alphabet-letters from memory. Application of the cognitive strategies from the Plan and Recall quadrants showed the most inefficiencies. The lowest PRPP subquadrant scores were observed in Evaluating, Recall Facts, Sensing, and Programming. Except for the Attending subquadrant and the descriptor 'Regulates', Year 2 children were significantly better than Year 1 children at applying cognitive strategies from all other PRPP quadrants and subquadrants.

CONCLUSION

The findings provide beginning evidence that efficient use of cognitive strategies from all four PRPP quadrants is important for children achieving proficiency in accurate and automatic alphabet-letter-writing skills. Recommendations for occupational therapy handwriting assessment and intervention are provided.

PLAIN LANGUAGE SUMMARY

Research suggests that occupational therapists can best help children with handwriting difficulties by using a cognitive approach. This approach involves instructing children how to form letters correctly, encouraging self-evaluation, and providing opportunities to practice handwriting. However, the cognitive (thinking) skills required for children to write alphabet-letters accurately are not well understood. To investigate this, a study was conducted on 408 mainstream children in their first two years of formal schooling (Year 1 and Year 2). The study examined how accurately the children could write lowercase alphabet-letters from memory and which cognitive skills they used to do so. The cognitive skills investigated were related to attention, perception, recalling, planning, and performing. The assumption tested was that mistakes in correctly writing alphabet-letters could be attributed to difficulties in using these cognitive skills effectively. The study found that Year 1 and Year 2 children made errors in over half of the 26-lowercase alphabet-letters they wrote. The cognitive skills, which scored the lowest were children's ability to evaluate their writing, recall how and where to write letters, gather information from their vision, and think carefully to ensure accuracy while writing. This implied that these thinking skills had the most impact on the children's ability to write alphabet-letters correctly. More research is needed to confirm these findings and determine the reliability of the tool used in this study to measure the children's thinking skills.

Ice Cream: new virtual reality tool for the assessment of executive functions in children and adolescents: a normative study

This study focuses on the obtention of normative data for participants between 8 and 16 years old who were administered the Ice Cream test, a virtual reality tool designed to evaluate executive functions. The normative sample comprised n = 821 participants (49% female), with an age range of 8 to 16 years old, recruited across nine different testing sites in Spain. Experienced evaluators in psychological assessment, recruited and trained by the developer of the test, administered the test to the recruited sample. An empirical analysis of Ice Cream identified three factors, namely planning, learning and flexibility. Descriptive normative groups by age and gender were initially provided. A homoscedasticity analysis by gender showed no statistically significant differences between male and female participants. Cluster analysis by age suggested the creation of different age groups, respectively, 8 to 11 and 12 to 16 in Planning and Flexibility, and 8 to 9 and 10 to 16 in Learning, and subsequently, descriptive data for the established age groups per factor are shown. A confirmatory factor analysis showed the suitability of the 3 factors established as measured of three differentiated executive functions. Complementary data on the validity and reliability, and internal consistency of the scales are provided. Obtained normative data are relevant for evaluating executive functions in children and adolescents in a more ecological way. Further studies are needed to determine sensitivity and specificity of Ice Cream VR test to measure executive functions in different clinical populations.

Can Interacting with Animals Improve Executive Functions? A Systematic Review

There has been growing interest in the potential benefits of using human-animal interactions to improve executive functions: cognitive processes that allow individuals to plan, solve problems, and self-regulate behaviour. To date, no comprehensive review has been conducted. The purpose of this study was to evaluate existing literature, adopting broad inclusion criteria. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 16 papers were identified from peer-reviewed literature. Additional papers were identified from grey literature, including 6 dissertations and 1 thesis. A review of these 23 studies found that human-animal interactions and executive functions are investigated in three main ways: (1) exploring the potential benefits of the human-pet relationship, (2) exploring the impact of an animal's presence during administration of executive function tests, and (3) evaluating the efficacy of animal-assisted services (e.g., animal-assisted therapy) on executive functions. Five of the included studies reported a significant improvement across all measured domains of executive functions, but effect sizes were underreported. Comparatively, 9 studies reported mixed findings, d = 0.32-0.55, while 8 studies reported no significant results. The overall rigour of the research was limited, with great heterogeneity between the study methodologies and outcome measures used. It is recommended that future studies utilise high-quality research methodologies through the use of randomisation, pre- and postmeasures, and appropriate control conditions, where possible.

Relationships between motor skills and executive functions in developmental coordination disorder (DCD): A systematic review

BACKGROUND

Individuals with developmental coordination disorder (DCD) experience motor skill and executive function (EF) difficulties that challenge their daily activities.

AIM/OBJECTIVE

This systematic review aims to provide an in-depth analysis of the relationships between motor skills and EFs in studies among individuals with DCD.

MATERIAL AND METHODS

We conducted a systematic search of eight electronic databases for articles (published 1994-2021) reporting on quantitative studies that estimated relationships between motor skills and EFs when assessing children, adolescents and adults with DCD. Motor skills and EFs were assessed via reliable and validated assessment tools. Two reviewers independently screened the articles. We evaluated the quality of the selected articles according to EPHPP guidelines and the methodological quality of the assessments from these studies using the COSMIN checklist and reported results following the PRISMA-P checklist. This systematic review was registered in PROSPERO (CRD42019124578).

RESULTS

A total of 30,808 articles were screened. Eleven articles met the inclusion criteria and were reviewed. Findings from nine studies demonstrated weak to strong correlations between aspects of motor skills and EFs.

CONCLUSIONS AND SIGNIFICANCE

Limited evidence supports the relationships between motor skills and EFs among individuals with DCD. Occupational therapists should consider the possibility of this relationship and give more consideration to these components when planning intervention for individuals with DCD.

Turkish Adaptation of the Executive Functions and Occupational Routines Scale: Validity and Reliability Among Children with Dyslexia

The purpose of the present study was to provide a Turkish cultural adaptation (EFORTS-T) of the Executive Functions and Occupational Routines Scale (EFORTS) and to investigate its psychometric quality in children with dyslexia. We culturally adapted the original English version of this instrument with internationally suggested methods. Participants included the mothers of either randomly selected children with dyslexia (study group, n = 158) or age and sex-matched typically developing children (control group, n = 167). These participants completed a demographic form, the EFORTS-T, and the Behavior Rating Inventory of Executive Function-Parent form (BRIEF-P). For internal consistency, the alpha coefficient of the new instrument was excellent (.93), and it showed satisfactory test-retest reliability over a 14-day interval (.91). The criterion-related validity between the EFORTS-T and the BRIEF-P was moderate (.73). Fit indices of the model supported its factor structure. In conclusion, our findings support the validity and reliability of the new Turkish version of EFORTS for evaluating EF and contributing to the daily occupational routines of children with dyslexia for Turkish respondents. Further studies are needed to apply this instrument to children of different age groups and psychiatric conditions.

Executive functions and household chores: Does engagement in chores predict children's cognition?

INTRODUCTION

The benefits of completing household chores appear to transfer beyond managing day-to-day living. It is possible that chore engagement may improve executive functions, as engagement in chores require individuals to plan, self-regulate, switch between tasks, and remember instructions. To date, little research has been conducted on household chores and executive functions in children, for whom these skills are still developing.

METHODS

Parents and guardians (N = 207) of children aged 5-13 years (M = 9.38, SD = 2.15) were asked to complete parent-report questionnaires on their child's engagement in household chores and their child's executive functioning.

RESULTS

Results of the regression model indicated that engagement in self-care chores (e.g., making self a meal) and family-care chores (e.g., making someone else a meal) significantly predicted working memory and inhibition, after controlling for the influence of age, gender, and presence or absence of a disability. For families with a pet, there was no significant relationship between engagement in pet-care chores and executive function skills.

CONCLUSION

We strongly recommend that further research explore the relationship between chores and executive functions. It is possible that parents may be able to facilitate their child's executive function development through encouraging participation in chores, whereas chore-based interventions (e.g., cooking programmes) may also be used to target deficits in ability.

Persistence on Task, Executive Functions, and the Perceived Meaning of Occupations Among Children

IMPORTANCE

Persistence on task-the voluntary continuation of a goal-directed action despite difficulties-is described as a behavioral component of involvement in an occupation; however, it has not yet been extensively studied in the context of pediatric occupational therapy.

OBJECTIVE

To describe persistent children, compared with their less persistent peers, in terms of age, sex, executive functions (EF), and perceived meaning of occupations and to assess whether intrapersonal factors, EF, and the perceived meaning of occupations can predict persistence.

DESIGN

Cross-sectional.

SETTING

A community in Israel.

PARTICIPANTS

Typically developing healthy children (N = 180) ages 6.0 to 12.5 yr and their parents.

OUTCOMES AND MEASURES

The Tower of Hanoi task (TOH; seven discs) was used to assess persistence on task. EF were assessed with the TOH (three discs) and the Verbal Working Memory test. Occupational meaning-challenge, value, sense of time, and autonomy-was assessed with the Perceived Meaning of Occupation Questionnaire.

RESULTS

Twenty-six children (14%) completed the task. They were older than their peers, performed better on most of the EF tests, and perceived more autonomy in their everyday activities (Mann-Whitney U = 1,185.0, p < .001). However, only the perceived autonomy of occupations was found to be a statistically significant factor that predicted persistence on task (B = -0.12, SE = 0.05, Wald = 7.60, p = .01).

CONCLUSIONS AND RELEVANCE

Perceived autonomy in everyday activities is crucial for persistence on task. Occupational therapy practitioners can promote children's involvement and persistence in cognitive tasks by supporting a sense of autonomy in everyday activities, although further study is needed. What This Article Adds: This article highlights the contribution of perceived autonomy in everyday activities to children's involvement and persistence on task by providing empirical data on children's persistence on task with regard to their EF and perceived meaning of occupations. Children who persisted longer and completed tasks differed from their less persistent peers in terms of age and EF. However, perceived autonomy in everyday activities was the only predictor of task completion.

Performance-Based Executive Function Instruments Used by Occupational Therapists for Children: A Systematic Review of Measurement Properties

Introduction

The use of executive function (EF) instruments to assess children's functional performance is obscured with a lack of consensus on which is most suitable to use within the occupational therapy profession. This review identifies EF instruments used by occupational therapists (OTs) for children and evaluates their measurement properties.

Methods

This systematic review was registered in PROSPERO (CRD42020172107). We reviewed occupational therapy-related studies published until March 2021, to identify performance-based EF instruments used among children by OTs. Two review authors independently screened, extracted, and evaluated the methodological rigor of the included studies. Adequacy of the measurement properties was determined using the COSMIN, and the Terwee criteria were used for synthesis of best evidence.

Results

Five EF assessments were found across eight study articles: Behavioural Assessment of the Dysexecutive Syndrome for Children, Children's Cooking Task, Children's Kitchen Task Assessment, Do-Eat, and Preschool Executive Task Assessment. Adequacy of measurement properties and synthesis of best evidence varied, leading to a low GRADE rating on the certainty of evidence for the included instruments.

Conclusions

There is limited evidence that supports the certainty of evidence on the measurement properties of the reviewed tools in helping OTs assess performance-based EF among children. Nevertheless, the authors conditionally suggest their use based on the critical need to measure children's EF. Further research is needed to establish the measurement properties of these measures across different childhood populations.

Evaluation of executive functions and everyday life for people with severe mental illness: A systematic review

•Assessment tools have progressed from measuring specific components, to more comprehensive assessments.•Performance-based tools, has the potential to include an EF index as part of the test scoring.•Most researchers either chose short versions of the assessment tools to address the subjects' attentional capacities.•Using more than one evaluation method enabled to draw a more precise picture of the function.

Daily Performance of Adolescents with Executive Function Deficits: An Empirical Study Using a Complex-Cooking Task

Purpose

To characterize and analyze the performance of adolescents with executive function deficits through the Children's Cooking Task (CCT) as a performance-based complex ecological assessment.

Methods

Participants were 41 adolescents (aged 10–14 years) with normal intellectual function and executive function deficit profiles based on the Behavior Rating Inventory of Executive Function (BRIEF) parent reports and self-reports (BRIEF-SR) and the WebNeuro and 40 controls with typical development matched by age and gender. Participants in both groups performed the CCT, an ecological standardized complex task.

Results

Significant group differences were found for all CCT outcome measures (total number of errors, task duration, and all qualitative rating variables). Significant correlations were found among children with executive function deficit profiles between the CCT performance duration and total number of errors and the BRIEF-SR subscale score. Two separate discriminant function analyses described primarily by the CCT correctly classified the study groups.

Conclusion

The poor performance of adolescents with executive function deficit profiles exhibited through the standardized complex task, as well as the relationships with their executive functions, supplies better insight about their daily confrontations. Identifying how they perform may lead to development of focused interventions to improve these adolescents' daily performance, participation, and wellbeing.

Assessment of Sensory Processing and Executive Functions at the School: Development, Reliability, and Validity of EPYFEI-Escolar

The aim of this study was to determine the psychometric properties of the Assessment of Sensory Processing and Executive Functions at the School (EPYFEI-Escolar), a questionnaire designed to assess the sensory processing and executive functions as underlying processes for school participation. The total sample consisted of 536 children aged between 3 and 11 years old who lived in Spain. A total of 103 teachers completed the questionnaire. An exploratory factor analysis was conducted, which showed five main factors: (1) initiation, organization, execution, and supervision of the action; (2) inhibitory control; (3) sensory processing; (4) emotional self-regulation and play; and (5) self-competence. Some of these factors were similar to those found in the EPYFEI for parents in the home context. The reliability of the analysis was high, both for the whole questionnaire and for the factors it is composed of. The results provide evidence of the potential usefulness of the EPYFEI-Escolar in school contexts for determining academic needs and difficulties of children; moreover, this tool can also be used to plan intervention programs in the school environment according to the needs of each child and school.

A metacognitive intervention model to promote independence among individuals with autism spectrum disorder: Implementation on a shopping task in the community

Adolescents with autism spectrum disorder show low independence levels and difficulty performing complex daily activities. The many intervention approaches for these individuals include deconstructing complex activities into basic components, processing and practicing tasks, and developing compensation strategies. The aim of this study was to examine the effectiveness of a short-term metacognitive intervention combined with virtual supermarket practice to improve the independent implementation of a shopping task among adolescents with autism spectrum disorder. The study included 56 adolescents with autism spectrum disorder, of whom 33 performed the metacognitive intervention and 23 served as controls. Outcome measures included assessments of cognitive and metacognitive functions and a performance-based evaluation of a shopping task in the natural environment. Compared to the control group, the intervention group experienced significant improvement in accuracy and efficiency while performing a shopping task. In addition, the executive functions domain was found to be the main predictor of accuracy and efficiency in performing the shopping task. These findings indicate the short-term metacognitive intervention, reinforced by a technology-based training programme, may effectively enhance the independent execution of a shopping task by adolescents with autism spectrum disorder and expand their potential participation in the community.