A Randomised Controlled Trial of a Play-Based Intervention to Improve the Social Play Skills of Children with Attention Deficit Hyperactivity Disorder (ADHD)

An evaluation of intervention appropriateness from the perspective of parents: A peer-mediated, play-based intervention for children with ADHD

INTRODUCTION

A peer-mediated, play-based intervention has been developed to address social participation challenges experienced by children with ADHD. To facilitate implementation into clinical practice, interventions should be evaluated for appropriateness to the end-user, as well as effectiveness. Previous research demonstrated the approach is effective for improving children's social play skills. This study aimed to evaluate the appropriateness of the intervention for children with ADHD and their families.

METHODS

Parents of children with ADHD who participated in the play-based intervention were interviewed 1 month after completion. Parents were asked about their perspective of parent and children's experiences of the intervention, the perceived benefits for children and parents, the logistics of participating, and recommended adaptations to the intervention. Interviews were analysed thematically, and themes were mapped to the elements of the adopted definition of appropriateness to understand whether parents supported the appropriateness of the intervention for their families.

CONSUMER AND COMMUNITY INVOLVEMENT

Consumers were not directly involved in the decisions made about this study.

FINDINGS

One core theme, 'collaborative efforts', emerged from the data. Major themes comprising the core theme were 'on the same page', 'therapeutic relationship', and 'getting the job done'. Three sub-themes of 'engagement and motivation', 'the effort was worth it for the reward', and 'Rome wasn't built in a day' were nested within the major themes.

CONCLUSION

Parents largely supported the appropriateness of the intervention, indicating it addressed an important goal for their child, participation was a positive experience, and they perceived the intervention to be beneficial. Future adaptions of the intervention are needed to increase its ecological validity and to generalise the strategies to other social environments and playmates, such as peers at school.

PLAIN LANGUAGE SUMMARY

This study looked at an intervention that uses play with peers to help children with ADHD develop their play skills. The researchers wanted to know if parents thought the intervention was a good fit for their families and if it helped their children. Parents gave an interview a month after the intervention ended. They were asked about their thoughts on the intervention, how it helped their children and themselves, how easy it was to take part, and what changes could be made to make the intervention better. After analysing parents' answers, the researchers found parents mostly agreed that the intervention was a good fit. They said it helped their children to play with their peers, and they had a good time doing it. Parents thought the intervention was helpful, they liked that it was a joint effort between them and the occupational therapist, and they felt it was worth the effort. However, they also suggested some changes. They wanted the intervention to fit into other real-life social situations, such as school, so their children could use the skills they learned in other places. Overall, parents thought the intervention was helpful and suitable for their children and themselves, but some changes might make it more helpful.

Examining the effectiveness of a social-play-based programme to reduce symptoms of Attention-Deficit/Hyperactivity Disorder in Saudi elementary school children

BACKGROUND

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental conditions in children, and can profoundly affect their social interactions, well-being, and relationships with parents, peers, and teachers.

OBJECTIVE

This study investigated the effectiveness of a social-play-based intervention programme in reducing ADHD symptoms in a sample of 67 Saudi boys aged 8-10 diagnosed with ADHD.

METHODS

The programme consisted of ten 60-minute sessions of play-based activities, delivered to the experimental group twice weekly for 5 weeks. The control group followed the usual school curriculum. Teachers and parents completed the Conners' Teacher Rating Scale-Revised: Short Form and Conners' Parent Rating Scale-Revised: Short Form for all participants at pre-test, post-test, and follow-up.

RESULTS

The experimental group showed a significant reduction in ADHD-associated behavioural problems over time, with moderate to large effect sizes. No significant changes over time were found for the control group. The results were maintained at a 2-month follow-up.

CONCLUSIONS

We recommend incorporating social-play-based activities and skill training into the school context. Reducing ADHD symptoms may improve children's academic performance and perspective on school.

Seeking consensus on a play-based intervention framework for promoting play of children with HIV/Aids in a low-resourced setting: A Delphi study

INTRODUCTION

Implementing occupation-based practice in low-resourced settings can be challenging especially when working with children with HIV/Aids whose daily occupation of play is often affected by their health condition and other contextual factors such as poverty or stigma.

AIM

The aim of this paper is to obtain consensus from experts on the content and application of a play-based intervention for children with HIV/Aids living in a low-resourced setting.

METHODS

A Delphi study involving two rounds using an online survey format was conducted with experts from the field of child development, play and/or HIV/Aids. Consensus agreement was reached when at least 70% of Delphi experts rated each item at 3 or higher on a 5-point Likert scale.

CONSUMER AND COMMUNITY INVOLVEMENT

This paper is part of a multi-stage study that involved input and feedback from families of children who were born HIV/Aids, occupational therapists working with families of children with HIV/Aids, and input from local and international experts working with people with HIV/Aids.

RESULTS

Thirty-seven experts completed the first round, and 35 completed the second round of the study. Consensus was achieved on the application of the Cooper's Model of Children's Play, techniques to be used and the structure of the intervention. Experts also agreed on the inclusion of a pre-intervention workshop as part of the play-based intervention.

DISCUSSION AND CONCLUSION

The consensus on the content and application of a play-based intervention framework through a process of gaining expert perspectives provides confidence that the intervention planned to promote play for children with HIV/Aids living in low-resourced settings is likely to be effective.

The effectiveness of play as an intervention using International Classification of Functioning outcome measures for children with disabilities - a systematic review and meta-synthesis

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.

Longitudinal study of peer victimization, social support, and mental health during early adolescence

BACKGROUND

Peer victimization predicts the development of mental health symptoms in the transition to adolescence, but it is unclear whether and how parents and school environments can buffer this link.

METHODS

We analyzed two-year longitudinal data from the Adolescent Brain Cognitive Development (ABCD) study, involving a diverse sample of 11 844 children across the United States (average at baseline = 9.91 years; standard deviation = 0.63; range = 8.92-11.08; complete case sample = 8385). Longitudinal associations between peer victimization and two-year changes in mental health symptoms of major depression disorder (MDD), separation anxiety (SA), prodromal psychosis (PP), and attention-deficit/hyperactivity disorder (ADHD) were examined including a wide range of covariates. Mixed linear models were used to test for the moderating effects of parental warmth and prosocial school environment.

RESULTS

20% of children experienced peer victimization. Higher exposure to peer victimization was associated with increases in MDD, SA, and ADHD symptoms. Parental warmth was associated with decreases in MDD symptoms but did not robustly buffer the link between peer victimization and mental health symptoms. Prosocial school environment predicted decreases in PP symptoms and buffered the link between peer victimization and MDD symptoms but amplified the link between peer victimization and SA and ADHD symptoms.

CONCLUSIONS

Peer victimization is associated with increases in mental health symptoms during the transition to adolescence. Parental warmth and prosocial school environments might not be enough to counter the negative consequences of peer victimization on all mental health outcomes.

Evidence for Protective Effects of Peer Play in the Early Years: Better Peer Play Ability at Age 3 Years Predicts Lower Risks of Externalising and Internalising Problems at Age 7 Years in a Longitudinal Cohort Analysis

Peer play ability may be a protective factor against childhood mental health difficulties but there is lack of empirical evidence to support this hypothesis. We conducted longitudinal structural equation modelling study over a population cohort (N = 1676) to examine the effect of age 3 peer play ability on children's age 7 mental health outcomes (measured by the Strengths and Difficulties Questionnaire subscales). We modelled effects for the entire population and two sub-groups at high-risk for mental health problems based on age 3 temperament. Controlling for demographic variables, temperament, maternal distress, play with parents and number of siblings, better peer play ability at age 3 years predicted lower risk of problems on all 4 SDQ subscales at age 7 years for the general population. For the low-persistence subgroup, better peer play ability at age 3 predicted lower risk of age 7 hyperactivity, emotional and peer problems, whereas better peer play ability at age 3 predicted only lower risk of age 7 hyperactivity for the high-reactivity group. Taken together our results provide evidence that supports the hypothesis that early peer play ability may be a protective factor against later mental health difficulties. We conclude that further research aimed at establishing causation is worth pursuing.

Review: Adverse event monitoring and reporting in studies of pediatric psychosocial interventions: a systematic review

BACKGROUND

Adverse event monitoring in studies of psychotherapy is crucial to clinical decision-making, particularly for weighing of benefits and harms of treatment approaches. In this systematic review, we identified how adverse events are defined, measured, and reported in studies of psychosocial interventions for children with mental disorders.

METHOD

Medline, PsycINFO, Embase, ProQuest Dissertations and Theses Global, and the Cochrane Library were searched from January 2011-January 2023, and Google Scholar from January 2011-February 2023. English language experimental and quasi-experimental studies that evaluated the efficacy or effectiveness of psychosocial interventions for childhood mental disorders were included. Information on the definition, assessment, and report of adverse events was extracted using a checklist based on Good Clinical Practice guidelines.

RESULTS

In this review, 117 studies were included. Studies most commonly involved treating anxiety disorders or obsessive-compulsive disorder (32/117; 27%); 44% of the experimental interventions tested (52/117) were cognitive behavioral therapies. Adverse events were monitored in 36 studies (36/117; 31%) with a protocol used in 19 of these studies to guide monitoring (19/36; 53%). Twenty-seven different events were monitored across the studies with hospitalization the most frequently monitored (3/36; 8%). Event severity was fully assessed in 6 studies (17%) and partially assessed in 12 studies (33%). Only 4/36 studies (11%) included assessing events for cause.

CONCLUSIONS

To date, adverse events have been inconsistently defined, measured and reported in psychosocial intervention studies of childhood mental health disorders. Information on adverse events is an essential knowledge component for understanding the potential impacts and risks of therapeutic interventions.

Play therapy efficacy in ADHD-symptom reduction as measured by the Test of Variables of Attention (TOVA)

Objective: We aimed to investigate the effect of play therapy combined with the standard psychotropic medication treatment, compared to only standard psychotropic medication treatment in ADHD children as measured by the test of variables of attention (TOVA).Methods: This is a case-control study conducted at Soerojo Hospital, Magelang, Indonesia. Children (N = 66) were purposively recruited. The children were divided into two groups based on the intervention received: the experimental group (play therapy and standard psychotropic medication) and control group (standard psychotropic medication only). Methylphenidate was used as the standard psychotropic therapy. The TOVA was performed before and after intervention. The pre-intervention and post-intervention mean difference (MD) in the Attention Comparison Score (ACS) and Comparison to the Normative Sample (CNS) for each group was compared and statistically analysed using t-tests and Wilcoxon tests.Results: There was a significant difference between the ACS score of the experimental group's MD and the control group's MD (p < 0.05). For most TOVA parameters on CNS scores, the experimental group had a significantly higher MD than the control group.Conclusion: Play therapy coupled with psychotropic medication reduced ADHD symptoms, including inattention and impulsivity, as objectively measured by the TOVA.

A scoping review of gamification for mental health in children: Uncovering its key features and impact

Mental health conditions in children and adolescents have wide-ranging effects, limiting opportunities for future productive lives. While there has been an upsurge of interest in using games for learning, gamification to optimize health outcomes is worth reviewing when this approach to address mental health conditions is in its infancy. A literature search was conducted with two hundred and fifteen articles involving participants up to 19 years of age with diagnosable mental health conditions, involving the concept of game design elements to motivate health in the context of comparing gamification and non-gamification approaches were retrieved after employing Boolean operators and pre-determined search strategies. Literature of participants with addiction to alcohol or substance use and organic brain issues were excluded as their mental health recovery differed regardless of gamification impact. Findings, extracted from 8 included articles following rigorous screening and critical appraisal, showed that gamification to relieve mental health symptoms were conducted via mobile devices or computers. Key features of the games involved applications or video where players with mental health conditions took on roles in a virtual world with narratives. Real-life knowledge and skills to manage the symptoms of mental health conditions were learned in the process as players leveled up in the game. Only one study utilized gamification platforms that could detect breathing changes but it was shown to be only helpful towards relief of anxiety symptoms. Nevertheless, the potential for gamification for mental health outcomes remains promising.

A pairwise randomised controlled trial of a peer-mediated play-based intervention to improve the social play skills of children with ADHD: Outcomes of the typically-developing playmates

To examine the effectiveness of a play-based intervention for improving social play skills of typically-developing playmates of children with ADHD. Children (5-11 years) were randomised to an intervention (n = 15) or waitlisted control group (n = 14). The Test of Playfulness was scored by a blinded rater. Between-group statistics compared the change of the intervention (10-week intervention) and waitlisted control (10-week wait) groups. Change in the intervention group following intervention was significantly greater than the change in the waitlisted control group. When combining data from the groups, playmates' (n = 29) mean ToP scores improved significantly following intervention, with a large effect pre- to post-intervention and pre-intervention to follow-up. Typically-developing playmates of children with ADHD benefited from participation in a peer-mediated intervention.

[Formula: see text]Parental interaction style, child engagement, and emerging executive function in fetal alcohol spectrum disorders (FASD)

Children with fetal alcohol spectrum disorders (FASD) are known to experience cognitive and neurobehavioral difficulties, including in areas of executive function and social skills development. Interventions for these challenges have focused on a number of areas, including parent-based training. Despite the general consensus that specific parenting styles consistent with an "authoritative" - warm but firm - parenting approach may influence behavioral self-regulation, it is not known what specific parental interaction styles are associated with child engagement and emerging executive function in this population. The current study used an observation-based behavioral coding scheme during parent-child play interactions and associated parent report-based executive function measures in children with FASD. Here, we demonstrate that parental interaction styles with increased responsive/child-oriented behavior and parental affect are associated with higher levels of child play engagement, while parental interaction that has increased achievement-orientation is associated with higher levels of emerging executive function in children with FASD. These findings help inform future studies on behavioral targets in parent-based training programs and highlight the importance of considering certain parental interaction styles during parent-child play.

Cognition Mediates Playfulness Development in Early Childhood: A Longitudinal Study of Typically Developing Children

IMPORTANCE

Play, children's central occupation, and playfulness, its behavioral manifestation, are the foci of occupational therapy intervention. However, information about the development of playfulness behavior and the role of cognitive function is limited.

OBJECTIVE

To explore the development of playfulness and its relation to cognitive functioning from infancy to toddlerhood.

DESIGN

Longitudinal study with data collected at ages 6 mo, 18 mo, and 24 mo.

SETTING

Laboratory (age 6 mo) and home (ages 12 and 18 mo).

PARTICIPANTS

Eighty-six typically developing children drawn from a convenience sample of 109 low-risk families of middle to upper socioeconomic status.

MEASURES

The Mullen Scales of Early Learning (MSEL) to assess cognitive functioning and the Test of Playfulness (ToP) to assess children's playfulness.

RESULTS

ToP scores were significantly higher at age 24 mo than at age 6 mo, t(88) = -60.30, p < .001, 95% confidence interval (CI) [-1.47, -1.38]. Correlation analysis revealed that the more playful the infant was at age 6 mo, the higher their cognitive functioning was at age 18 mo and the more playful they were at age 24 mo. Toddlers with higher cognitive performance at age 18 mo demonstrated more playful behavior at age 24 mo (β = 0.120, SE = 0.05, 95% CI [0.0377, -0.2276]).

CONCLUSIONS AND RELEVANCE

Children's playfulness is evident as early as age 6 mo and continues to develop through toddlerhood, depending on their cognitive growth. Occupational therapists play a key role in working with families with young children, promoting cognitive development to further the development of playfulness behaviors. What This Article Adds: Understanding the development of playfulness and exploring its relationship with cognitive functioning in typically developing children fills important gaps in occupational therapy knowledge and contributes to delivery of early intervention, especially when cognition or playfulness are at risk. Our findings confirmed that cognitive functioning contributes to the development of playfulness.

A Comprehensive Analysis of the Relationship between Play Performance and Psychosocial Problems in School-Aged Children

During childhood, play contributes to the physical, emotional, cognitive and social development of infants and children and may enhance future mental health. The aim of this study was to examine the relationship between play performance factors and psychosocial problems in school-aged children. A total of 142 typical Spanish children aged 5 to 9 years were included. Play performance was measured with the My Child’s Play questionnaire, while the Strengths and Difficulties Questionnaire was used to evaluate internalizing and externalizing problems. The findings showed that personal, environmental and activity factors of play performance were associated with psychosocial problems and prosocial behavior in children. Moreover, children with high psychosocial difficulties reported significantly poorer play performance. As executive functioning during play was the factor that was most strongly associated with internalizing and externalizing psychosocial difficulties, it is possible that executive functions have a decisive role on both social cognition and self-regulation during play performance.

Psychoeducation Intervention Effectiveness to Improve Social Skills in Young People with ADHD: A Meta-Analysis

OBJECTIVE

Attention Deficit Hyperactivity Disorder (ADHD) can be associated with limited understanding of the condition and poor social skills. Some evidence favors a psychoeducational approach, but little is known about the effectiveness of psychoeducation.

METHODS

Systematic review and meta-analysis of studies assessing psychoeducational interventions that aim to improve social skills of young people with ADHD.

RESULTS

Ten studies, including 943 participants, reported across 13 papers met the inclusion criteria. Although effect sizes were small, findings suggest the included interventions significantly improved social skills in young people with ADHD.

CONCLUSIONS

Results show promise for psychoeducational behavioral interventions . However, the recommendations that can be developed from existing evidence are somewhat limited by the low quality of studies. Further rigorous trials are needed. In addition, future research should consider the long-term outcomes for these interventions, they should be iteratively co-designed and research should consider the context they intend to be delivered in.

Pathological gaming and its association with lifestyle, irritability, and school and family environments among Japanese elementary school children

BACKGROUND

Pathological gaming (PG) has emerged as one of the major public health concerns worldwide. We aimed to assess PG and its associated factors among elementary school children in Japan.

METHODS

We conducted a school-based observational study in Toyama, Japan in 2018. Totally, 13,413 children in the 4th-6th grades (mean age, 10.5 years) participated in the study. We distributed questionnaires and inquired about their lifestyle, irritability, and school and family environments. Referring to criteria of gaming disorder in the International Statistical Classification of Disease (ICD-11), we asked about three core symptoms: impaired control over gaming, increasing priority given to gaming over other activities, and continuation of gaming despite the negative consequences. Children who had all three criteria in the questionnaire were defined as PG.

RESULTS

The response rate was 97.6% and 11,826 children were included in our analyses (88.2%). The prevalence of PG was 5.6% (7.8% in boys, 3.2% in girls). Besides sex, PG was significantly associated with lifestyles including skipping breakfast (odds ratio, OR=1.33; 95% confidence interval, CI: 1.05-1.68), physical inactivity (OR=2.23; 95% CI: 1.63-3.05 for rare), late bed time (OR=2.52; 95% CI: 1.96-3.25 for ≥11 p.m), frequent irritability (OR=1.89; 95% CI: 1.47-2.43), frequent feeling of school avoidance (OR=1.92; 95% CI: 1.49-2.46), fewer close friends (OR=1.30; 95% CI: 1.08-1.56 for some), low academic performance (OR=1.53; 95% CI: 1.13-2.08), no child-parental interaction (OR=1.34; 95% CI: 1.02-1.75), and no rules at home (OR=1.21; 95% CI: 1.02-1.43).

CONCLUSION

Unhealthy lifestyles, irritability, and low functioning in school and family environments were associated with PG. Besides having a healthy lifestyle, parental involvement appears to be an essential countermeasure for PG in children.

Social participation to support good mental health in neurodisability

BACKGROUND

Young people with neurodisability experience lower levels of mental wellbeing and are at increased risk of mental illness compared with their non-disabled peers. Social participation is recognized as a protective factor against mental illness and a potential pathway to support better mental wellbeing in neurodisability.

METHOD

This co-design study involved young people, parents and clinicians. First, possible interventions were identified through a rapid systematic evidence review. Any study designs were considered, which included people with a neurodisability aged 0-18 years, which evaluated a therapy intervention with social participation and mental health outcomes. Titles and abstracts were screened by two reviewers, from the included studies data were extracted and then presented using written summaries. Second, the summaries were discussed and prioritized in stakeholder groups with young people, parents and clinicians. Groups were audio recorded and framework analysis was used to identify and specify intervention elements and their delivery.

RESULTS

The evidence review identified 13,870 records, from which 43 were included. These records were published 1994-2017 and reported studies with 4-249 participants aged 16 months-18 years with a range of neurodisabilities. Five intervention approaches (social skills training, arts, sports, technology and play) were identified from the review. Two themes emerged from the stakeholder groups: intervention in the real world, feeling judged and feeling safe. The groups prioritized an intervention in real-world social leisure contexts (i.e. existing clubs and groups) using nine key intervention elements (e.g. feedback and positive verbal reinforcement) delivered by club leaders trained by healthcare professionals using five intervention procedures (e.g. a manual and video training).

CONCLUSION

This study has identified core elements of social participation interventions that may improve mental health outcomes in young people with neurodisability, which should now be tested.

Occupational therapy interventions in child and adolescent mental health to increase participation: A mixed methods systematic review

Introduction

Mental health disorders and low levels of mental well-being can have a lasting effect on life satisfaction and contribution to society for children and adolescents, yet the effectiveness of occupational therapy interventions is unknown.

Methods

A mixed methods systematic review was conducted including studies with children and adolescents aged 5–16 years, who had mental health difficulties, that evaluated occupational therapy interventions and focused on participation in everyday occupations as an outcome.

Results

The nine included studies were generally very low quality. The results could not be pooled due to heterogeneity. For children with Asperger’s syndrome, the Cognitive Orientation to Daily Occupational Performance intervention had clinically significant improvements on occupational performance and social skills. For children with attention deficit hyperactivity disorder, the Ultimate Guide to Play, Language and Friendship intervention improved playfulness and the Cognitive–Functional intervention had a statistically significant improvement on occupational performance and behaviour.

Conclusion

One intervention used by occupational therapists with children with Asperger’s syndrome and two interventions used with children with attention deficit hyperactivity disorder had some evidence of effect. No evidence was identified for the effectiveness of occupational therapy interventions for children and adolescents with other common mental health conditions.

A systematic review of video-modelling interventions for children and adolescents with attention-deficit hyperactivity disorder

OBJECTIVE

To identify, appraise, and synthesise the evidence for video-modelling interventions for individuals with attention-deficit hyperactivity disorder (ADHD).

METHOD

We searched four electronic databases. Two independent researchers screened abstracts and methodologically assessed data using the Kmet appraisal checklist.

RESULTS

A total of 15 studies met the inclusion criteria (11 original studies and four follow-up studies). Of the 11 original studies, one was a randomised controlled trial, one was a controlled between-group comparative design, two were one group pre-test post-test studies, one was an experimental 2 × 2 factorial design, and six were single-case experimental design studies. Studies included 1-35 participants with ADHD aged 5-16 years. Three studies targeted behaviour, three targeted social play skills, two targeted social behaviour, one targeted social skills, one targeted goal orientation and friendship quality, targeted and one attention/comprehension of social behaviour. In four studies video-modelling was the whole intervention, with no other intervention components reported. Nine studies reported positive outcomes immediately after intervention, two studies reported mixed findings. All studies were found to have good or strong methodological quality.

CONCLUSION

There is preliminary evidence to suggest video-modelling may be a promising intervention approach for targeting the social skills and behaviours of individuals with ADHD when used in conjunction with other intervention components. Future studies need to lower the risk of bias and use larger sample sizes before the efficacy of video-modelling interventions can be fully investigated.

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

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).

Sensory modulation and negative affect in children at familial risk of ADHD

BACKGROUND/AIMS

Sensory modulation difficulties are commonly reported in patients with ADHD, however there has been little focus on the development of these difficulties in young children at a higher risk of later ADHD diagnosis. This study investigated whether children with a familial history of ADHD show greater sensory modulation difficulties. We also explored whether sensory modulation was linked to negative affectivity, which has been highlighted as a potential early marker of ADHD.

METHODS

Parents of children under 6 years with a family history of ADHD (n = 65) and no family history (n = 122) completed questionnaires on sensory modulation and temperament.

RESULTS

Children from families with ADHD were reported to display extreme patterns of hyperresponsiveness and hyporesponsiveness, relative to controls. No differences emerged for the sensory seeking domain. Some children within the high-risk group reported high scores across all three sensory modulation patterns. Regression analysis revealed that hyperresponsiveness predicted higher levels of negative affect.

CONCLUSIONS/IMPLICATIONS

This study is the first to report greater sensory modulation difficulties in children at familial risk of ADHD. Future research should establish whether children with sensory modulation and temperament difficulties in early childhood are more vulnerable to developing ADHD.

A Systematic Review Comparing the Play Profiles of Children with Special Health Care Needs with Typically Developing Children

INTRODUCTION

Although play has been used as a means to meet therapeutic goals by health care practitioners for a long time, there is a need to continuously review its conceptualisation and use in everyday practice to promote evidence-based practice. This systematic review aimed to evaluate the evidence on how the play of children with Special Health Care Needs (SHCN) is similar or different to that of typically developing children.

METHODS

Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, we conducted a comprehensive review across five electronic databases for all studies that compared how the play of children with SHCN was similar or different to that of typically developing children. Data were extracted from the included studies, and methodological quality was assessed.

RESULTS

Eighteen studies met eligibility criteria. All the studies in this review were at risk of bias due to the study design. There was great variation in sample sizes, ranging between five and 112 participants in the diagnostic groups and five and 546 participants in control groups (typically developing children). The included studies investigated different aspects of play, which made it difficult to synthesise. However, of the 18 studies reviewed, thirteen reported that children with SHCN engage in less play, compared with typically developing children.

CONCLUSIONS

Evidence supports the assumption that children with SHCN are less playful and spend less time engaging in play compared with typically developing children. This systematic review reveals paucity of research on play for children with several common chronic conditions such as HIV/AIDS, cancer, and cardiovascular diseases. Future studies need to reduce risks of bias, including the use of appropriate sample sizes, and must provide detailed results after investigating play in children with SHCN.

Can We Play Together? A Closer Look at the Peers of a Peer-Mediated Intervention to Improve Play in Children with Autism Spectrum Disorder

Peer-mediated interventions (PMIs) are often used to support children with autism spectrum disorder (ASD) to develop social skills. However, more investigation is needed to better understand the role of peers as both intervention recipients and models. Sixty-five typically developing peers who participated in a PMI for children with ASD were investigated using a randomised control trial. Play sessions of the dyads were scored using the Test of Playfulness. Results showed a significant moderate intervention effect for the peers from pre- to post-intervention; outcomes for children with ASD were not influenced by peer characteristics; and, the children demonstrated a similar pattern of play interaction. Implications for practice are discussed.Clinical Trials Registry Australian New Zealand Clinical Trials Registry, https://www.anzctr.org.au/ (ACTRN12615000008527; Universal Trial Number: U1111-1165-2708).

Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years

IMPORTANCE

Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth.

OBJECTIVE

This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5-21 yr at home, at school, and in the community.

METHOD

The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5-21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research.

RESULTS

One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners.

CONCLUSIONS AND RECOMMENDATIONS

On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence.

WHAT THIS ARTICLE ADDS

When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5-21 yr.

Activity- and Occupation-Based Interventions to Support Mental Health, Positive Behavior, and Social Participation for Children and Youth: A Systematic Review

IMPORTANCE

Children and youth are often challenged to maintain well-being, positive behavior, and social participation.

OBJECTIVE

To identify evidence for occupational therapy interventions for children and youth with and at risk for mental health concerns.

DATA SOURCES

Articles published in English-language peer-reviewed journals between January 2010 and March 2017 identified through searches of MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane databases.

Study Selection and Data Collectio

: The methodology in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to complete the review. Of 5,310 articles screened by title and abstract, 357 were retrieved for full-text review, and 62 met inclusion criteria. Articles describing interventions that were activity or occupation based were included. Conference proceedings, non-peer reviewed publications, dissertations, theses, and presentations were excluded.

FINDINGS

Of the 62 studies included in the review, 20 (32%) were Level I studies, 22 (36%) were Level II studies, and 20 (32%) were Level III studies. Articles were categorized by type: outdoor camps, video and computer games, productive occupations and life skills, meditation, animal-assisted interventions, creative arts, play, sports, and yoga. Moderate to strong evidence supports the use of yoga and sports. Moderate-strength evidence supports the use of play and creative arts. Evidence for the use of animal-assisted interventions, meditation, video and computer games, and productive occupations was of low strength.

CONCLUSION AND RELEVANCE

Substantial evidence exists to support the use of activity- and occupation-based interventions to address the mental health, behavioral, and social participation concerns of children and youth. Occupational therapy practitioners should match the desired outcome of therapy with the appropriate intervention to provide the best and most effective services to their clients.

WHAT THIS ARTICLE ADDS

This review provides additional support for the use of activity- and occupation-based interventions (i.e., those that involve active participation) to improve the behavior, social participation, and mental health of children and youth.

Effectiveness of Social Skills Interventions Incorporating Peer Interactions for Children With Attention Deficit Hyperactivity Disorder: A Systematic Review

IMPORTANCE

Few studies examining the use of peers during interventions have been published, and no systematic review has been conducted to evaluate the available literature.

OBJECTIVE

To examine the effectiveness of social skills interventions incorporating peers for children with attention deficit hyperactivity disorder (ADHD) to improve social interactions.

DATA SOURCES

A search of five databases (CINAHL, PubMed, Web of Science, Google Scholar, and PsycINFO) produced 697 articles. Sixty-one were retrieved for full-text review, and 15 articles met inclusion criteria.

STUDY SELECTION AND DATA COLLECTION

Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to abstract data. Inclusion criteria: Participants younger than age 18 yr with any ADHD pattern, social skills interventions with peer involvement, outcome measures within the domain of occupational therapy, written in English, and involved a peer as the sole or primary component at some point in the social skills intervention. Exclusion criteria: Studies older than 20 yr or that used participants with comorbidities or multiple conditions.

FINDINGS

Interventions incorporating both peer categories were effective for increasing play skills, reducing undesirable social behaviors (e.g., inappropriate verbalizations, dominant behaviors, aggression), and improving communication (e.g., pragmatic language, collaboration, joint participation) and social participation. Improvements were maintained over time, as evidenced by follow-up studies.

CONCLUSIONS AND RELEVANCE

Outcomes of these studies demonstrate moderate evidence that supports the use of social skills interventions incorporating peers for children with ADHD to improve social interactions, supporting their use by occupational therapists and the need for more studies.

WHAT THIS ARTICLE ADDS

This article provides guidance to occupational therapy practitioners on social skills intervention options for children with ADHD.

Parental Occupational Executive Training: Feasibility and Parental Perceptions

Young children with attention deficit hyperactivity disorder (ADHD) cope with functional difficulties attributed to executive dysfunction. This study evaluates the feasibility of the Parental Occupational Executive Training (POET) intervention. Parents of 71 children (4-7 years) with ADHD attended 8 to 10 weekly, personally tailored intervention sessions with an occupational therapist. Quantitative and qualitative measures were used to examine feasibility in four indices: parental attendance, adherence, and acceptance, and therapist fidelity. Parental attendance and home-strategy use during daily activities rates were high. Parents identified the occupational performance coaching model's principles as supporting their ability to implement the intervention. Therapists demonstrated high fidelity to the POET's theoretical bases. The POET is a feasible intervention with high parental attendance (98.61%), parental adherence (80.56%-94.44%), and therapist fidelity (100.00%). It can be implemented within child development centers and occupational therapy clinics and leads to parents' increased adherence.

Investigative interviewing of youth with ADHD - recommendations for detective training

Attention deficit hyperactivity disorder (ADHD) in youth can lead to a trajectory of early and repeated contact with the criminal justice system (CJS), where such youth face significant challenges due to the nature of their diagnosis and the lack of specialized detective training in this area. This article reviews Australian detectives' perceptions regarding contact with ADHD-affected youth, ongoing contact of such youth with the CJS, and the impact of ADHD on interviewing time efficiency and quality of information gathered. It explores detectives' perceived impact of ADHD on components of the Cognitive Interview (CI). It overviews detectives' perceptions regarding their own skill/ability, training availability and future training preferences regarding the interviewing of ADHD-affected youth. The authors highlight best practice in specialized detective training, as well as in working with ADHD-affected youth. Recommendations are made regarding the design features of a potential specialized training programme for detectives interviewing ADHD-affected youth.

A Play-Based, Peer-Mediated Pragmatic Language Intervention for School-Aged Children on the Autism Spectrum: Predicting Who Benefits Most

This study explored characteristics of children with autism with large intervention effects following a peer-mediated pragmatic language intervention, to devise algorithms for predicting children most likely to benefit. Children attended a 10-week intervention with a typically-developing peer. Data from a pilot study and RCT formed the dataset for this study. The POM-2 measured intervention outcomes. Children completed the EVT-2, TACL-4, and Social Emotional Evaluation at baseline, and parents completed the CCC-2 and CCBRS. High CCC-2 Use of Context and CCBRS Separation Anxiety scores and comparatively lower EVT-2, CCC-2 Nonverbal Communication and Cohesion scores predicted children with large intervention effects. Results can be used by clinicians to predict which children within their clinics might benefit most from participating in this intervention.

Can I join in? Multiple case study investigation of play performance generalisation for children with autism spectrum disorder from dyad to triad

INTRODUCTION

Children with autism spectrum disorder (ASD) have difficulties with play, social interaction with peers and generalisation of intervention outcomes. The Ultimate Guide to Play, Language and Friendship (PLF) has demonstrated effectiveness in improving play performance of children with ASD and their typically developing (TD) peers. The aim of this investigation was to examine the changes in play performance when an additional TD child is added to an existing dyad of a child with ASD and a TD playmate to inform future delivery and adaptations of the intervention.

METHODS

Participants in this multiple case study design were five children with ASD and their TD peer who completed a dyad intervention as part of a randomised control trial investigation of the PLF and an additional TD peer who joined the play dyad. A trained occupational therapist delivered an adapted version of the PLF to the triad over four clinic sessions. An independent rater scored each child (N = 15) on The Test of Playfulness at pre- and post-triad intervention. Line graphs were used to examine case data and compare to dyad play performance and patterns of interaction.

RESULTS

Four of the five children with ASD generalised their play performance from the dyad to the triad social environment. However, the triad intervention did not demonstrate improvements in play performance. The play performance scores for the children with ASD and their TD peers were variable and demonstrated changes in their play pattern from the dyad to the triad.

CONCLUSION

This investigation delivered preliminary evidence of play performance generalisation from a dyad to a triad with TD peers for children with ASD. Careful consideration of characteristics of all playmates is recommended for delivering the intervention to support play performance of children with ASD.

Mothers supporting play as a choice for children with disabilities within a culturally and linguistically diverse community

Background: Play is a right for children; an essential childhood occupation influenced by their family environment. Despite increasing recognition of unstructured outdoor play benefits, children with disabilities experience limited play opportunities.Aim: To apply a capabilities approach lens to understand outdoor play decision-making by mothers of children with disabilities within a culturally and linguistically diverse community.Materials and methods: Data collection for this case study involved semi-structured interviews with five mothers of primary school-aged children with disabilities and a week-long survey that profiled their children's outdoor play. Analysis was thematic and involved identifying barriers and opportunities at each ecocultural layer, aggregating strategies families used to address the barriers, and understanding their overall play decision-making.Findings: Mothers considered the child's interests and abilities, valued play as both a means and ends, planned for play, and facilitated in the moment as required. Multiple factors influenced mothers' outdoor play decisions. Mothers' values were child-centred, positively influencing the child's play opportunities.Conclusion and significance: This study's capabilities lens could inform professions such as occupational therapy to support families of children with disabilities from culturally diverse communities to advocate for play opportunities across settings.

Changes in Flexibility and Force are not Different after Static Versus Dynamic Stretching

In this study, we examined the effects of static and dynamic stretching on range of motion (ROM), passive torque (PT) at pain onset, passive stiffness, and isometric muscle force. We conducted a randomized crossover trial in which 16 healthy young men performed a total of 300 s of active static or dynamic stretching of the right knee flexors on two separate days in random order. To assess the effects of stretching, we measured the ROM, PT at pain onset, passive stiffness during passive knee extension, and maximum voluntary isometric knee flexion force using an isokinetic dynamometer immediately before and after stretching. Both static and dynamic stretching significantly increased the ROM and PT at pain onset (p<0.01) and significantly decreased the passive stiffness and isometric knee flexion force immediately after stretching (p<0.01). However, the magnitude of change did not differ between the two stretching methods for any measurements. Our results suggest that 300 s of either static or dynamic stretching can increase flexibility and decrease isometric muscle force; however, the effects of stretching do not appear to differ between the two stretching methods.

Considering equifinality in treatment planning for social impairment: Divergent paths in neurodevelopmental disorders

Youth with autism spectrum disorder (ASD) present with deficits in both social cognition and executive functioning (EF), which contribute to social impairment. Autistic youth are also frequently diagnosed with comorbid attention-deficit/hyperactivity disorder (ADHD), a disorder that, like ASD, includes impaired EF and social functioning. The comorbidity of ASD and ADHD may result in compounded social impairment, but prior research has not sufficiently evaluated the extent to which this comorbidity profile responds to evidence-based intervention targeting social deficits. It is conceivable that dually targeting EF and social cognition impairment will be more impactful than direct social skills training alone. The authors present an integrative model for intervention programming that examines pathways to social impairment in order to more effectively improve social skills and thereby impact both proximal (e.g., emotion expression, current peer relationships) and more distal outcomes (e.g., depression, self-esteem) in youth with ASD and other neurodevelopmental disorders.

A Randomized Controlled Trial of a Play-Based, Peer-Mediated Pragmatic Language Intervention for Children With Autism

PURPOSE

This randomized controlled trial evaluated the effectiveness of a play-based pragmatic language intervention for children with autism.

METHODS

A sample of 71 children with autism were randomized to an intervention-first group (n = 28 analyzed) or waitlist-first (n = 34 analyzed) group. Children attended 10, weekly clinic play-sessions with a typically developing peer, and parents mediated practice components at home. The Pragmatics Observational Measure (POM-2) and the Social Emotional Evaluation (SEE) evaluated pragmatics before, after and 3-months following the intervention.

RESULTS

POM-2 gains were greatest for intervention-first participants (p = 0.031, d = 0.57). Treatment effects were maintained at 3-month follow-up (p < 0.001-0.05, d = 0.49-0.64). POM-2 scores were not significantly different in the clinic and home settings at follow-up.

CONCLUSION

Findings support the combination of play, peer-mediation, video-feedback and parent training to enhance pragmatic language in children with autism.

The feasibility and appropriateness of a peer-to-peer, play-based intervention for improving pragmatic language in children with autism spectrum disorder

Purpose: This study trialled a play-based, peer-to-peer intervention with children with autism spectrum disorder (ASD) to identify suitable instruments for measuring changes in pragmatic language following the intervention, and evaluate preliminary effectiveness. It also aimed to investigate the appropriateness of the intervention for participants. Method: Ten children with ASD, their typically developing peers, and parents participated. The Pragmatics Observational Measure (POM), Social Emotional Evaluation (SEE) and Profiling Elements of Prosody in Speech Communication (PEPS-C) measured the participant's social communication skills before, after, and 2-months following the intervention. Parent interviews were conducted two months after the intervention and responses were analysed using a thematic approach. Result: Children demonstrated gains in pragmatic language on the POM (χ²(3) = 11.160, p = 0.011) and related higher-level language on the SEE (χ²(2) = 6.686, p = 0.035). The PEPS-C did not produce any significant results. Parent interview responses indicated the intervention was appropriate for the children and families involved. Conclusion: The intervention warrants further investigation of effectiveness with a more robust research design. Consideration should be given to using observational measures of pragmatic language away from the clinic environment to evaluate generalisation, and future development of the intervention might consider variations in playmates and group size.

Social skills training for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years

BACKGROUND

Attention deficit hyperactivity disorder (ADHD) in children is associated with hyperactivity and impulsivity, attention problems, and difficulties with social interactions. Pharmacological treatment may alleviate the symptoms of ADHD but this rarely solves difficulties with social interactions. Children with ADHD may benefit from interventions designed to improve their social skills. We examined the benefits and harms of social skills training on social skills, emotional competencies, general behaviour, ADHD symptoms, performance in school of children with ADHD, and adverse events.

OBJECTIVES

To assess the beneficial and harmful effects of social skills training in children and adolescents with ADHD.

SEARCH METHODS

In July 2018, we searched CENTRAL, MEDLINE, Embase, PsycINFO, 4 other databases and two trials registers.We also searched online conference abstracts, and contacted experts in the field for information about unpublished or ongoing randomised clinical trials. We did not limit our searches by language, year of publication, or type or status of publication, and we sought translation of the relevant sections of non-English language articles.

SELECTION CRITERIA

Randomised clinical trials investigating social skills training versus either no intervention or waiting-list control, with or without pharmacological treatment of both comparison groups of children and adolescents with ADHD.

DATA COLLECTION AND ANALYSIS

We conducted the review in accordance with the Cochrane Handbook for Systematic Reviews of Intervention. We performed the analyses using Review Manager 5 software and Trial Sequential Analysis. We assessed bias according to domains for systematic errors. We assessed the certainty of the evidence with the GRADE approach.

MAIN RESULTS

We included 25 randomised clinical trials described in 45 reports. The trials included a total of 2690 participants aged between five and 17 years. In 17 trials, participants were also diagnosed with various comorbidities.The social skills interventions were described as: 1) social skills training, 2) cognitive behavioural therapy, 3) multimodal behavioural/psychosocial therapy, 4) child life and attention skills treatment, 5) life skills training, 6) the "challenging horizon programme", 7) verbal self-instruction, 8) meta-cognitive training, 9) behavioural therapy, 10) behavioural and social skills treatment, and 11) psychosocial treatment. The control interventions were no intervention or waiting list.The duration of the interventions ranged from five weeks to two years. We considered the content of the social skills interventions to be comparable and based on a cognitive-behavioural model. Most of the trials compared child social skills training or parent training combined with medication versus medication alone. Some of the experimental interventions also included teacher consultations.More than half of the trials were at high risk of bias for generation of the allocation sequence and allocation concealment. No trial reported on blinding of participants and personnel. Most of the trials did not report on differences between groups in medication for comorbid disorders. We used all eligible trials in the meta-analyses, but downgraded the certainty of the evidence to low or very low.We found no clinically relevant treatment effect of social skills interventions on the primary outcome measures: teacher-rated social skills at end of treatment (standardised mean difference (SMD) 0.11, 95% confidence interval (CI) 0.00 to 0.22; 11 trials, 1271 participants; I2 = 0%; P = 0.05); teacher-rated emotional competencies at end of treatment (SMD -0.02, 95% CI -0.72 to 0.68; two trials, 129 participants; I2 = 74%; P = 0.96); or on teacher-rated general behaviour (SMD -0.06 (negative value better), 95% CI -0.19 to 0.06; eight trials, 1002 participants; I2 = 0%; P = 0.33). The effect on the primary outcome, teacher-rated social skills at end of treatment, corresponds to a MD of 1.22 points on the social skills rating system (SSRS) scale (95% CI 0.09 to 2.36). The minimal clinical relevant difference (10%) on the SSRS is 10.0 points (range 0 to 102 points on SSRS).We found evidence in favour of social skills training on teacher-rated core ADHD symptoms at end of treatment for all eligible trials (SMD -0.26, 95% CI -0.47 to -0.05; 14 trials, 1379 participants; I2= 69%; P = 0.02), but the finding is questionable due to lack of support from sensitivity analyses, high risk of bias, lack of clinical significance, high heterogeneity, and low certainty.The studies did not report any serious or non-serious adverse events.

AUTHORS' CONCLUSIONS

The review suggests that there is little evidence to support or refute social skills training for children and adolescents with ADHD. We may need more trials that are at low risk of bias and a sufficient number of participants to determine the efficacy of social skills training versus no training for ADHD. The evidence base regarding adolescents is especially weak.

A Feasibility RCT Evaluating a Play-Informed, Caregiver-Implemented, Home-Based Intervention to Improve the Play of Children Who Are HIV Positive

Background/aim

In South Africa, contextual factors have been identified as barriers to outdoor, unstructured play. The human immunodeficiency virus (HIV) and resulting progressive HIV encephalopathy (PHE) is a pandemic in this area, associated with development delays that are not addressed by highly active antiretroviral treatment (HAART). This study aimed to describe the playfulness in children with HIV and PHE on HAART living in challenging socioeconomic areas in South Africa aged 6 months to 8 years and to evaluate the feasibility and preliminary effectiveness of a play-informed, caregiver-implemented, home-based intervention (PICIHBI) for improving play.

Methods

A feasibility randomized control trial allowed for comparison of PICIHBI and conventional one-on-one occupational therapy interventions. Children were filmed playing pre-, mid-, and postintervention, using the Test of Playfulness (ToP) to assess playfulness. The PICIHBI comprised of 10 monthly sessions facilitated by an occupational therapist, involving group discussions with caregivers and periods of experiential play.

Results

Twenty-four children with HIV and/or PHE were randomized into one of the two intervention groups. Overall, the group (n = 24) had a median score of 0 (lowest item score) on nine of 24 ToP items and only had a median score of 3 (highest score) on two items. Pre- to postintervention overall ToP scores improved marginally for the PICIHBI group (n = 12) and the conventional group (n = 12). Between-group differences were not significant. The PICIHBI group demonstrated a significant increase in one ToP item score at midassessment. No significant ToP item changes were found in the conventional group.

Conclusion

Children with HIV were found to have the most difficulty on ToP items relating to the play elements of internal control and freedom from constraints of reality. The PICIHBI did not significantly improve children's play and was not more effective than the conventional intervention. Considerations for feasibility and effectiveness, including barriers to attendance, are discussed.

Parents' perceptions of the long-term appropriateness of a psychosocial intervention for children with attention deficit hyperactivity disorder

BACKGROUND/AIM

Designing psychosocial interventions that parents perceive as appropriate is essential to enhancing their engagement with the intervention and their long-term use of the intervention strategies. The aim of this study was to explore the long-term appropriateness of a play-based psychosocial intervention for children with Attention Deficit Hyperactivity Disorder (ADHD) from the perspectives of parents.

METHODS

Semi-structured phone interviews were conducted with 14 parents of children with ADHD who participated in a randomised controlled trial of the play-based intervention 1 year earlier.

RESULTS

Thematic analysis led to the development of three core-themes: (i) Everybody needs a parenting handbook, (ii) No one thing you are dealing with, and (iii) A different approach: Reframing.

DISCUSSION

The core-themes related back to a definition of intervention appropriateness that acknowledges the intervention as important/relevant, beneficial, socially and ecologically valid and promotes sustainable change, indicating parents perceived the intervention as appropriate. The core-themes also resembled aspects of the process of family adaptation. Findings highlight the importance of designing interventions that are appropriate from parents' perspectives to enhance their long-term engagement and use of the intervention strategies as well as outcomes for their child in the long term.

Peer-mediated intervention to improve play skills in children with autism spectrum disorder: A feasibility study

BACKGROUND/AIM

Children with autism spectrum disorder (ASD) frequently demonstrate impaired play skills and poor quality social interactions compared to typically developing peers. Complex interventions to improve play skills should be investigated with randomised control trials (RCT) where possible to support evidence-based practice for occupational therapists. Prior to a RCT, multiple feasibility studies are recommended to identify barriers to the trial. The aim of this study is to adapt a complex intervention to improve play skills in children with ASD and investigate the feasibility of conducting a RCT.

METHODS

Participants were 10 children with ASD paired with typically developing playmates chosen by their families. Pairs attended 10 intervention sessions involving video modelling, therapist- and peer-mediation and free play. Participant numbers needed for future investigation of effectiveness were calculated and time and cost considerations were reviewed. The Test of Playfulness (ToP) was the primary outcome measure; both parent- and child-report outcome measures were evaluated for appropriateness.

RESULTS

To determine effectiveness of the intervention 34 pairs in both control and intervention groups will be needed to conduct a RCT over an 18-month timeframe. ToP scores showed a positive, but not statistically significant trend from pre- to post-intervention. These improvements were maintained at follow-up in both clinic and home environments. The Piers-Harris 2 and the Parent Relationship Questionnaire were identified as appropriate secondary outcome measures; additional parent- and teacher-report outcome measures are recommended for the RCT.

CONCLUSION

A RCT to investigate effectiveness of this intervention for improving play skills of children with ASD and their playmates are feasible.

The state of play in children's occupational therapy: A comparison between Ireland, Sweden and Switzerland

Introduction

Play is viewed as an important occupation in childhood and consequently in children's occupational therapy. However, few studies have explored the place of play in therapy practice. This study aimed to contribute to this knowledge gap by exploring play in occupational therapy in three European countries.

Method

A cross-sectional survey of occupational therapists in Ireland, Sweden and Switzerland was conducted to examine the use of play with children under 12 years old. A web-based survey was distributed to 935 occupational therapists, resulting in 338 returned surveys (36%). Responses were analysed using descriptive statistics and content analysis.

Results

Results were organised into three themes: (1) demographics and practice context; (2) play education and (3) use of play in practice. Respondents reported that although they valued play as an occupation, their primary focus was on play as a means to achieving other goals. Lack of education on play (research, theory and interventions) and pressures in the workplace were identified as barriers to play-centred practice.

Conclusion

Findings indicate that there is a mismatch between therapists valuing play as an occupation and how play is utilised in therapy practice. There is a need to strengthen education and research on play occupation to strengthen play-centred practice.