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Collaborative goal setting is recognized as a hallmark of good practice in early intervention (EI). This qualitative study describes mothers' and practitioners' perceptions of the utility of the Family Goal Setting Tool: Autism Spectrum Disorder Version (FGST: ASD Version), which supports family identification and prioritization of goals and collaborative engagement in goal setting meetings. Participants included nine mothers and 11 practitioners involved in an autism spectrum disorder--specific EI service in Australia. Participants were interviewed individually or in focus groups, with conversations transcribed verbatim. Inductive content analysis was employed. Four themes emerged with both mothers and practitioners, suggesting the tool facilitated (a) a comprehensive approach, (b) collaboration, (c) goal prioritization, and (d) reduction in stress of goal setting. Practitioners also described the tool as empowering families and enabling family-centered practice. Mothers and practitioners both reported positive impacts of using the FGST: ASD Version and recommended its continued use.

Background: Environments are important to children's participation, but little is known about which environmental factors restrict their participation, particularly in children with moderate to severe developmental disability. Method: Parents of 64 children attending special schools completed the Environmental Restriction Questionnaire (ERQ). Two researchers classified the item contents of the ERQ using the International Classification of Functioning, Disability and Health -- Children and Youth (ICF-CY) to provide uniform interpretation. Results: At home, the environmental restrictions related to Products and technology within the ICF-CY. The environmental restrictions in the community involved 3 areas: Products and technology, Support and relationships, and Services, systems, and policies. The environmental restrictions on children's educational participation originated from Support and relationships and Attitudes of the parents. Conclusions: The findings offer insights into the critical environmental restrictions on the participation of children with developmental disability. Resources and support that target modifiable environmental factors may help to promote children's participation.

Children with developmental disabilities are at risk for limited participation in everyday activities. This study investigated factors that hindered or facilitated participation in 58 children with moderate-to-severe developmental disabilities who attended special schools. The parents completed surveys on their children's participation, developmental profile, environmental restrictions, parental self-efficacy and family demographics. Multiple regression analyses indicated that four variables were identified as strong predictors of specific children's participation and, overall, explained a small-to-moderate magnitude of variance. Social-emotional ability was associated positively with all aspects of children's participation (including diversity, intensity and enjoyment). Children with better communication and those who had only one sibling engaged in a higher number of activities and did so more frequently. The children of parents with higher self-efficacy enjoyed themselves more during participation. The findings provide preliminary information that could be useful for families and health care professionals to facilitate participation of children with moderate-to-severe developmental disabilities.

Background: The Internet is a frequently accessed source of information for parents of a child with autism. To help parents make informed decisions about treatment options, websites should contain accurate information. This study aimed to evaluate the quality of information in a sample of autism-relevant websites. Materials and Methods: Autism-related keywords were entered into three widely used search engines in April 2013 and the 20 most frequently appearing sites identified. Website quality was rated, by two independent raters, using the DISCERN tool. Websites were also coded according to the type of references/sources provided to support the intervention content presented. Results: The mean DISCERN score was 46.5 (range 23-67.5), of a possible 80. Information about treatment risks and no treatment as an option was rarely described. Only six (30%) websites provided research references when describing intervention options. Conclusions: Many websites did not meet criteria for quality health information and failed to cite evidence supporting described interventions. Implications of these findings are discussed.

Threshold concepts were used to underpin a major curriculum reform endeavour in occupational therapy. After rigorous interrogation of troublesome knowledge and ensuring that the emergent concepts conformed to the five characteristics of previously proposed threshold concepts, we identified five threshold concepts. Two years into the rollout of the new curricula, academics participated in two focus groups. Questions focused on staff members' perspectives regarding their use of threshold concepts, and how students engaged with the threshold concepts in assessment activities. The focus groups were transcribed verbatim and analysed using standard qualitative analysis techniques. Peer and member checking ensured the accuracy of interpretations. Three key themes emerged: (1) staff engaged in threshold crossings; (2) threshold concepts conferred many benefits; and (3) students' professional identity evolved. Study limitations and implications for embedding of the threshold concepts in curricula generally and particular courses more specifically will be discussed.

Early intervention (EI) for children with physical disabilities is advocated as a means of enhancing child outcomes and family functioning. The issues confronted by service providers in delivering this support have received relatively little attention. The purpose of this study was to gain an understanding of the experiences of frontline EI staff delivering services to children with physical disabilities and their families. Researchers sought views about the ways in which EI programs provide services, how programs build and maintain relationships with families and team members, the prevalence of changing and unmet family needs, the presence of barriers to optimal service delivery, and recommendations for service improvement. Qualitative interviews with 10 staff members highlighted both positive aspects of service quality and issues encountered in the provision of services. Staff commented favorably on family-centered practice; aspects of service structure/delivery, including offering a wide range of supports, flexible service provision, and the focus on intervening early; and provider-related aspects including teamwork and interagency coordination and appropriate personal qualities and skills. Despite the strong endorsement of EI, participants also identified several challenges: meeting the high demand for services, under and unmet needs, and inadequate funding and staffing.

Background: This qualitative study describes parents' and service providers' experiences in using the Family Goal Setting Tool (FGST). This article looks specifically at the tool's perceived clinical utility during annual, collaborative goal setting. Methods: Participants included eight parents and ten service providers involved in a Family and Early Childhood Service in Queensland, Australia. Participants were interviewed individually (parents and one service provider) or in a focus group (service providers). The transcribed interviews were analysed using standard content analysis techniques. Results: Four key themes emerged including: (i) the facilitation of goal setting, (ii) strengths-based focus, (iii) family centred processes and (iv) family empowerment. Conclusions: Both parents' and service providers' were positive about the FGST. Insights into barriers to holistic goal setting and the clinical utility of the tool are described. Further refinement of the tool and trial in a range of early intervention contexts is required.

Preliminary data supports the effectiveness of Cognitive Orientation to (daily) Occupational Performance (CO-OP) for children with Asperger syndrome (AS). Children with AS often experience social and organizational difficulties spanning daily occupations. This case study explored the pattern of Global Strategies and Domain-Specific Strategies (DSS) use, the type of guidance, and dimensions of time on task used by two children with AS (aged 10 and 12 years) in addressing social and organizational goals during the CO-OP intervention. Coding of the videotaped CO-OP sessions suggested that both children (a) utilized all the Global strategies, particularly "understanding the context" and "plan"; (b) used six common DSS, namely transitional supports, affective supports, attending, task-specification, task modification, and supplementing task knowledge, with task-specification being most prominent; (c) required minimal guidance while "doing"; and (d) engaged in considerable time "talking about the task." The results provide initial insights into strategies that may enable children with AS to achieve social and organizational goals. (Contains 4 tables and 1 figure.)

Background: In recent years, community based therapy service providers have explored different service delivery models to optimize child and family outcomes. This qualitative study aimed to explore parents' experiences of one particular service team that adopted a strengths approach, utilizing natural learning environments. Materials and methods: Nine parents undertook in-depth, semi-structured interviews that were taped, transcribed, and examined using thematic content analysis. Rigour was ensured through peer and member checking, field journals and an audit trail. Results: Several key themes emerged including; families' initial experiences of the service, their views of their child with a disability, their hopes for the future, and their experiences of receiving intervention from the team. Conclusions: Parents were generally positive about the adoption of a strengths approach. "Working together", "being positive" and "information exchange" were the main themes that parents' attributed to their positive experiences with the service.

This study explores the use of occupational performance coaching (OPC) with three parent-child dyads using descriptive case study methodology. OPC is a parent-directed intervention in which parents are coached to improve their own or their children's performance in home and community contexts. In this study, parent and child performance was examined using a pre-post intervention design with the key outcome measures being the Canadian Occupational Performance Measure (COPM) and goal attainment scaling (GAS). Parent experiences of engaging with a therapist using OPC were explored through thematic analysis of interviews with parents after completing intervention. Themes relating to learning, changes at home, and the challenges and rewards of OPC emerged from interviews with parents. Results indicate that OPC may be a useful intervention for therapists seeking to achieve occupational performance outcomes with children and parents. Further research avenues are described. (Contains 2 tables.)

Social skills are necessary for developing successful relationships and promoting learning. "Interpersonal skills" (IPS) are needed for maintaining friendships while "learning-related skills" (LRS) are required for positive classroom behaviours. In this study, we investigated the construct validity of LRS and IPS within two existing assessments: the "Child Behavior Rating Scales" (CBRS) and the "Preschool and Kindergarten Behavior Scales--2nd edition" (PKBS-2). Teachers completed the CBRS and PKBS-2 for 117 Singaporean children aged 3-6 years. Rasch analysis was used to identify items that fit the unidimensional constructs of LRS and IPS within each instrument. Specific items from within the CBRS were found to measure LRS and IPS. Within the PKBS-2, items were found to measure IPS and a new construct labelled "Compliance". Instead of creating new assessment tools to measure new constructs, this study innovatively demonstrated how Rasch analysis can be used to document the existence of new constructs within already existing tools. The identification of new constructs and the use of these tools in an Asian context are presented. (Contains 2 notes and 5 tables.)

Introduction: Students who are enrolled in professional education programs such as occupational therapy may have inherent attitudes towards the future clients they work with. These attitudes may be influenced by the level of their professional education as well as cultural values of their country of origin. Purpose: The purpose of the study was to examine occupational therapy students' attitudes towards individuals with disabilities from an international, cross-cultural perspective and to investigate the possible impact of professional education on students' attitudes. Method: 485 occupational therapy students from 11 university programs (3 from Australia, 3 from the United Kingdom, 3 from the United States, and 2 from Taiwan) completed the "Interactions with Disabled Person's" (IDP) scale. Results: Significant differences were found between occupational therapy students from Australia, Taiwan, the United States, and the United Kingdom on the following IDP variables: overall attitude towards individuals with disabilities, "discomfort", "sympathy", "uncertainty", "coping", "fear", and "vulnerability". Significant differences between first year students as a total group and final year students as a total group were found on their overall attitudes towards individuals with disabilities, "discomfort", and "uncertainty". Conclusion/implications: The attitudes towards individuals with disabilities among first year and final year occupational therapy students varies between countries and the students' year level also impacts on their attitudes towards individuals with a disability. (Contains 3 tables.)

Background: Early intervention services adopting a family-centred approach are considered important for ensuring parent satisfaction. This study investigated the satisfaction of two mothers with an early intervention programme for young children with autistic spectrum disorder. Materials and Methods: While 16 mother-child dyads participated in a larger study, two mothers who reported considerably lower satisfaction with the programme than the rest of the mothers were the focus of this paper. Using descriptive case studies, various child, parent and service delivery factors that may have influenced satisfaction are described. Results: Child and parent factors that may have lessened satisfaction for these two mothers included the child's lack of improvement, child's goal performance post-intervention, parenting stress and decreased parenting competence. Both mothers also had decreased perceptions of the family-centredness of the service and expressed difficulties with establishing collaborative partnerships. Conclusion: This paper proposes that parental satisfaction may be influenced by numerous factors relating to the child, parent and service. Relationships with service providers appear to be particularly important.

The acquisition of social communication skills is a major challenge faced by children with autism. This pilot study investigated the effects of the Stronger Families Project, a social-pragmatic intervention, on the communication and symbolic abilities of 16 children aged 2-4 years with autism. Standardized measures of the child's communication and symbolic behaviour were conducted by independent observers at a university clinic pre and post-intervention, and parents were interviewed to determine the impact of variables such as maternal stress and competence on the child's social communication. Changes in some communication and symbolic behaviours occurred following the Stronger Families Project intervention according to parent report. However, improvements based on ratings by independent observers were not significant. Results are discussed in relation to the assessment of changes in the social communication and symbolic play of children with autism following intervention using clinical observation and parent report. (Contains 2 tables.)

Play is the primary occupation of childhood and provides a potentially powerful means of assessing and treating children with autistic disorder. This study utilized a cross-sectional comparison design to investigate the nature of play engagement in children with AD (n = 24), relative to typically developing children (n = 34) matched for chronological age. Play behaviours were recorded in a clinical play environment. Videotapes comprising 15 minutes of the childrens spontaneous play behaviour were analysed using time-interval analysis. The particular play behaviours observed and play objects used were coded. Differences in play behaviours (p less than 0.0001) and play object preferences (p less than 0.0001) were identified between the groups. Findings regarding play behaviour contribute to contention in the literature surrounding functional and symbolic play. Explanations for play object preferences are postulated. Recommendations are made regarding clinical application of findings in terms of enhancing assessment and intervention by augmenting motivation.

There is little research that reports children's perspectives on physical activity, bodies and health. This paper, drawn from a larger multi-method study on physical activity in the lives of seven- and eight-year-old Australian children, attempts to "give a voice" to 13 children's views. Interviews focused on children's activity preferences and related decision making and motivations pertaining to these activities, as well as how they thought about the relationships between physical activity, health and their bodies. Data suggest some tensions surrounding the importance of fun for children alongside their awareness of "healthist" discourses that require self-monitoring and improvement. (Contains 1 table.)

This paper describes a process of assisting parents of young children with Autistic Spectrum Disorder (ASD) to identify and prioritise their goals for their children's early intervention. A modified version of the Canadian Occupational Performance Measure (M-COPM) was used to facilitate this process. Twenty-two child-parent dyads involved in a home-based early intervention program participated in this study. Parents were able to identify and prioritise three to six early intervention goals for their children. Consistent with the core impairments of ASD, identified goals related to the domains of communication, behaviour, play and social interaction. The M-COPM was found to be a useful tool for enabling parents to identify goals for their children, when used and understood from a strong client and family-centred philosophical perspective. Pre- and post-intervention parent ratings of goal performance and satisfaction are presented to demonstrate the use of the M-COPM as an outcome measure. Implications for practitioners in early childhood and special education settings, and areas for further research, are also discussed. (Contains 2 figures and 1 table.)

Over the past decade, cognitive approaches with children with developmental coordination disorder (DCD) have been investigated. Although studies have focused on intervention outcomes, few have documented the components of the approach that support the enhancement of children's performance. This study used systematic observation of videotaped intervention sessions to identify the frequency and type of strategies that four children with DCD used during a cognitive intervention (CO-OP). The strategies used by younger and older children were compared, with differences found in verbal-based strategy use. Cognitive strategy use appears to be more related to the individual child and intervention goal than to age. (Contains 4 tables and 7 figures.)

While questions of children's engagement in physical activity are being widely debated, little is known about how physical activity is valued and managed within families. This paper reports on qualitative data from a multi-method study on lower primary aged children. The focus of the broader study was to determine the relationships between young children's physical activity patterns, skills, and recreational interests, and their families' location, income, commitment to physical activity, and other responsibilities. Drawing on interviews with 12 purposively selected families, it was found that physical activity was highly valued across different family contexts, that children's engagement was shaped by their interests, friendships, and safety, and that issues such as income, family configuration, parental work commitments, and transport were potential barriers to further engagement. (Contains 1 table.)

A study of 82 preschoolers determined that a new play assessment (Child-Initiated Pretend Play Assessment), which identifies cognitive play skills, possessed acceptable interrater reliability and could discriminate between the play of typically developing preschoolers and those with preacademic problems. (Contains 65 references.) (JOW)

Provides an overview of play in occupational therapy. Examines how occupational therapists' view of play has evolved and offers a model of play as occupation to illustrate how children's ability to play is influenced by developmental disabilities. Also outlines occupational-therapy assessment and treatment practices that use play and identifies aspects of best practice. (Author/DB)

The purpose of this letter to the editor is to comment on a recently published paper in the Journal of Autism and Developmental Disorders, 'An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial' by Schaaf et al. (2013). The authors are commended for undertaking a randomised clinical trial (RCT) examining the efficacy of occupational therapy using sensory integration (OT/SI). The study complies with many of the recommended standards of RCT's including: (a) detailed eligibility criteria, (b) well-matched experimental and control groups, (c) use of gold-standard instruments to measure the symptoms of autism spectrum disorder, (d) the use of functionally relevant outcome measures, (e) fidelity checking, and (f) manualization of the intervention. Additional aspects of rigour that could be considered in subsequent research include: (a) independent blinded measure of observational outcomes, (b) treatment and control interventions of equivalent dose, (c) public access to the manualized treatment guidelines, and (d) the use of a comparison occupational therapy intervention to address the same goals as the OT/SI intervention. Keywords Autism spectrum disorder * Intervention * Sensory functionsDear Dr Volkmar,, We write to comment on a recently published paper in the Journal of Autism and Developmental Disorders, 'An Intervention for Sensory Difficulties in Children with Autism: A Randomized Trial' by [...]