Effectiveness of Therapy Ball Chairs on Classroom Participation in Children With Autism Spectrum Disorders

Teaching Graduate Students to Translate Nonbehavioral Treatments Into Behavioral Principles

Behavior analytic translations of nonbehavioral treatments were recommended by Brodhead in Behavior Analysis in Practice, 8(1), 70-78 (2015) as part of a decision-making framework for practitioners working on interprofessional treatment teams. Professionals from different disciplines often have overlapping scopes of practice and competence, yet each recommends interventions according to their discipline-specific worldview and training. Nonbehavioral treatment recommendations may be especially challenging for behavior analytic practitioners who are committed to the science of human behavior and who are also ethically obligated to work cooperatively and in the best interest of the client. Learning to translate nonbehavioral treatments into behavior analytic principles and procedures may function as a valuable means of improving professional judgment, thereby promoting evidence-based practice and effective collaboration. Behavioral translations may expose procedures that are, in fact, conceptually systematic, creating more opportunities for behavior analysts to partner in interprofessional care. Using a behavioral skills training package, graduate students of applied behavior analysis were taught to translate nonbehavioral treatments into behavior analytic principles and procedures. All students produced more comprehensive translations following training.

Sensory integration therapy for children with autism and sensory processing difficulties: the SenITA RCT

BACKGROUND

Carers report unmet need for occupational therapy services addressing sensory difficulties in autism, yet insufficient evidence exists to recommend a therapeutic approach.

OBJECTIVES

Our aim was to determine the clinical effectiveness and cost-effectiveness of sensory integration therapy for children with autism and sensory difficulties across behavioural, functional and quality-of-life outcomes.

DESIGN

We carried out a parallel-group randomised controlled trial, incorporating an internal pilot and a process evaluation. Randomisation utilised random permuted blocks.

SETTING AND PARTICIPANTS

Children were recruited via services and self-referral in Wales and England. Inclusion criteria were having an autism diagnosis, being in mainstream primary education and having definite/probable sensory processing difficulties. Exclusion criteria were having current/previous sensory integration therapy and current applied behaviour analysis therapy.

INTERVENTION

The intervention was manualised sensory integration therapy delivered over 26 weeks and the comparator was usual care.

OUTCOMES

The primary outcome was problem behaviours (determined using the Aberrant Behavior Checklist), including irritability/agitation, at 6 months. Secondary outcomes were adaptive behaviour, functioning and socialisation (using the Vineland Adaptive Behavior Scales); carer stress (measured using the Autism Parenting Stress Index); quality of life (measured using the EuroQol-5 Dimensions and Carer Quality of Life); functional change (according to the Canadian Occupational Performance Measure); sensory processing (determined using the Sensory Processing Measure™ at screening and at 6 months to examine mediation effects); and cost-effectiveness (assessed using the Client Service Receipt Inventory). Every effort was made to ensure that outcome assessors were blind to allocation.

RESULTS

A total of 138 participants were randomised (n = 69 per group). Usual care was significantly different from the intervention, which was delivered with good fidelity and adherence and minimal contamination, and was associated with no adverse effects. Trial procedures and outcome measures were acceptable. Carers and therapists reported improvement in daily functioning. The primary analysis included 106 participants. There were no significant main effects of the intervention at 6 or 12 months. The adjusted mean difference between groups on the Aberrant Behavior Checklist - irritability at 6 months post randomisation was 0.40 (95% confidence interval -2.33 to 3.14; p = 0.77). Subgroup differences in irritability/agitation at 6 months were observed for sex of child (intervention × female = 6.42, 95% confidence interval 0.00 to 12.85; p = 0.050) and attention deficit hyperactivity disorder (intervention × attention deficit hyperactivity disorder = -6.77, 95% confidence interval -13.55 to -0.01; p = 0.050). There was an effect on carer stress at 6 months by region (intervention × South England = 7.01, 95% confidence interval 0.45 to 13.56; p = 0.04) and other neurodevelopmental/genetic conditions (intervention × neurodevelopmental/genetic condition = -9.53, 95% confidence interval -18.08 to -0.98; p = 0.030). Carer-rated goal performance and satisfaction increased across sessions (p < 0.001), with a mean change of 2.75 (95% confidence interval 2.14 to 3.37) for performance and a mean change of 3.34 (95% confidence interval 2.63 to 4.40) for satisfaction. Health economic evaluation suggests that sensory integration therapy is not cost-effective compared with usual care alone.

LIMITATIONS

Limitations included variability of the intervention setting (i.e. NHS vs. private), delay for some receiving therapy, an error in administration of Vineland Adaptive Behavior Scales and no measurement of comparator arm goal performance.

CONCLUSIONS

The intervention did not demonstrate clinical benefit above standard care. Subgroup effects are hypothesis-generating only. The intervention is likely to be effective for individualised performance goals, although it is unclear whether effects were in addition to standard care or were maintained.

FUTURE WORK

Further investigation of subgroup effects is needed.

TRIAL REGISTRATION

This trial is registered as ISRCTN14716440.

FUNDING

This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 29. See the NIHR Journals Library website for further project information.

Evaluating the Use of Stability Ball Chairs for Children with ASD in a Clinic Setting

This study used an alternating treatments embedded within a nonconcurrent multiple baseline across participants design to evaluate the effects of a stability ball chair on the on-task and in-seat behavior for three children with autism in a clinic setting. Results indicated increases for both in-seat and on-task behavior with the stability ball chair compared to a standard table chair, however, results varied across participants. On-task behavior had a greater increase across participants compared to in-seat behavior with the stability ball chair. Social validity results found that therapists had an overall positive view of stability ball chairs. This study provides clinicians with options for alternative seating to increase the on-task and in-seat behavior of children with autism. This study extends the use and evaluation of alternative seating, from typically studied settings and contexts, such as classrooms, to clinic settings with younger populations.

Effect of using adaptive seating equipment on grasping and visual motor integration in children with hemiparetic cerebral palsy: a randomized controlled trial

Background

Adaptive seating is commonly used as an intervention method to enhance postural control. The aim of this study is to investigate the effect of using therapy ball as a seat alternative to using typical chair on grasping and visual motor integration in the children with hemiparetic cerebral palsy. For this aim, thirty children with hemiparetic cerebral palsy from both sexes were included in this study. The children ages ranged from 3 to 6 years old. The degree of spasticity was 1 to 1+ according to modified Ashworth scale. The children were able to sit independently and follow instructions. Children were randomly assigned into two groups (experimental group and control group). Each child was evaluated before and after 3 successive months of selected occupational therapy exercises program. All the children of both groups received the same selected occupational therapy exercises program, but the children in the experimental group performed the exercises while sitting on therapy ball, and the children in the control group performed the exercises while sitting on typical chair.

Results

There was a significant improvement in the measured variables for both groups after treatment. The post-treatment results of the two groups of grasping and visual motor integration for age equivalent scores revealed significant difference (p=0.008 and p=0.011 respectively) in favor of the experimental group.

Conclusions

Therapy ball could be used as a seat alternative to using typical chair to facilitate visual motor integration and grasping in the children with hemiparetic cerebral palsy.

Implications of Sensory Processing and Attentional Differences Associated With Autism in Academic Settings: An Integrative Review

The impact of classroom environments on student engagement and academic performance is well-documented. Autism spectrum disorder (ASD) is associated with atypical sensory processing and attentional impairments, which may lead to challenges in successfully accessing educational material within these settings. These symptoms may help explain why students with ASD show discrepancies between intellectual ability and academic performance. Given the increasing number of students with ASD present in classrooms, understanding strengths and weaknesses in sensory processing and attention is necessary in order to design better classroom environments and develop more efficacious accommodations and interventions to support optimal student success. Therefore, the objectives of this review are to provide a brief review of the current literature on sensory processing and attention in ASD, survey how sensory and attentional functions affect academic outcomes in both neurotypical and ASD learners, and suggest potential accommodations/interventions for students with ASD based on these findings.

Efficacy of Sensory Interventions on School Participation of Children With Sensory Disorders: A Systematic Review

Research demonstrates lower school participation in children with sensory disorders. However, the scientific body of evidence supporting existing sensory intervention modalities is difficult to tackle. More specifically, the literature appears poorly organized, with a highly variable terminology, often with nonoverlapping definitions and lack of good keywords classification that would help organize the diversity of approaches. This systematic review organizes the body of evidence for 3 specific approaches (sensory based, sensorimotor, and sensory integration) and questions their efficacy in improving school participation for children with sensory disorders. Two methods were compared: first, a standard systematic review of the literature in 3 databases using appropriate keywords and descriptors, then an original method based on forward and backward citation connections. A total of 28 studies were retrieved, of which only 7 used the standard method for systematic reviews. For sensory-based approaches, the efficacy of weighted-vest varies according to different factors such as the protocol of use. For sensorimotor approaches, the efficacy of therapy balls, air cushions, platform swing, and physical exercise varies according to the child's sensory characteristics. The efficacy of the sensory integration approach remains mixed across studies.

The Effects of Stability Ball Seating on the Behavior of Children with Autism During Instructional Activities

Children with ASD often display behavior problems that can lead to academic and social disruptions. This has led to the introduction of stability balls as an alternative seating method for children, both on the autism spectrum and with other needs. This study used a multiple baseline design and duration data to evaluate the effects of stability ball seating on attending and in-seat behavior for children with ASD who received ABA therapy in their homes. The intervention replaced their standard seating method with a stability ball. In the final phase participants chose their own seating method before beginning table work to assess preference. Following intervention the stability ball was found to increase both attending and in-seat durations for children with ASD.

An evaluation of sensory processing training on the competence, confidence and practice of teachers working with children with autism

Purpose

At present, there is no research to support teachers’ use of sensory interventions in the classroom. This study aims to investigate the extent to how participation in a sensory processing training session would improve teachers’ competence, confidence and practice towards supporting children with autism.

Design/methodology/approach

A pilot study design with mixed qualitative and quantitative methods was used to evaluate the impact of sensory processing training on six teachers who taught at least one child with autism in a mainstream school. The Autism Education Trust Competency Framework and face-to-face semi-structured interviews were completed with participants both pre (Time 1) and post (Time 2) training session.

Findings

Quantitative findings presented statistically significant differences (p < 0.05) in results with large effect sizes in the areas of confidence, knowledge, implementing sensory strategies, adjusting sensory environments, reviewing and reflecting. Qualitative data provided by participants corroborated this and indicated a need for further and more detailed training in the area. There was no change in the practice of teachers consulting with pupils about their sensory needs.

Practical implications

This study found that the attendance of teachers at sensory processing training is justified and the promotion of sensory processing training is therefore warranted.

Originality/value

Findings of this pilot study indicate that sensory processing training for teachers does improve competence, confidence and practice towards supporting children with autism. Review of the session to allow more detail, including consulting with the children themselves, is recommended.

Single-case synthesis tools I: Comparing tools to evaluate SCD quality and rigor

Tools for evaluating the quality and rigor of single case research designs (SCD) are often used when conducting SCD syntheses. Preferred components include evaluations of design features related to the internal validity of SCD to obtain quality and/or rigor ratings. Three tools for evaluating the quality and rigor of SCD (Council for Exceptional Children, What Works Clearinghouse, and Single-Case Analysis and Design Framework) were compared to determine if conclusions regarding the effectiveness of antecedent sensory-based interventions for young children changed based on choice of quality evaluation tool. Evaluation of SCD quality differed across tools, suggesting selection of quality evaluation tools impacts evaluation findings. Suggestions for selecting an appropriate quality and rigor assessment tool are provided and across-tool conclusions are drawn regarding the quality and rigor of studies. Finally, authors provide guidance for using quality evaluations in conjunction with outcome analyses when conducting syntheses of interventions evaluated in the context of SCD.

The Sensory Environment and Participation of Preschool Children With Autism Spectrum Disorder

Sensory processing is recognized as impacting participation for preschool children with autism spectrum disorder (ASD). Little research exists to examine the impact of the sensory environment on the participation patterns of children with ASD, specifically from a contextual standpoint. The researchers in this study examined the viewpoint of teachers and occupational therapists on the sensory-related environmental barriers to participation within the preschool context. Qualitative descriptive methodology was used for data collection and analysis. Thirteen preschool teachers and occupational therapists were interviewed. Sensory aspects of the environment both inhibited and enhanced participation. Physical and temporal components of the environment are identified as being the most influential. Modifications of the environment are identified as increasing participation. It is important to consider the sensory aspects of the environment, in addition to the sensory processing patterns of the person in assessment and intervention planning within the preschool environment.

The State of the Science on Sensory Factors and Their Impact on Daily Life for Children: A Scoping Review

The objective of this study was to identify and synthesize research about how sensory factors affect daily life of children. We designed a conceptual model to guide a scoping review of research published from 2005 to October 2014 (10 years). We searched MEDLINE, CINAHL, and PsycINFO and included studies about sensory perception/processing; children, adolescents/young adults; and participation. We excluded studies about animals, adults, and review articles. Our process resulted in 261 articles meeting criteria. Research shows that children with conditions process sensory input differently than peers. Neuroscience evidence supports the relationship between sensory-related behaviors and brain activity. Studies suggest that sensory processing is linked to social participation, cognition, temperament, and participation. Intervention research illustrates the importance of contextually relevant practices. Future work can examine the developmental course of sensory processing aspects of behavior across the general population and focus on interventions that support children's sensory processing as they participate in their daily lives.

Using a Multifaceted Approach to Working With Children Who Have Differences in Sensory Processing and Integration

Pediatric occupational therapy practitioners frequently provide interventions for children with differences in sensory processing and integration. Confusion exists regarding how best to intervene with these children and about how to describe and document methods. Some practitioners hold the misconception that Ayres Sensory Integration intervention is the only approach that can and should be used with this population. The issue is that occupational therapy practitioners must treat the whole client in varied environments; to do so effectively, multiple approaches to intervention often are required. This article presents a framework for conceptualizing interventions for children with differences in sensory processing and integration that incorporates multiple evidence-based approaches. To best meet the needs of the children and families seeking occupational therapy services, interventions must be focused on participation and should be multifaceted.

Engagement for Students With Severe Intellectual Disability: The Need for a Common Definition in Inclusive Education

Classroom engagement is an area of frequent discussion and study in the field of education, though engagement is defined differently for various student populations. The purpose of this article is to examine how engagement is defined for students without disability, at risk, or with mild disability as compared to those with severe intellectual disability. We discuss engagement for both populations of students and the resulting implications for inclusive practice. Finally, we emphasize the importance of utilizing a universal definition within the framework of the Universal Design for Learning to enhance learning outcomes for all students, including those with severe intellectual disability.

A Century of Therapeutic Use of the Physical Environment

In this article, we describe the use of the objects and spaces of the physical environment by occupational therapy practitioners in the United States over the profession's first 100 years. Using professional literature selected by decade from the years 1917 through 2016 to obtain data, we applied grounded theory methods to complete a detailed description. Team-based analysis over four coding schemes yielded a theoretical description of the profession's therapeutic use of the physical environment. Study findings included descriptions across occupational therapy's history of (1) treatment spaces, (2) the concepts of adapting and grading, and (3) a typology of constructive and nonconstructive applications of objects and activities by occupational therapy clients and practitioners. This extended historical perspective on trajectories of change in intervention space, the role of physical products in intervention, therapist repertoire, and the enduring role of adaptation suggests how the physical environment may be used in future practice.

Effectiveness of a Sensory-Enriched Early Intervention Group Program for Children With Developmental Disabilities

OBJECTIVE. The study’s objective was to evaluate the effectiveness of the Interdisciplinary Sensory-Enriched Early Intervention (ISEEI) group program for children with developmental delays.

METHOD. We conducted a retrospective chart review of 63 children ages 18–36 mo who participated in ISEEI. We evaluated participants with the Bayley Scales of Infant and Toddler Development III (Bayley–III) and the Infant/Toddler Sensory Profile (ITSP) at enrollment and after 3–9 mo. We conducted a paired t test to examine changes in the Bayley–III between pre- and posttests.

RESULTS. At enrollment, 70% of children presented atypical scores in two or more areas of sensory processing in the ITSP. Results revealed that children with sensory processing difficulties demonstrated significant improvement in all areas of development except fine motor skills; children without sensory processing difficulties showed significant improvement in language and cognition.

CONCLUSION. The ISEEI group program is an effective method to ameliorate developmental delays.

Elementary Students' Physical Activity Levels and Behavior When Using Stability Balls

OBJECTIVE

Physical activity is positively related to improved student behaviors. Stability balls have been used as interventions to affect student behavior. The objective of this study was to determine whether the use of stability balls elicits more physical activity than the use of regular chairs and whether stability balls positively influence behavior.

METHOD

Participants (n = 43 fourth graders) sat on stability balls during class and wore accelerometers. Eight were randomly selected for behavioral observations using momentary time sampling.

RESULTS

Significant decreases in accelerometer counts were found. No obvious difference for on-task behaviors was found between students using stability balls and those using chairs.

CONCLUSION

Stability balls do not necessarily elicit more physical activity than do chairs; however, students accumulate light-intensity physical activity when using them. Classroom behavior was not detrimentally affected by stability ball use; thus, stability balls do not appear to detract from the classroom instructional atmosphere.

Effects of Stability Balls on Children's On-Task Behavior, Academic Achievement, and Discipline Referrals: A Randomized Controlled Trial

OBJECTIVE

We used a randomized controlled design to investigate whether using stability balls during the school day was associated with higher levels of on-task behavior and academic achievement and fewer discipline referrals.

METHOD

Over 9 mo, students in 2 second-grade classrooms in a southeastern rural elementary school used stability balls as chairs while students in 2 control classrooms used chairs as usual. We collected measures of on-task behavior, standardized measures of literacy and mathematics achievement, and discipline referrals.

RESULTS

We found similar levels of on-task behavior and achievement in treatment and control classrooms and a downward trend in disruptive behaviors in treatment classrooms.

CONCLUSION

This study did not find use of stability balls for entire general education classrooms to be a practical use of resources for schools. More research with rigorous controlled designs is needed to support the use of stability balls for the general education population.

Effectiveness of Ayres Sensory Integration® and Sensory-Based Interventions for People With Autism Spectrum Disorder: A Systematic Review

This systematic review examines the literature published from January 2006 through April 2013 related to the effectiveness of Ayres Sensory Integration® (ASI) and sensory-based interventions (SBIs) within the scope of occupational therapy for people with autism spectrum disorder to improve performance in daily life activities and occupations. Of the 368 abstracts screened, 23 met the inclusion criteria and were reviewed. Moderate evidence was found to support the use of ASI. The results for sensory-based methods were mixed. Recommendations include performing higher level studies with larger samples, using the Fidelity Measure in studies of ASI, and using carefully operationalized definitions and systematic methods in examination of SBIs.

Video methodologies in research: Unlocking the complexities of occupation

Background.

Video methods are used by numerous academic disciplines researching human action. Occupational therapists and scientists have primarily employed video data to enumerate subcomponents of occupational behaviour, to conduct reliability tests, and to study clinical reasoning. There is a gap in the literature using video data to explore complex dimensions of typical occupational behaviour.

Purpose.

This paper aims to encourage the use of video methodology beyond its current state in research on occupation.

Key Issues.

Drawing on recent theoretical developments in the literature and empirical illustrations from a video-based project with migrants, this paper demonstrates the potential contributions of video data to understandings of identity, the physical environment, the stream of occupations, and collective occupations. The paper also discusses the unique advantages and richness of collecting video data in comparison to interviews and traditional observations. The challenges in employing video methodologies are discussed.

Implications.

Video research offers unprecedented opportunities to study human occupation in incommensurable detail as it unfolds through sociocultural and physical environments.

Review of occupational therapy intervention research in the practice area of children and youth 2009-2013

PURPOSE. We conducted a systematic review examining the extent to which pediatric intervention research recently published in the American Journal of Occupational Therapy reflects occupational therapy's holistic occupation-based tenets. METHOD. We surveyed 10 systematic reviews and analyzed 38 single effectiveness studies for intervention approach, type, level of environmental targeting, level of occupational task and participation practice, and measures used. RESULTS. Of the 38 single effectiveness studies, 12 (32%) explicitly incorporated both environmental targets of intervention and practice of complex or in vivo occupational tasks, with steady increases during the 2009-2013 time frame. CONCLUSION. In the area of children and youth, occupational therapy is making steady gains in reflecting and demonstrating the effectiveness of the profession's holistic, occupation-based tenets. Occupational therapy researchers must be mindful to ensure that despite the reductionist nature of intervention research, interventions reflect the profession's holistic understanding of the interplay between the child, environment, and occupations.

Optimizing participation of children with autism spectrum disorder experiencing sensory challenges: A clinical reasoning framework

Background.

Remedial sensory interventions currently lack supportive evidence and can be challenging to implement for families and clinicians. It may be timely to shift the focus to optimizing participation of children with autism spectrum disorders (ASD) through accommodation and self-regulation of their sensory differences.

Purpose.

A framework to guide practitioners in selecting strategies is proposed based on clinical reasoning considerations, including (a) research evidence, (b) client- and family-centredness, (c) practice contexts, (d) occupation-centredness, and (e) risks.

Key issues.

Information-sharing with families and coaching constitute the basis for intervention. Specific strategies are identified where sensory aversions or seeking behaviours, challenges with modulation of arousal, or sensory-related behaviours interfere with participation. Self-regulatory strategies are advocated. The application of universal design principles to shared environments is also recommended.

Implications.

The implications of this framework for future research, education, and practice are discussed. The clinical utility of the framework now needs to be tested.

A systematic review of sensory processing interventions for children with autism spectrum disorders

Children with autism spectrum disorders often exhibit co-occurring sensory processing problems and receive interventions that target self-regulation. In current practice, sensory interventions apply different theoretic constructs, focus on different goals, use a variety of sensory modalities, and involve markedly disparate procedures. Previous reviews examined the effects of sensory interventions without acknowledging these inconsistencies. This systematic review examined the research evidence (2000-2012) of two forms of sensory interventions, sensory integration therapy and sensory-based intervention, for children with autism spectrum disorders and concurrent sensory processing problems. A total of 19 studies were reviewed: 5 examined the effects of sensory integration therapy and 14 sensory-based intervention. The studies defined sensory integration therapies as clinic-based interventions that use sensory-rich, child-directed activities to improve a child's adaptive responses to sensory experiences. Two randomized controlled trials found positive effects for sensory integration therapy on child performance using Goal Attainment Scaling (effect sizes ranging from .72 to 1.62); other studies (Levels III-IV) found positive effects on reducing behaviors linked to sensory problems. Sensory-based interventions are characterized as classroom-based interventions that use single-sensory strategies, for example, weighted vests or therapy balls, to influence a child's state of arousal. Few positive effects were found in sensory-based intervention studies. Studies of sensory-based interventions suggest that they may not be effective; however, they did not follow recommended protocols or target sensory processing problems. Although small randomized controlled trials resulted in positive effects for sensory integration therapies, additional rigorous trials using manualized protocols for sensory integration therapy are needed to evaluate effects for children with autism spectrum disorders and sensory processing problems.

Effectiveness of sensory processing strategies on activity level in inclusive preschool classrooms

BACKGROUND

The purpose of this study was to investigate the effectiveness of sensory processing strategies in improving the activity level of children with sensory integration dysfunction.

METHODS

The study used a matching-only pretest-posttest control group design, which requires random matching of sensory integration dysfunction to the corresponding intervention group (n = 18) and control group (n = 18). The intervention group comprised 3-6-year-old children who received an 8-week school-day intervention during implementation of the theme curriculum.

RESULTS

The 8-week treatment significantly reduced the activity level and foot-swinging episodes in children with sensory integration dysfunction, and obtained a medium-effect size. However, the level of improvement in the control group did not show any statistically significant change.

CONCLUSION

Sensory processing strategies could improve activity levels in children with sensory integration dysfunction. However, this study was unable to exclude a developmental effect. The social validity results show that sensory processing strategies can be integrated into the theme curriculum and improve activity levels in children.

Engaged Moments: Mediated Action and Children with Autism in the Classroom Setting

The purpose of this microethnographic study is to explore ways to better understand engagement in occupation of children with autism spectrum disorder. Using video data, moments of engagement were examined in a child with autism spectrum disorder during the daily classroom activity of Circle Time. The interpretive frame focused on mediated action, the interaction between the agent, and cultural tools. Three scenes were analyzed using narrative and micro-analytic strategies. Analyses of two scenes highlighted how social and material mediators offer opportunities for engagement. Other children with autism provided appropriate scaffolds and demonstrated evidence of intersubjectivity, whereas material tools provided proximal prompts that enabled the child to engage. The third scene suggests that engagement may not always be observable (i.e., engagement may be a subjective state). Implications for practice and methodological insights are offered.

Review of occupational therapy research in the practice area of children and youth

We conducted a systematic review focusing on articles in the occupational therapy practice category of Children and Youth published in the American Journal of Occupational Therapy over the 2-yr period of 2009-2010. We used the frameworks of the International Classification of Functioning, Disability and Health (ICF) and Positive Youth Development (PYD) to explore occupational therapy research progress toward the goals of the Centennial Vision. We organized 46 research articles by research type and classified them within these two frameworks. Most reviewed published research investigated variables representing constructs falling within the ICFdomains of Body Functioning and Activity. The effect of occupational therapy interventions on PYD resided primarily in building competence. To meet the tenets of the Centennial Vision, occupational therapists must document changes in children's engagement in everyday life situations and build the evidence of occupational therapist's efficacy in facilitating participation.