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Cognition is a critical part of performance and participation across daily life activities (Katz & Toglia, 2018). Children who have known conditions such as developmental delay, prematurity, cerebr...

Aim: This article is the second part of a systematic review updates and broadens a previous systematic review (Frolek Clark & Schlabach, 2010) to examine the evidence for of interventions within th...

Occupational therapy practitioners working in school settings must articulate their distinct value in supporting student participation and educational performance. Using a systems-level practice, t...

A survey of 955 early childhood practitioners in one Midwestern state was conducted to assess judgments of their desired use versus their current use or implementation of 10 sets of recommended practices from the Division for Early Childhood of the Council of Exceptional Children. Practitioners from early intervention, preschool, preschool special education, Early Head Start, Head Start, and other early childhood programs participated in the study. Results indicated large effect size differences in practitioners’ judgments of their desired versus current use of the practices, differences in terms in which practices were considered most valued and most frequently used by the practitioners, and a continued gap in the use of practices compared with results reported in similar studies conducted 15 and 22 years ago, respectively. The findings are discussed in terms of the need to adopt and use effective professional development practices to ensure practitioner use of valued practices and the need to develop a comprehensive system of personnel development to provide an infrastructure to support practitioners’ knowledge and skills of recommended practices.

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. This article presents a case example of a young child with autism spectrum disorder who receives occupational therapy evaluation and intervention in natural environments (home and child care center). Systematic review findings supporting enhancement of key life occupations through interventions to develop cognitive, motor, social–emotional, and self-care skills for young children were published in AOTA’s Occupational Therapy Practice Guidelines for Early Childhood: Birth–5 Years (Frolek Clark & Kingsley, 2020) and the March/April 2020 issue of the American Journal of Occupational Therapy (Gronski & Doherty, 2020; Kingsley et al., 2020; Tanner et al., 2020). Each article in the Evidence Connection series applies evidence from the published reviews on a topic to a related case. These articles are designed to promote application of the evidence to practice.

Importance: This Practice Guideline provides stakeholders with a condensed summary of a large number of effectiveness studies. It is a valuable tool for facilitating decision making related to occupational therapy interventions for children ages birth–5 yr. Objective: Early childhood (birth–5 yr) is a critical period in which the foundation of key life occupations is developed (e.g., eating, dressing, play, learning, social participation, rest and sleep, and chores). The development of cognitive, motor, social–emotional, and self-care skills is important to support these occupations. This Practice Guideline synthesizes recent systematic reviews (SRs) on these areas of development to promote decision making for and high-quality interventions with this population. Method: Four SRs related to cognition, mental health, motor function, and ADLs analyzed studies published from 2010 to 2017 retrieved from six electronic databases (MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane). Results: A total of 196 articles were included in the SRs, which served as a guide to final clinical recommendations. Case studies describe translation and application to practice. Conclusions and Recommendations: A variety of interventions within the domain of occupational therapy were found to support the development of cognitive, social–emotional, motor, and self-care skills. Although some of these interventions are typically implemented by occupational therapy practitioners, others can be implemented by parents after training or by teams working in preschool settings. These findings should be used to inform evidence-based practice provided by occupational therapy practitioners working in various early childhood settings. What This Article Adds: This Practice Guideline gives occupational therapy practitioners clear information about which interventions will be effective for specific outcomes. Better intervention choices mean better outcomes for young children and their families.

Nationally, student proficiency in reading and writing is very low and requires ongoing focus from state and local agencies. With almost 25% of occupational therapists working in early intervention and school settings (AOTA, 2015), their role of facilitating literacy (e.g., reading, writing, speaking and listening) is critical. Occupational therapy practitioners support the development and growth of literacy at the system, home or school, and individual levels.

Findings from research syntheses of adult learning and in-service training studies identified the importance of professional development as a factor influencing practitioner use of recommended and evidence-based intervention practices. These relationships were used to test the hypothesis that practice-specific evidence-based capacity-building professional development would be related to early childhood practitioners’ reported use of recommended early childhood intervention practices. The participants were practitioners working with birth to 3-year-old, 3- to 5-year-old, or birth to 5-year-old children with identified disabilities, developmental delays, or at-risk conditions in home-based or center-based programs or both. The predictors included three practitioner background variables (e.g., years of professional experience) and three professional development variables (e.g., evidence-based professional development practices). Results indicated that the three professional development practice variables accounted for significant amounts of variance in the practitioners’ reported use of 10 different practices beyond that accounted for by the three background variables. The findings highlight the importance of evidence-based capacity-building professional development as a factor influencing practitioners’ judgments of their use of recommended practices.

To identify the relationship between early reading and writing performance, 48 kindergarten students (M age = 74.23 months) were assessed during the second semester. Significant correlations were found between reading, handwriting, fine-motor, and visual-motor measures. The scores of students in the At Risk reading group were significantly lower in handwriting, fine-motor, and visual-motor measures than students in the At Grade Level–reading group. Predictors of alphabet writing included student age, name writing, and initial sound fluency. Predictors of name writing included student age, alphabet writing, and visual-motor integration tests.

Evidence Connection articles provide case examples of how practice decisions may be informed by findings of systematic reviews sponsored by the American Occupational Therapy Association Evidence-Based Practice Project. This Evidence Connection article is the second article in a two-part series. The first article described a case report of occupational therapy provided to a child with a diagnosis of autism spectrum disorder and challenges in sensory integration in a clinic setting (Parham et al., 2019). This article describes the same child’s occupational therapy service delivery by the occupational therapist working in the school setting.

Evidence Connection articles provide case examples of how practice decisions may be informed by findings of systematic reviews sponsored by the American Occupational Therapy Association (AOTA) Evidence-Based Practice (EBP) Project. This Evidence Connection article describes a case report of a child with a diagnosis of autism spectrum disorder who has difficulties in function and participation related to challenges in sensory integration. This article is the first in a two-part series, and it focuses on occupational therapy provided to the child by a clinic-based therapist in collaboration with the child’s school-based occupational therapist. Part 2 in this series will describe the same child’s intervention by the school-based therapist. Intervention decisions are informed by findings of systematic reviews of intervention effectiveness that were part of an AOTA EBP Project addressing occupational therapy interventions for children and youth with challenges in sensory integration and sensory processing.

Occupational therapists working in early intervention and schools bring a unique perspective regarding child development and occupational performance to the table. The occupational therapy theories and frames of reference that guide pediatric practice are a key part of the occupational therapy domain and process. Occupational therapists need to carefully select appropriate theories and frames of reference to guide practice, given the unique needs of the children and students they serve.

This systematic review examines the evidence for the effectiveness of cognitive and occupation-based interventions to improve self-regulation in children and youth who have challenges in processing and integrating sensory information. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guided the methodology. Five studies identified through a comprehensive database search met the inclusion criteria and were separated into categories of cognitive and occupation-based interventions. Articles that did not specifically measure sensory integration (SI) or processing challenges were omitted. Synthesis of the articles suggests that self-regulation (e.g., sensory processing, emotional regulation, executive functioning, social function) improved with cognitive and occupation-based interventions. Because the number of studies that measured sensory processing or SI challenges was limited, researchers are encouraged to include these measures in future research to understand the impact of a broader range of cognitive and occupation-based interventions.

This systematic review examined the research evidence for interventions used by occupational therapists to improve cognitive development in children from birth to age 5. Thirteen studies met the inclusion criteria and were reviewed by three teams of two people. From the selected articles, which described Level I and IV studies, two general categories emerged: (1) developmental interventions and (2) joint attention interventions. Developmental interventions occurred in neonatal intensive care units, home, child care centers, and preschools. Synthesis of the articles indicates that developmental interventions result in gains in early cognitive development (e.g., infant and preschool age) with inconclusive evidence for gains through school age. Educating parents of preterm infants to be more sensitive to their child’s needs and more responsive in interactions increased cognitive outcomes and joint attention. Interventions using joint attention enhanced generalization to novel situations and increased play, language, and social interactions in preschoolers with autism. Further studies that describe intervention strategies used to enhance cognitive functioning to promote preliteracy skills such as joint attention, imitation, memory, problem solving, and decision making and are conducted by occupational therapists are needed.

We examined the research evidence for interventions used in occupational therapy to promote the motor performance of young children ages 0–5 yr. We identified 24 trials, Levels I–III, that met our review criteria. The studies fell into three categories: (1) developmental interventions for infants (ages 0–3 yr), (2) interventions for young children with or at risk for cerebral palsy (CP), and (3) visual–motor interventions for preschool children (ages 3–5 yr). Developmental interventions showed low positive short-term effects with limited evidence for long-term effects, and findings on the benefits of neurodevelopmental treatment were inconclusive. Interventions using specific protocols for children with CP resulted in positive effects. Visual–motor interventions for children with developmental delays (ages 3–5 yr) resulted in short-term effects on children’s visual–motor performance. Of the intervention approaches used in occupational therapy, those that embed behavioral and learning principles appear to show positive effects.

Educational practice is moving away from an “eligibility-oriented” student–problem approach toward a problem-solving approach that connects evaluation and interventions. This approach involves the identification of variables used to frame interventions, and, ultimately, it permits evaluation of intervention effectiveness. This article describes a problem-solving model developed and used within the Heartland Area Education Agency. This model relies on collecting baseline data and ongoing data, producing a basis not only for decision making, but also for evaluating the chosen intervention. This systematic and collaborative approach is used by the educational team to identify concerns about students’ academic and nonacademic performance, to plan interventions, and to establish measurable outcomes.

AOTA recognizes SI as one of several theories and methods used by occupational therapists and occupational therapy assistants working with children in public and private schools. Regardless of the theories and methods utilized, occupational therapy practitioners work within the framework of occupational therapy toward the desired outcome of health and participation through engagement in occupations that allow participation in a child's daily life (AOTA, 2008). When children demonstrate sensory-related deficits that interfere with their ability to access the general education curriculum, occupational therapy using a sensory integrative approach is appropriate.

These guidelines about supervision, roles, and responsibilities are to assist in the appropriate utilization of occupational therapists, occupational therapy assistants, and occupational therapy aides and in the appropriate and effective provision of occupational therapy services. It is expected that occupational therapy services are delivered in accordance with applicable state and federal regulations, relevant workplace policies, the Occupational Therapy Code of Ethics (AOTA, 2005), and continuing competency and professional development guidelines.

These guidelines about supervision, roles, and responsibilities are to assist in the appropriate utilization of occupational therapy personnel and in the appropriate and effective provision of occupational therapy services. All personnel are expected to meet applicable state and federal regulations, adhere to relevant workplace policies and the Occupational Therapy Code of Ethics (AOTA, 2000), and participate in ongoing professional development activities to maintain continuing competency.

Based on the educational team recommendations, occupational therapists and occupational therapy assistants working in educationally related settings provide services to students who are eligible for Section 504 or special education under IDEA and need occupational therapy to benefit from their education program. It is the occupational therapist's responsibility to develop an intervention plan based on the student's needs and the therapist's professional knowledge base. The occupational therapist chooses and applies any frame of reference within the domain and process of occupational therapy. Regardless of the frame of reference utilized, the desired outcome of occupational therapy services is always engagement in occupations that allows participation in a student's daily life. When students demonstrate deficits in sensory integration that contribute to a significant and documented discrepancy in their skills within their educational program, the use of a sensory integrative approach may be one frame of reference for, intervention chosen by the occupational therapist.