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92 Cards in this Set
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Sensory integration
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Frame of Reference/model of practice often seen in Pediatrics, Proponent: Jean Ayres.
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Theoretical base of Sensory Integration
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a) Adaptive responses occur in optimal arousal states and are prerequisite to sensory integration.
b) Facilitation of multiple sensory systems may be needed. c) The “just-right challenge” in activities promotes growth and development. d) Facilitation of sensory modulation, discrimination, and integration results in improved postural control, praxis and bilateral integration, and participation. e) Intervention is directed to underlying deficits in sensory modulation, discrimination, and integration and to foundational abilities. f) Impacts of sensory integration include self-regulation, self-esteem, social participation, academic performance, and participation in daily life routines and activities. |
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Areas of concern on function–dysfunction continua for Sensory Integration
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a) Atypical responses (i.e., unusual over-, under-, or fluctuating responsivity) to the sensory aspects of materials, activities, or situations (sensory modulation disorder)
b) Poor ability to conceptualize, plan, and execute motor actions associated with signs of poor perception of touch and body position (somatodyspraxia) c) Poor ability to coordinate both sides of the body and atypical postural and ocular mechanisms associated with signs of inefficient processing and perception of movement and body position (bilateral integration and sequencing deficit) d) Poor visual perception and visual–motor integration (constructional and visuodyspraxia) |
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Guide to evaluation in Sensory Integration
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a) Identify strengths of the child and family.
b) Identify occupational dilemmas. c) Determine whether occupational dilemmas may be related to sensorimotor deficits. d) Conduct formal and informal assessments of sensory and motor skills abilities e) Summarize data, and determine the relationship of the findings to the child’s occupational dilemmas. List behaviors and possible underlying sensory or motor mechanisms. |
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Assessments used in Sensory Integration
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Sensory Integration and Praxis Tests: considered the gold standard for evaluating sensory integration and praxis
b) Sensory Processing Measure: parent, teacher, or self-report assessment of sensory processing skills c) Sensory Profile: parent, teacher, or self-report assessment that includes measures of sensory over- and underresponsivity d) Clinical observation of sensory integration |
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Practice applications of Sensory Integration
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a) Focus on enhancing independence in life skills using principles of sensory integration.
b) Provide opportunities for engagement in sensorimotor activities rich in tactile, vestibular, and proprioceptive input. c) Design the therapeutic environment to tap into the child’s inner drive to play. d) Create playful activities that challenge the child’s skills, and astutely observe the child’s ability to process and use sensory information. e) Communicate with the child’s parents and teachers to ensure that the therapeutic process is aligned with goals at home and in school. |
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Person–Environment–Occupation (PEO) Model
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Model of Practice often seen in Pediatrics. Proponents: Law et al., 1994
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Concepts and assumptions of Person-Environment-Occupation Model
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a) Person: personal characteristics of the client
b) Environment: cultural, social, psychological, organizational, and physical components of the client’s surroundings c) Occupation: self-directed, functional tasks and activities d) Occupational performance: outcome of the transactional relationships among child, environment, and occupation e) Person–environment–occupation fit: goal of interventions to promote change in the child, occupation, and environment to optimize occupational performance |
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Person-Environment-Occupation Model Use in pediatric practice
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a) A family-centered approach is used.
b) Interventions target changes in the child, occupation, and environment. c) Changes can occur at each level of the environment, including home, neighborhood, community, and state or country. d) Assessment and outcome measurement incorporate a broad repertoire of measures. |
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Evaluation and analysis of occupational performance using Person-Environment-Occupation Model
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a) Consider the skills, abilities, tasks, and activities that are meaningful to the child and environments where occupational engagement occurs.
b) Analyze each PEO aspect in relationship to the child and family. c) Assess potential strengths and weaknesses by conceptualizing the fit among PEO aspects. |
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Intervention Using Person-Environment-Occupation Model
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a) Support a family-centered approach.
b) Recognize the influence of culture and values in implementing the evaluation process. c) For evaluation of and intervention with older children, support their values and perceptions as individuals and in the context of family and community. d) Consider the environment as both an area for evaluation and a change element for intervention. |
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Model of Human Occupation
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Model of Practice, Proponents: Kielhofner
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Concepts and assumptions of Model of Human Occupation
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a) Volition: a person’s desire to participate in certain occupations
b) Habituation: internalized readiness to demonstrate consistent patterns of behavior c) Environment: surroundings that create opportunities for or barriers to participation in meaningful and culturally relevant occupationsd) Performance capacity: physical and mental components enabling a person to participate in occupations e) Dimensions of doing: Occupational participation, occupational performance, occupational skill |
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Volition in the Model of Human Occupation
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a) Volition: a person’s desire to participate in certain occupations
b) Personal causation: a person’s sense of competence and effectiveness while engaged in occupations c) Values: that which is important and meaningful to the person d) Interests: activities that provide enjoyment and satisfaction to the person |
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Evaluation and analysis of occupational performance based on the Model of Human Occupation
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a) Short Child Occupational Profile: occupation-focused assessment that determines whether volition, habituation, skills, and environment facilitate or restrict occupational participation
b) Child Occupational Self-Assessment: client-directed assessment that covers everyday activities including self-care, school tasks, social activities, family-related activities c) Pediatric Interest Profiles: self-report survey of play and leisure interests d) Pediatric Volitional Questionnaire: observational assessment to understand volition e) School Setting Interview: collaborative interview that describes student–environment fit in multiple school settings |
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Use of the Model of Human Occupation in pediatric practice
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a) Occupational participation: Children are helped to participate in self-care tasks, attend school, and interact with family and friends.
b) Occupational performance: Children increase their ability to engage in occupations. c) Occupational skill: Children demonstrate improved actions associated with occupations |
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Occupational Adaptation Model
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Model of Practice, Proponents: Schkade & Schultz
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Concepts and assumptions of Occupational Adaptation Model
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a) The three basic elements targeted in intervention are (1) the person, (2) the occupational environment, and (3) the interaction of person and occupational environment.
b) Occupational adaptation is a normative process that is prominent in periods of transition |
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The Three basic elements targeted in Occupational Adaptation Model
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The three basic elements targeted in intervention are (1) the person, (2) the occupational environment, and (3) the interaction of person and occupational environment:
1) The person has an innate desire for mastery in occupation; in addition to the person’s sensorimotor, cognitive, and psychosocial systems, intervention targets his or her experience of personal limitations and potential. 2) The environment is where occupation occurs and has social, physical, and cultural properties; the environment produces a demand for the mastery of occupation. 3) The interaction between person and occupational environment produces a press for mastery as evaluated by the person and elements of the environment. |
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Evaluation and analysis of occupational performance using the Occupational Adaptation Model |
a) Understand the person.
b) Understand the occupational environment. c) Identify desired outcomes. d) Prioritize and measure desired outcomes. |
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Use of Occupational Adaptation Model in pediatric practice
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a) Occupational readiness: for example, improvements in fine and gross motor skills, strength, coordination, dexterity
b) Occupational activities: for example, interventions addressing core features of the child’s or family’s difficulty engaging in desired occupations |
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Ecology of Human Performance Model
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Model of Practice, Proponent: Dunn et al.
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Concepts of Ecology of Human Performance Model
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a) The person is composed of sensorimotor, cognitive, and psychosocial skills.
b) The demands of a task determine which specific behaviors the person will need to participate successfully. c) The context includes the temporal, physical, social, and cultural aspects of the environment. d) Performance range is the number and type of tasks available to the person. |
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Assumptions of Ecology of Human Performance Model
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a) A dynamic relationship exists between children and their contexts.
b) Contrived and natural contexts are different from each other. c) Occupational therapy promotes self-determination and full inclusion. d) Independence occurs when the client’s wants and needs are satisfied. |
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Evaluation and analysis of occupational performance using Ecology of Human Performance Model
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a) Identify what the child wants and needs to do.
b) Evaluate contextual features. c) Identify the child’s performance features. d) Analyze the characteristics of the desired tasks. e) Develop conceptually based hypotheses and associated interventions. |
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Use of Ecology of Human Performance Model in pediatric Intervention approaches
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a) Create, promote: focus on populations; the therapist creates an intervention
b) Establish, restore: focus on the child’s skills and abilities; the therapist establishes skills c) Alter: focus on context; the therapist identifies the child’s needs to be successful in various contexts d) Modify: focus on context or task; the therapist adjusts the demands of the task or changes environment variables e) Prevent: focus on problem anticipation |
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Prevalence of disorders and impairments in Children and Youth
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Between 5% and 11% of school-age children have a mental health disorder.
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Occupational therapy in mental health in Children and Youth
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a) Occupational therapy practitioners believe in the positive relationship between health and participa-tion in a balance of meaningful occupations.
b) The public health model of service delivery has three major levels: (1) universal or whole population services, (2) targeted or selective services, and (3) intensive services. c) School-based intervention uses a Response to Intervention (RtI) approach. |
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Response to Intervention approuch in School Settings
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Tier 1-interventions include assisting in schoolwide prevention efforts, collaborating with school
personnel to create positive environments, and observing all children’s behaviors. Tier 2-interventions include developing and running programs for at-risk students and consulting with teachers to modify learning demands for at-risk students. Tier 3-interventions include providing individual or group intervention for students with mental health concerns and collaborating with school-based mental health providers. |
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Cognitive–behavioral therapy strategies for Children and Youth
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a) Psychoeducation: Educate child and family about the disorder.
b) Affective education: Teach skills to identify and recognize emotions and influences on emotions c) Cognitive restructuring: Teach skills to recognize faulty or anxious thinking. d) Relaxation training: Teach progressive muscle relaxation techniques, deep breathing, and guided imagery. e) Exposure to fears and contingency management: Provide exposure involving gradual introduction of feared events and rewards for brave behaviors. |
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Autism Spectrum Disorder Etiology and incidence
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a) Abnormalities in the cerebellum, limbic system, and cortex and defects in brain lateralization
b) Affects 1 in 110 children |
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Autism Spectrum Disorder Prognosis
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a) Only about 20% of adults with autism are able to lead moderately independent lives; 20% to 25% experience good quality of life and lead moderately independent lives, and 50% have acceptable, semi-independent quality of life.
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Autism Spectrum Disorder Impact on function
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a) Impairments in communication, social skills, and performance in most activities
c) Difficulties in ADL and IADL performance, play, and ability to study and work d) Failure to develop speech or failure to use speech functionally e) Impaired social interactions f) Presence of selective attention, stereotypical behaviors, and routinized and unproductive patterns of behaviors |
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Autism Spectrum Disorder Treatment options
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a) Behavioral intervention: applied behavior analysis, which involves careful assessment of specific behaviors accompanied by detailed plans for intervention based on behavior modification principles.
b) Early intervention services c) Pharmacological options: clomipramine, pimozide, clozapine, fluoxetine for anxiety and hyperactivity |
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Autism Spectrum Disorder Implications for occupational therapy practice
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a) Observation can often substitute for formal evaluation.
b) An integrated developmental model is used when conducting assessments. c) Treatment goals must be sensitive to the probability that change will occur in small steps. d) Behavioral and sensory integration intervention may be most effective. e) Interventions focus on self-care and communication, emphasizing motivation and attention to tasks; use of visual outlines facilitates effective performance and participation in self-care and transfer of skills in various contexts. f) Sensory–perceptual interventions may decrease disruptive behaviors and increase functional behaviors; an example is the ALERT program for self-regulation g) Inclusion in class improves behavioral symptoms. h) A multidisciplinary approach to intervention is often used. i) Use of technology may include keyboarding for expression or augmentative communication devices. |
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Components of praxis often affected in children with autism
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a) Ideation: ability to conceptualize and identify a motor goal with an idea of how to achieve a goal
b) Motor organization: ability to plan and organize a series of intentional motor actions in response to environmental demands c) Feed forward praxis: process of sending a motor plan to the brain, comparing previous performance, and detecting potential errors in the plan before or after execution d) Execution: performance of motor responses with precision e) Feedback processes: recognition of and response to a motor act and its consequences |
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Assessment methods for Autism Spectrum Disorder
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a) Record review: review of significant information and medical records
b) Skilled observation: preferred over long standardized tests; observe variables that affect performance and participation (home, school, community) c) Interviews: gathering of information about areas of concern to parents and children d) Measures: norm-referenced, criterion-referenced tests and ecological tests |
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Specific functions evaluated for Patients with Autism Spectrum Disorder
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a) ADLs
b) Emotional regulation c) Family occupations d) Play e) Participation in school f) Sensory integration and praxis g) Social skills h) Technology needs |
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Assessment tools frequently used with children with Autism Spectrum Disorder (ASD)
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a) Adaptive Behavior Assessment System
b) Autism Behavior Checklist c) Bayley Scales of Infant Development d) Bruininks–Oseretsky Test of Motor Proficiency e) Coping Inventory f) Peabody Developmental Motor Scales g) Pediatric Evaluation of Disability Inventory h) Sensory Integration and Praxis Tests i) Scales of Independent Behavior–Revised j) School Function Assessment j) Sensory Processing Measure k) Sensory Profile l) Vineland Adaptive Behavior Scales |
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Examples of ecological assessments for children that can be used for Autism Spectrum Disorder
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a) Knox Preschool Play Scale
b) Transdisciplinary Play-Based Assessment c) School Function Assessment |
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Asperger Syndrome
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Note. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM; 2013) eliminates Asperger syndrome and replaces it with autism spectrum disorder. Because it will take time for this change to make its way into textbooks, curricula, and testing, this outline refers to Asperger syndrome as described in the DSM, 4th edition, revised (American Psychiatric Association [APA], 2000, p. 84).
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Criteria for diagnosis of Asperger’s disorder
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1) Qualitative impairment in social interaction, as manifested by at least two of the following:
-Marked impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction -Failure to develop peer relationships appropriate to developmental level -A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people) -Lack of social or emotional reciprocity 2) Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following: -Encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus -Apparently inflexible adherence to specific, nonfunctional routines or rituals -Stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements) -Persistent preoccupation with parts of objects -The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning. -There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years). -There is no clinically significant delay in cognitive development or in the development of self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood. -Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. |
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Pervasive Developmental Disorders
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Disorders on the Autism Spectrum
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Asperger’s disorder Assessment
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a) Development of language, cognitive, self-help, and adaptive behavior skills is typically within normal limits
b) Because people with Asperger syndrome may miss assignments, resulting in lower grades, organizational skills should be explored during the occupational therapy assessment along with other executive functions c) Many people with Asperger syndrome may experience sensory processing disorders. Sensory processing should be a focus of the occupational therapy assessment d) When using the Model of Human Occupation as the framework for assessment, tools such as the Role Checklist may give the practitioner and client valuable insight into the former and current roles and the value the client places on these roles |
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Asperger's Disorder Occupational performance challenges
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a) Sensory processing disorders
b) Nonverbal communication deficits include an inability to infer what others are thinking or to pick up on social context cues. c) Professorial speech, or speech with little regard for the interest of the listener, is typical; other speech and language characteristics may include delayed development, superficially perfect expressive language, formal pedantic language, odd prosody, peculiar voice characteristics, and impairment of comprehension including misinterpretation of literal versus implied meanings |
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Asperger's Disorder Sensory processing disorders
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a) People with Asperger syndrome sometimes demonstrate hypersensitivity to stimulation that is imposed on them.
b) Sensory processing disorders are associated with problems in negotiating in the community and with social skills deficits. Examples include difficulty standing in line (because of hypersensitivity to touch), inability to tolerate crowds at social events, and hypersensitivity to noise in a gymnasium. c) People with Asperger syndrome tend to be anxious, poorly coordinated, and eccentric. They often have problems with hearing, vision, movement, and touch d) Sensory integration treatment often benefits children and adults with Asperger syndrome. Treatment may lessen the client’s anxiety, improve motor coordination, and increase the client’s social participation in a variety of contexts. |
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Intervention for Asperger's disorder
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a) A behavioral analysis may lead to the identification of environmental factors that cause anxiety and should include an examination of the positive or negative consequences of a behavior as reinforcing or extinguishing subsequent behavior.
b) Social skills training can teach pragmatic language skills, including the appropriate use of gestures and expressions, appropriate physical proximity to others, and vocal inflection. c) A consistent routine helps people with Asperger syndrome function more independently. Whereas predictability may decrease distress, “interruption of a ritual or preoccupation may upset a child . . . and lead to distress”. d) Preparation for transitions is often helpful. For example, telling a child in school “In 10 minutes, we’ll go to recess” can lessen anxiety around the transition. e) Reducing distractions in the environment can promote function. Eliminating unrelated sensory stimuli—for example, by removing clutter on bulletin boards and providing worksheets with one math problem per page—can help students focus attention on the task at hand. f) Planned breaks for getting up and moving around can promote function. g) Skills learned in one setting may not readily generalize to other settings. |
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Legislation that Relates to Autism Spectrum Disorders
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a) The Individuals With Disabilities Education Act of 1990 is a federal law that entitles equal access to education for students with physical and mental disabilities
b) The Americans With Disabilities Act of 1990 is a federal law that requires accessibility of facilities and programs, accommodations in the workplace, and supports for independent living. Reasonable accommodations in the workplace are changes or modifications that would not impose an “undue burden” on the employer and would enable a person with a disability to work. |
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Mood Disorders in general relating to Pediatrics
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Note. Mood and depressive disorders are not commonly diagnosed in children. This section provides an overview of mood and depressive disorders that can be detected as early as adolescence along with implications for occupational therapy intervention.
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Major depression in General and relating to Pediatrics
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DSM–5 definition (APA, 2013)
a) At least five of the following symptoms are present: -Irritability -Anhedonia -Unintentional weight loss or gain -Insomnia or hypersomnia -Psychomotor agitation or retardation -Fatigue -Feelings of guilt or worthlessness -Poor concentration b) The diagnosis is made in the absence of obvious organic causes (e.g., anemia, hyperthyroidism). |
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Major Depression Etiology and incidence in General and Relating to Pediatrics
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a) Etiology includes psychosocial stressors, genetics, sensory changes, and central nervous system changes.
b) Incidence is approximately 11% in 13- to 18-year-olds. |
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Major Depression Prognosis in General and Relating to Pediatrics
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a) Clients are generally able to return to independent occupational functioning, although only 40% of depressive episodes resolve spontaneously within 1 year.
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Impact of Major Depression on function in General and Relating to Pediatrics
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a) School and social dysfunction
b) Inability to participate in leisure, ADL, and IADL activities c) Cognitive impact: loss of concentration, diminished problem-solving ability, poor coping d) Slowed or increased psychomotor activity |
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Treatment options of Major Depression in General and Relating to Pediatrics
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a) Pharmacological treatment (antidepressant medication) that generally works on neurotransmitters such as serotonin, norepinephrine, or dopamine to regulate mood; not commonly used for pediatric populations but may be used for adolescents
b) Electroconvulsive therapy c) Group or individual psychotherapy, cognitive therapy |
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Specific Pharmacological treatment for Major Depression in General and Relating to Pediatrics
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a) Selective serotonin reuptake inhibitors: fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa)
b) Serotonin and norepinephrine reuptake inhibitors: venlafaxine (Effexor), duloxetine (Cymbalta) c) Monoamine oxidase inhibitors: phenelzine (Nardil); isocarboxazid (Marplan); tranylcypromine (Parnate); selegiline (Emsam) |
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Implications of Major Depression for occupational therapy practice in general and relating to pediatrics
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a) Provide opportunities for self-expression with a focus on values, beliefs, spirituality, and emotional regulation.
b) Provide social skills training. c) Assist clients in creating meaningful and satisfying patterns of occupational engagement. d) For clients with suicidal ideation, create a contract for safety. |
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Specific occupational therapy supports for major depression in general and relating to pediatrics
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a) Eliminate decision making to increase activity engagement and reduce stress.
b) Offer simple, structured, familiar tasks. c) Encourage daily routines. d) Arrange for shorter school and work days with reduced tasks and expectations. e) Invite participation; do not force it. f) Keep conversations short and direct. g) Provide a reasonable, just-right challenge. h) Be alert for signs and talk of suicide. |
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Common assessments used for children’s social participation in relation to major depression
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a) Canadian Occupational Performance Measure
b) Knox Preschool Play Scale c) Test of Playfulness d) Social Skills Rating System e) School Function Assessment f) Occupational Therapy Psychosocial Assessment of Learning g) Miller Function and Participation Scales |
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Manic episode Definition in general relating to Pediatrics
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Elevated or irritated mood with at least three of the following characteristic behaviors:
-Grandiosity -Decreased need for sleep -Talkativeness -Flight of ideas -Distractibility -Increased activity -Excessive involvement in pleasurable activities with disregard for consequences |
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Etiology and incidence of Manic Episodes in general and relating to Pediatric
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a) Manic episodes often first appear in the late teens or early 20s and have a rapid, abrupt onset; the prevalence and incidence in children and adolescents are not known.
b) Pure manic episodes without subsequent depression are rare. |
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Prognosis of Manic episodes in general and releating to pediatrics
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a) Independent functioning can be sustained with maintenance treatment.
b) Long-term treatment using medication is typical. |
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Impact on function of Manic episodes in general and relating to pediatrics
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a) Judgment is poor, and clients tend to engage in acting-out behaviors.
b) Impulsiveness and grandiosity interfere with vocational and social activities. c) Hyperactivity is present and impairs functioning during episodes. |
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Treatment options for Manic episodes in general and relating to Pediatrics
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a) Pharmacological treatment: lithium
b) Family therapy c) Brief hospitalization |
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Implications for occupational therapy practice for Manic episodes in general and relating to Pediatrics
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a) Monitor behavior changes, and provide a structured environment to help clients manage behavior.
b) Help clients focus and set limits to contain manic impulses. c) Assist clients in coping with the possibility of chronic illness by learning signs of impending episodes. d) Help clients alter their lifestyle, monitor their symptoms, and involve family members. |
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Specific occupational therapy supports for Manic episodes in general and relating to Pediatrics
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a) Do not engage in arguments.
b) Ignore comments about inflated behaviors and superior skills; encourage client to reengage in task. c) Allow autonomy as much as possible. d) Redirect energies to perform physical activities. e) Offer simple, structured tasks. |
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Hypomanic episode in general relating to Pediatrics
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a) This less severe and disabling form of manic episode appears as excessive energy.
b) Clients show impaired judgment and irritability. c) Clients may present with rapid mood swings from euphoria to irritability, may obtain less sleep than usual, and may not finish tasks started. d) There is no existing literature on specific evaluation and intervention of hypomanic episode for children and adolescents. |
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Dysthymia in general relating to Pediatrics
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a) Less severe depressive symptoms for at least 2 years, with periods of no more than 2 months at a time symptom free
b) May coexist with Axis I (general diagnostic categories) or Axis III (general medical conditions) disorders |
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Etiology and incidence of Dythymia in general and relating to Pediatrics
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a) Occurs in roughly 2.5% of the adult population
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Prognosis of Dythymia in general and Pediatrics
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a) Notable for chronicity; diagnosis can be difficult
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Impact on function of Dythymia in general and relating to Pediatrics
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a) Function is generally impaired; the client may be able to hold a job or relationship but loses interest and often appears lethargic.
b) In children, dysthymia may present as school phobia, difficulty sleeping, and negative behaviors in school. |
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Treatment options for Dythymia in general and relating to Pediatrics
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a) Pharmacological options: selective serotonin reuptake inhibitors
b) Cognitive therapy and psychotherapy c) Play therapy for children |
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Bipolar disorder in general and relating to Pediatrics Definition
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a) Fluctuations in mood with alternating episodes of mania and depression
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Three types of Bipolar disorder in general relating to Pediatrics
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a) Bipolar disorder I: intermittent manic and major depressive episodes
b) Bipolar disorder II: intermittent hypomanic and major depressive episodes with no occurrence of manic episodes c) Cyclothymia (see next section for definition) |
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Etiology and prevalence of Bipolar disorder in general relating to Pediatrics
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a) Genetic influence; clear familial pattern
b) Prevalence of 3.5% in adults, at least half of of whom experience symptoms before age 25; no data available on prevalence and incidence in children and adolescents |
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Prognosis of Bipolar disorder in general relating to Pediatrics
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a) Often a chronic condition; 95% experience recurrence
b) Long-term treatment with psychotropic medication necessary |
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Impact on function of Bipolar disorder in general relating to Pediatrics
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a) Suicidal thinking or behaviors that affect social relationships
b) Intense emotional states that affect performance in school c) Episodes of drastic changes in mood and behaviors that affect relationships with others |
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Treatment options of Bipolar disorder in general relating to Pediatrics
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a) Pharmacological treatment: lithium
b) Group psychotherapy, family therapy, educational and behavioral approaches |
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Implications for pediatric practice
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a) Intervention must be geared toward pervasiveness and persistence of functional deficits.
b) Self-esteem and self-concept are likely to be damaged by the chronic nature of the disorder. The practitioner helps clients identify strengths and weaknesses and likes and dislikes through exposure to a wide range of activities. c) Needed skills may have been lost or never acquired. The practitioner uses educational approaches, social skills training, and cognitive–behavioral approaches. |
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Cyclothymia in general relating to Pediatrics definition
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Episodes of hypomania and depressed mood over at least a 2-year period
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Prevalence of Cyclothymia relating to Pediatrics
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Incidence and prevalence in children and adolescents not known
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Impact on function in general relating to Pediatrics
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a) Less impairment than in bipolar disorder
b) Vocational function impaired during depressed moods c) Social function impaired because of unpredictable mood swings d) Substance abuse a potential problem |
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Implications of Cyclothymia for occupational therapy practice in general relating to Pediatrics
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a) Difficulty with time management may cause clients to overcommit, resulting in interpersonal friction because of inability to meet commitments. Practitioners can provide training in effective use of time and realistic self-appraisal.
b) Clients usually have low motivation and appear “gloomy.” |
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Occupations and activities for clients with mood disorders in general relating to Pediatrics
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a) Improve self-esteem and increase motivation
b) Provide opportunities for self-expression c) Provide outlets for different emotions d) Provide opportunities to focus on values, beliefs, spirituality, and emotional regulation |
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Oppositional Defiant Disorder Diagnostic criteria
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a) Oppositional defiant disorder (ODD) is a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months during which four or more of the following criteria are present (a criterion is met only if the behavior occurs more frequently than typically observed in people of comparable age and developmental level):
-Often loses temper -Often argues with adults -Often actively defies or refuses to comply with adults’ requests or rules -Often deliberately annoys people -Often blames others for his or her mistakes or misbehavior -Is often touchy or easily annoyed by others -Is often angry and resentful -Is often spiteful or vindictive b) The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. c) The behaviors do not occur exclusively during the course of a psychotic or mood disorder. d) Criteria are not met for conduct disorder, and, if the person is age 18 years or older, criteria are not met for antisocial personality disorder. e) ODD is typically diagnosed in preadolescence. f) Attention deficit hyperactivity disorder (ADHD) may occur with ODD, and when ADHD symptoms are controlled, ODD symptoms may improve. |
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Treatment Behavioral therapy for Oppositional Defiant Disorder (ODD)
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a) Consistent expectations and consequences
b) Use of the same behavior program both in the home and at school c) Positive reinforcement system (e.g., stickers or tokens). |
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Five characteristics of optimal treatment for Oppositional Defiant Disorder
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a) Instructions or requests are clear and simple.
b) Time-ins are used to increase pleasant social and physical contact. c) Time-outs are used to decrease pleasant social and physical contact. d) Clients practice positive behaviors in brief, intensive practice sessions. e) Incidental teaching involves catching the client being compliant and rewarding him or her to reinforce the desired behavior |
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Focus of occupational therapy intervention for Oppositional Defiant Disorder
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functional outcomes for the client within context (e.g., home, school, day care, job)
-Following classroom or work rules -Taking direction from other people -Following society’s rules -Ameliorating skill deficits (most pronounced during times of stress) -Using coping strategies to more successfully engage in everyday occupational pursuits -Using self-management strategies such as relaxation techniques (deep breathing) or visualization techniques (Gonyea & Kopeck, 2011) |
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Interventions to improve social skills, problem solving, and anger management for Oppositional Defiant Disorder
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a) Videotape modeling and role-plays of conflict situations
b) Reading and discussion of stories about children who encounter and deal with social problems c) Child-centered intervention, in which the child initiates and directs the activities and the therapist supports the child d) Formation of groups of clients with similar interests to help them cope and practice social interaction e) Socratic questioning to encourage the child to articulate a rationale for his or her decisions f) Behavior management techniques such as recording progress on charts, timeouts, and alternating preferred and nonpreferred activities |
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Interventions for parents of children and youths with Oppositional Defiant Disorder
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a) Teaching parents to attend to and praise their child’s appropriate behaviors and to provide simple and clear commands and use time-outs
b) Teaching parents to use “labeled praise” to reinforce to the child the behaviors that are appropriate c) Role-playing with parents to handle situations at home and in the community (e.g., grocery store) d) Teaching parents stress management skills |
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Interventions in the environment for Oppositional Defiant Disorder
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a) Use of a sensory integration approach to adapt the environment to limit distractions and promote the child’s self-regulation and attention
b) Emphasis on structure and routines |
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Assessment for Oppositional Defiant Disorder
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a) Clients who have experienced failure may not be receptive to engaging in a formal assessment process. The practitioner should take care not to reinforce a sense of failure by pushing the client to take on challenging tasks or encouraging the client to continue an activity when the practitioner notes signs that the client is fatiguing or becoming frustrated.
b) People with ODD are not always truthful and generally do not have insight into their oppositional behavior. They are unlikely to be able to articulate an accurate picture of their behavior. c) Informal evaluation strategies, such as observing the client in his or her natural environment and interviewing the parent or caretaker, are often most appropriate for clients with ODD. |
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AOTA position on violence in the schools relating to Oppositional Defiant Disorder
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a) People who have ODD are at risk for developing conduct disorder, which may include violent behavior. Violent behavior can disrupt participation in occupations and the healthy choice of occupations.
b) Violence can lead to occupational deprivation. c) Replacing poor occupational choices with more productive activities fosters positive change. d) “Occupational therapy practitioners provide services that support a vision of social justice, dignity, and social action throughout the life span by addressing the engagement patterns and lifestyle choices of at-risk youth through methods such as effective transition services and life skills remediation”. |
