Pilot Study of Let's Get Organized: A Group Intervention for Improving Time Management

Occupational Balance and Emotional Regulation in People With and Without Serious Mental Illness

Background. Serious mental illness affects daily functioning, including occupational balance. Purpose. This study aims to compare occupational balance and emotional regulation between people with serious mental illness and the healthy population and to examine the relationship between occupational balance and emotional regulation. Method. A cross-sectional study was performed. Occupational balance and emotional regulation were measured using the Occupational Balance Questionnaire and the Emotional Regulation Questionnaire, respectively. A multivariate analysis (analysis of covariance) was conducted. Findings. The sample consisted of 112 individuals, divided into two groups: the serious mental illness group (n  =  55); and the healthy group (n  =  57). People with serious mental illness reported lower occupational balance and lower cognitive reappraisal than the healthy population. Furthermore, the higher cognitive reappraisal, the higher the occupational balance, and the higher the expressive suppression, the lower the occupational balance. Conclusion. The results provide preliminary evidence of the relationship between occupational balance and emotional regulation.

Evaluation of the group intervention "Let's Get Organized" for improving time management, organisational, and planning skills in people with mild intellectual disability

BACKGROUND

Limited time management skills cause problems in daily life for people with mild intellectual disability (ID) and "Let's Get Organized" (LGO) is a promising manual-based occupational therapy group intervention aiming to support management skills.

AIMS/OBJECTIVES

To evaluate the applicability of the Swedish version of LGO-S by i) exploring enhancements in time management skills, satisfaction with daily occupations, and aspects of executive functioning in people with time-management difficulties and mild ID, and ii) describing clinical experiences of using the LGO-S for people with mild ID.

MATERIAL AND METHODS

Twenty-one adults with mild ID were included. Data were collected pre-/post-intervention and at 3- and 12-month follow-ups with: Swedish version of Assessment of Time Management Skills (ATMS-S), Satisfaction with Daily Occupation (SDO-13), and Weekly Calendar Planning Activity (WCPA-SE). There were few follow-up participants (n = 6-9).

RESULTS

Significant change in time management skills that maintained at 12-months follow-ups. Significant increase in regulation of emotions at 12-month follow-up. Results at 12-months follow-up indicated sustainability in outcomes as measured by ATMS-S. A non-significant positive trend was observed in other outcomes between pre- and post-intervention.

CONCLUSIONS AND SIGNIFICANCE

LGO-S seems applicable for improving skills in time management, organisation and planning also for people with mild ID.

A more active parenting after attending Let's Get Organized - Experiences of parents with ADHD

BACKGROUND

Parenting demands a high degree of attention, planning, and problem-solving, including time management, demands that can be challenging for parents with ADHD. Let's Get Organized (LGO) is an occupational therapy group intervention aiming at developing skills in time management, organisation and planning. There is a need to investigate if LGO may have an impact also on parenting.

AIM

To describe how parents with ADHD experienced the intervention, their time management strategies, parenting and family life after the occupational therapy group intervention LGO.

METHOD

Interviews were performed with 15 parents with ADHD, after completing LGO. Data were analysed using qualitative content analysis.

RESULTS

The findings are described in one overarching main category, Active parenting and better relations within and outside the family through daily time management with three underlying generic categories: Let's Get Organized facilitates empowerment in daily life; The individual and family - both facilitators of and obstacles to implementation of time management strategies; and A changed parenting and family life.

CONCLUSIONS AND SIGNIFICANCE

Participants experienced a positive impact on time management skills after LGO, which generated more active parenting and better predictability in the whole family. LGO can be a valuable intervention for parents with ADHD.

START - physical exercise and person-centred cognitive skills training as treatment for adult ADHD: protocol for a randomized controlled trial

BACKGROUND

Core symptoms in attention deficit hyperactivity disorder (ADHD) are inattention, impulsivity and hyperactivity. Many individuals with this disorder also have a sedentary lifestyle, co-morbid mental illness such as depressive and anxiety disorders, and reduced quality of life. People with ADHD often have impaired executive function, which among other things may include difficulty in time management and structuring of everyday life. Pharmacological treatment is often the first-line option, but non-pharmacological treatment is also available and is used in clinical settings. In children and adolescents with ADHD, physical exercise is used as a non-pharmacological treatment. However, the evidence for the effectiveness of exercise in adults is sparse.

OBJECTIVE

To implement the START intervention (START = Stöd i Aktivitet, Rörelse och Träning [Support in activity, movement and exercise]) consisting of a 12-week, structured mixed exercise programme with or without a cognitive intervention, in adults with ADHD, and study whether it has an effect on core symptoms of ADHD as well as physical, cognitive, mental and everyday functioning compared with usual treatment. A secondary aim is to investigate the participants' experiences of the intervention and its possible benefits, and to evaluate the cost-effectiveness of START compared with usual treatment.

METHODS

This is a randomized controlled trial planned to be conducted in 120 adults with ADHD, aged 18-65. The intervention will be given as an add-on to standard care. Participants will be randomized to three groups. Group 1 will be given a physiotherapist-led mixed exercise programme for 12 weeks. Group 2 will receive the same intervention as group 1 with the addition of occupational therapist-led cognitive skills training. Group 3 will be the control group who will receive standard care only. The primary outcome will be reduction of ADHD symptoms measured using the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS-v1.1), Clinical Global Impression-Severity scale (CGI-S) and CGI-Improvement scale (CGI-I). The effect will be measured within 1 week after the end of the intervention and 6 and 12 months later.

DISCUSSION

Data collection began in March 2021. The final 12-month follow-up is anticipated to be completed by autumn 2024.

TRIAL REGISTRATION

ClinicalTrials.gov (Identifier: NCT05049239). Registered on 20 September 2021 (last verified: May 2021).

The Psychometric Properties of the Original Version of Assessment of Time Management Skills (ATMS)

Background

To perform daily activities, time management and organizational skills are essential and therefore also important intervention focus in occupational therapy. To guide and evaluate intervention, valid and reliable instruments that measure time management and organization skills are necessary. The aim of this study was to evaluate the psychometric properties of the Assessment of Time Management Skills (ATMS).

Methods

Eligible participants were volunteer adults from the general population who were aged between 18 and 65 years, had a good understanding of English, and were not currently involved in any training or education to improve time management. The ATMS was filled out as a computer-administered survey. Rasch measurement analysis was used to evaluate the validity and aspects of reliability of the ATMS.

Results

In total, 241 adults (112 male and 129 female, mean age = 40) participated. The analysis of principal components of residuals (PCA) and the item goodness-of-fit indicated that the 30-item scale does not measure only one single trait. Three subscales, time management (11 items), organization and planning (11 items), and regulation of emotion (5 items), were detected. One item each on the 11-item subscale showed misfit, but they were kept due to high relevance. All three subscales showed excellent results on analyses of PCA, local independence, and reliability. Conclusions and Relevance. ATMS can provide valid measures of time management, organization and planning skills, and regulation of emotion in a general population and presumably also in a population with cognitive impairment. The measure is useful for occupational therapists in assessing patients' strengths and barriers in time management skills. It can also be useful in identifying the necessity of training time management skills, to guide OT intervention programs and to evaluate interventions. What This Article Adds. Knowledge about the psychometric properties and usefulness of the ATMS in English-speaking countries.

The impact of psychological theory on the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in adults: A scoping review

Psychological theory and interpretation of research are key elements influencing clinical treatment development and design in Attention Deficit Hyperactivity Disorder (ADHD). Research-based treatment recommendations primarily support Cognitive Behavioural Therapy (CBT), an extension of the cognitive behavioural theory, which promotes a deficit-focused characterisation of ADHD and prioritises symptom reduction and cognitive control of self-regulation as treatment outcomes. A wide variety of approaches have developed to improve ADHD outcomes in adults, and this review aimed to map the theoretical foundations of treatment design to understand their impact. A scoping review and analysis were performed on 221 documents to compare the theoretical influences in research, treatment approach, and theoretical citations. Results showed that despite variation in the application, current treatments characterise ADHD from a single paradigm of cognitive behavioural theory. A single theoretical perspective is limiting research for effective treatments for ADHD to address ongoing issues such as accommodating context variability and heterogeneity. Research into alternative theoretical characterisations of ADHD is recommended to provide treatment design opportunities to better understand and address symptoms.

Assessment of time-related deficits in older adults: a scoping review protocol

INTRODUCTION

People with cognitive impairments often have difficulties in managing their time for daily activities. In older adults with cognitive impairments such as dementia and stroke, these may present as disorientation, poor time awareness, time perception, daily time management and so on. Time-related deficits and associated behaviours impede independent living and add considerably to caregiver strain. Several interventions are being investigated to help people with cognitive impairments orient and navigate time and do their daily activities. The provision of interventions requires the use of sound assessment tools. However, it is not clear how time-related concepts are specifically evaluated in practice, what are the available assessments and how these assessments should be selected.

METHOD AND ANALYSIS

This protocol follows the Joanna Briggs Institute Reviewer's Manual (2020) for scoping reviews and is registered with the Open Science Framework (https://osf.io/4ptgy/). We will include the following databases: PubMed, CINAHL, Scopus, Web of Science and PsycINFO. Two reviewers will independently screen eligible studies for inclusion against the selection criteria and then review the full-text of the selected studies. We will extract the bibliographic data, study design and setting, and details of assessments used in the studies to evaluate time-related concepts including format, mode and duration of administration, psychometric properties and so on. The identified assessments will be mapped with regard to time-related concepts being evaluated and described using narrative synthesis.

ETHICS AND DISSEMINATION

As secondary data analysis, ethics approval is not required for this scoping review. We plan to disseminate the results through peer-reviewed journals and conferences targeting health professionals working with older adults.

Evaluation of the "Let's Get Organized" group intervention to improve time management: protocol for a multi-centre randomised controlled trial

BACKGROUND

Time management skills are essential for living in modern society. People with mental or neurodevelopmental disorders typically have cognitive limitations, including affected time management, which might lead to poor occupational balance, low self-efficacy, and poor parental sense of competence. "Let's Get Organized" (LGO) is a recently developed manual-based group intervention to train time management skills. The aim of this trial is to evaluate the efficiency of the Swedish version of LGO (LGO-S) compared to treatment as usual (individual occupational therapy) to improve time management for adults with impaired time management skills due to mental or neurodevelopmental disorders. Furthermore, to evaluate if the intervention is a cost-effective way to improve the quality of life and time management skills of these individuals, we will conduct a health economic evaluation.

METHODS

The trial will have a multi-centre, open, parallel randomised controlled design. A total of 104 adults with cognitive limitations due to mental or neurodevelopmental disorders will be recruited from open psychiatric or habilitation care units. Outcomes will be measured before and after a 10-week intervention, with a follow-up 3 months after completing the intervention. The primary outcome will be self-assessed time management skills. Secondary outcomes will be e.g. self-assessed skills in organisation and planning, regulation of emotions, satisfaction with daily occupations, occupational balance, self-efficacy, and quality-adjusted life years.

DISCUSSION

A recent feasibility study has shown promising results for LGO-S, and a randomised trial will provide robust evidence for the possible efficacy of LGO-S in comparison to treatment as usual.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03654248 . Registered on 20 August 2018.

Toward Control Over Time: Participant Experience of Attending the Let's Get Organized Group Intervention

IMPORTANCE

Time management is crucial for managing daily activities but is difficult for many people with neurodevelopmental or mental disorders. Few sustainable interventions have addressed time management in daily life.

OBJECTIVE

To describe the experiences and meaning of attending the Swedish version of the Let's Get Organized (LGO-S) group intervention.

DESIGN

Qualitative design with interviews 1 to 4 mo after the completed intervention.

SETTING

Outpatient psychiatric and adult habilitation clinics.

PARTICIPANTS

Twelve adults with neurodevelopmental or mental disorders.

INTERVENTION

LGO-S, a manual-based group intervention that focuses on time-management skills. Outcomes and Measures: Semistructured interviews analyzed with qualitative content analysis. All authors took an active part in the analysis process; consensus was reached.

RESULTS

The overarching theme, "a roller-coaster process toward control over time in daily life," describes the participants' process during and after intervention. Four main categories describe the meaning of understanding why time management is difficult and how to use tools for improvement, a process of change that was facilitated by the learning environment. Participants described the process as a struggle to take control over time, but they noted that the positive changes in daily life made it worthwhile.

CONCLUSIONS AND RELEVANCE

Participation had a positive impact on daily life. The opportunity for skills training with support over an extended period, a changed view on failure, and the group format appear to be important success factors. What This Article Adds: The LGO-S, with its structured training of time-management skills, contributes to occupational therapy practice with an intervention that clients experience as bringing meaningful and positive changes to daily life functioning.

One-year follow-up after the time management group intervention Let's Get Organized

BACKGROUND

Time management skills are essential to maintain occupations in everyday life. People with neurodevelopmental or mental disorders often experience persistent difficulties with managing time and organizing daily life, consequently, there is a need to establish interventions with sustainable results.

AIM

The aim was to perform a one-year post-intervention follow-up after the intervention Let's Get Organized (LGO-S) for people with neurodevelopmental or mental disorders.

METHODS

The study is a one-year follow-up of a single group pre-test-post-test design. Thirty-eight persons with difficulties in time management due to neurodevelopmental or mental disorders participated. Instruments to collect data were Assessment of Time Management Skills; Weekly Calendar Planning Activity and the Satisfaction with Daily Occupations instrument. Wilcoxons's signed-rank test was used to compare data over time.

RESULTS

There were no significant differences in the participants' outcomes between post-intervention and one-year follow-up in time management skills and regulation of emotions, satisfaction with daily occupations, and global satisfaction. A significant improvement could be seen in the subscale organization and planning at the one-year follow-up compared to post-intervention.

CONCLUSIONS

Improvements in time management skills, organization, and planning, regulation of emotions, and satisfaction with daily occupations after the LGO-S can be maintained in the long term.

Quality-of-Life Discrepancies Among Autistic Adolescents and Adults: A Rapid Review

IMPORTANCE

Quality of life (QoL) is a core outcome of occupational therapy, but it is decreased among autistic adolescents and adults. This is the first review of QoL from an occupational therapy standpoint.

OBJECTIVE

To identify self-reported QoL differences between autistic and nonautistic samples; investigate sex differences in QoL among autistic people; examine consistency in QoL among autistic people across age, intellectual disability (ID), and self- versus proxy-report method; and appraise occupational therapy-related interventions addressing QoL among autistic people.

DATA SOURCES

Articles published in peer-reviewed journals between 2010 and 2020, located through Academic Search Ultimate, PubMed, and OTseeker, along with the American Journal of Occupational Therapy, British Journal of Occupational Therapy, Canadian Journal of Occupational Therapy, and Australian Occupational Therapy Journal. Study Selection and Data Collection: Article samples consisted of at least 20% autistic females and used self-reported QoL measures. Qualitative research was excluded, as well as studies with participants younger than age 13 yr. Twenty-seven articles qualified (3 Level 1B, 13 Level 3B, and 11 Level 4).

FINDINGS

Autistic adolescents and adults demonstrated decreased self-reported QoL compared with nonautistic peers across age and ID presence. One article compared sex differences in QoL among autistic people. Interventions improved QoL among autistic people.

CONCLUSIONS AND RELEVANCE

Autistic adolescents and adults demonstrate decreased QoL in comparison with nonautistic peers. Questions remain related to sex differences in QoL among autistic people, an area for future research. Multiple evidence-based approaches to improve QoL in the autistic population are relevant to occupational therapy practice. What This Article Adds: Self-reported QoL among autistic adolescents and adults is clearly lower than among their nonautistic counterparts. This article provides information on multiple interventions related to occupational therapy to improve QoL among autistic people.