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.

Interventions Within the Scope of Occupational Therapy to Improve Children's Academic Participation: A Systematic Review

IMPORTANCE

Occupational therapy practitioners evaluate students' ability to participate in school and may provide services to improve learning, academic performance, and participation.

OBJECTIVE

To examine the effectiveness of interventions within the scope of occupational therapy practice to improve academic participation of children and youth ages 5-21 yr.

DATA SOURCES

We searched MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane databases for articles published from 2000 to 2017 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

STUDY SELECTION AND DATA COLLECTION

Within the scope of occupational therapy practice and focused on children ages 5-21 yr.

FINDINGS

Forty-six studies were included, based on three themes: (1) interventions to support participation and learning in the classroom; (2) interventions to support motivation and participation in literacy, including combined reading, written expression, and comprehension; and (3) interventions to support handwriting. Low strength of evidence supports the use of weighted vests and stability balls, and moderate strength of evidence supports the use of yoga to enhance educational participation. Moderate strength of evidence supports the use of creative activities, parent-mediated interventions, and peer-supported interventions to enhance literacy participation. Strong evidence supports therapeutic practice for handwriting intervention, and low strength of evidence supports various handwriting programs as replacement or additional instructional strategies to enhance handwriting abilities.

CONCLUSIONS AND RELEVANCE

More rigorous studies are needed that are conducted by occupational therapy practitioners in school-based settings and that use measures of participation and academic outcomes.

WHAT THIS ARTICLE ADDS

This systematic review provides occupational therapy practitioners with evidence on the use of activity-based and occupation-centered interventions to increase children's participation and learning in school.

Curriculum-Based Handwriting Programs: A Systematic Review With Effect Sizes

Challenges with handwriting can have a negative impact on academic performance, and these challenges are commonly addressed by occupational therapy practitioners in school settings. This systematic review examined the efficacy of curriculum-based interventions to address children's handwriting difficulties in the classroom (preschool to second grade). We reviewed and computed effect sizes for 13 studies (11 Level II, 2 Level III) identified through a comprehensive database search. The evidence shows that curriculum-based handwriting interventions resulted in small- to medium-sized improvements in legibility, a commonly reported challenge in this age group. The evidence for whether these interventions improved speed is mixed, and the evidence for whether they improved fluency is insufficient. No clear support was found for one handwriting program over another. These results suggest that curriculum-based interventions can lead to improvements in handwriting legibility, but Level I research is needed to validate the efficacy of these curricula.

Combining sigma-lognormal modeling and classical features for analyzing graphomotor performances in kindergarten children

This paper investigates the advantage of using the kinematic theory of rapid human movements as a complementary approach to those based on classical dynamical features to characterize and analyze kindergarten children's ability to engage in graphomotor activities as a preparation for handwriting learning. This study analyzes nine different movements taken from 48 children evenly distributed among three different school grades corresponding to pupils aged 3, 4, and 5 years. On the one hand, our results show that the ability to perform graphomotor activities depends on kindergarten grades. More importantly, this study shows which performance criteria, from sophisticated neuromotor modeling as well as more classical kinematic parameters, can differentiate children of different school grades. These criteria provide a valuable tool for studying children's graphomotor control learning strategies. On the other hand, from a practical point of view, it is observed that school grades do not clearly reflect pupils' graphomotor performances. This calls for a large-scale investigation, using a more efficient experimental design based on the various observations made throughout this study regarding the choice of the graphic shapes, the number of repetitions and the features to analyze.

An examination of the effectiveness of Handwriting Without Tears® instruction

Background.

Handwriting is an important childhood occupation, and implications of poor handwriting may have significant long-term effects.

Purpose.

The purpose of this study was to determine the effectiveness of Handwriting Without Tears® (HWT) on Grade 1 students’ handwriting and perception of skills.

Methods.

A cross-over design was used. Repeated measures, at three points, included the Minnesota Handwriting Assessment (MHA) and performance rating scales.

Findings.

Eighty-three boys and 66 girls with an average age of 6.2 years participated in the study. Students receiving HWT achieved significantly higher improvements compared to students with teacher-designed instruction in MHA Total Test Score and in MHA components of form, size, space, and alignment (all p < .05). Students had higher average performance ratings when receiving HWT in the first half of the school year.

Implications.

Instruction using HWT improves students’ perception and skill in handwriting performance.

Assessing handwriting intervention effectiveness in elementary school students: a two-group controlled study

This study examined the effectiveness of two approaches used in elementary schools to improve children's handwriting. Participants were 72 New York City public school students from the first and second grades. A nonequivalent pretest-posttest group design was used in which students engaged in handwriting activities using two approaches: intensive handwriting practice and visual-perceptual-motor activities. Handwriting speed, legibility, and visual-motor skills were examined after a 12-wk Handwriting Club using multivariate analysis of variance. The results showed that students in the intensive handwriting practice group demonstrated significant improvements in handwriting legibility compared with students in the visual-perceptual-motor activity group. No significant effects in handwriting speed and visual-motor skills were found between the students in intensive handwriting practice group and the students in visual-perceptual-motor activities group. The Handwriting Club model is a natural intervention that fits easily into existing school curriculums and can be an effective short-term intervention (response to intervention Tier II).