dr maria giatsi clausen [email protected]
TRANSCRIPT
Dr Maria Giatsi [email protected]
The Study
“Occupational therapists perceptions of preterm children’s academic difficulties in the early years of mainstream schooling”
Three-stages, mixed methods study (survey, online discussions, semi-structured interviews)
AIM: To investigate the occupational therapists’ role when working with preterm children with academic difficulties in the early years of mainstream schooling
OBJECTIVESTo document the problems/ difficulties healthy children whowere born prematurely present within their school performance as reported by occupational therapistsTo explore assessment procedures, treatment principles and,specific practices that are employed by occupational therapists while working with these children.To explore occupational therapists’ professional judgements onthe clinical significance of occupational therapy intervention for the above populationTo investigate how occupational therapists (OTs) arrive to certaindecisions when clinical outcome data may be lacking
Quantitative phase: Survey
The study investigated the perceptions of paediatric OTs regarding the type of difficulties with which children born preterm present, and explored the role of OT
Paediatric OTs completed a mail questionnaire (N=353)
The survey was also designed to capture:1. information on the extent of this paediatric population within OT
services, and how identifiable and accessible it is2. OT practices when working with these children3. what informs therapists’ clinical decision making
Qualitative phase: Online discussion groups
The second, qualitative part, used asynchronous, onlinediscussions (N=13), by utilising the virtual environment of WebCT,to further explore the topic
The discussion groups provided a forum for OTs’ reflexive comment on the issues emerging from the questionnaire analysis.
Online discussion groups: a “hybrid mode” of communication
Typed (therefore) written language
Exchange of info that is often informal (as in spoken language); transcripts read as if they were spoken conversation
Advantage: interpersonal involvement and interaction of “oral” discussion along with elaboration and expansion that writing provides
Disadvantage: Loss of spontaneity, superficial coverage of topic (stems from distancing thought from speaker)
Background More children in the preterm group, which attended mainstream
education, required some type of educational assistance, had to repeat a class, or used school services (including OT)
Performance on specific school tasks was poorer among the preterm children
Mathematics was almost the only area where these difficulties remained when considering statistical significance levels, or after controlling and adjusting for the IQ of the children
In the only OT-specific study, handwriting legibility and writing speed scores were found to be significantly lower in the preterm group
Findings: Common difficultiesMost common
difficulties children with SLD, born
preterm, present with
“sensorimotor”“attentional”“perceptual”“visuomotor”“behavioural”
“cognitive”“other”
86.285.675.174.645.342
17.1
Difficulties most commonly
affecting school
“attentional”“visuomotor”
“sensorimotor”“perceptual”“cognitive”
“behavioural”“other”
89.569.468.562.840.940.93.9
! Writing difficulties was also the second most common diagnostic label (83.6%;n=138), for children who were referred to OT services with a specific diagnosis
Affected school areas in children with SLD, born preterm
“writing”“reading”“maths”“motivation”“effort”“other”
93.3656558.953.316.8
1681171171069630
Differences between preterm and full-term children with specific learning difficulties (SLD)
29.4% of the participants (N=53) thought that there were distinct differences in the presenting problems of these two groups
These differences were reported in open-ended format; open-ended data were then “quantified” (content analysis) and categories emerging were entered into SPSS as separate variables.
“Sensorimotor”, “attention”, “perceptual”, “cognitive”, “language” or “psychosocial” difficulties: more frequent in the preterm group
More medical issues and a higher comorbidity of SLD with other conditions
Poorer overall developmental picture More severe difficulties (all types) and a slower progress requiring
more intense intervention
Discussion 1Study findings agree with previously conducted research (Feder etal, 2005)48 preterm children at the age of six to seven years were comparedto that of their matched full-term peersLower scores in handwriting legibility (p<.01) and writing speed(p<.005) for the preterm groupThe preterm group also demonstrated significantly lowerperformance in sensorimotor skills (p<.05)Writing linked to sensorimotor difficulties (p<.05), which appears tobe the main type of difficulties with which preterm children present
Discussion 2Some caution should be also exercised in the interpretation of theabove findings.The preponderance of sensorimotor difficulties, as the type ofdifficulties which might mostly handwriting, refers to a group of components, of
which, visuomotor, is only one. The impact of each of those skills on academic performance ingeneral, and on writing specifically, remains to be studied separately.The preoccupation of OTs with sensorimotor difficulties might alsorelate to the theoretical approach of Sensory Integration, which holds a special
meaning for OTsPossible assumption that these children have SI difficulties to whichhandwriting problems can be ascribed