Date Presented 4/1/2017
The purpose of this study was to assess caregiver-perceived performance and satisfaction with performance of daily occupations in families of children with emotional and behavioral special needs.
Primary Author and Speaker: Shana Cerny
Contributing Authors: Megan Aesoph, Nicki Green, Becky Johnson
PURPOSE: Emotional and behavioral special needs can be understood as any behavior or state of being that interferes with children’s learning, development, and success during their primary occupations of play, education, and social participation. It is important not only to acknowledge the child’s maladaptive responses but also to understand how the child’s performance impacts the family context and functional family performance. Identification of the areas of occupational performance that families perceive to be most problematic is an imperative component of the occupational therapy process.
Past research has focused on the occupational performance deficits of families with children presenting with physical disabilities, while minimal studies have looked at families of children with behavioral and emotional special needs. Therefore, the purpose of this study is to determine the areas of occupation that are most difficult in families of children with emotional and behavioral special needs and to assess caregiver-perceived performance and satisfaction with performance of these daily activities.
DESIGN: A cross-sectional research design was used to analyze the data in this report. These data are part of a larger study examining the effectiveness of the Trust-Based Relational Intervention® in facilitating occupational performance change within the family context in a sample of caregivers of children with behavioral and emotional needs. This report is focused on pretest subjective occupational performance data. Study participants included parents of a child or children with emotional and/or behavioral special needs who had experienced at least one early risk factor, such as difficult pregnancy or prenatal trauma (maternal), difficult birth, early hospitalization, abuse, neglect, or trauma.
METHOD: Data were collected through interviews with the primary investigator via teleconference or face-to-face meeting following informed consent. The Canadian Occupational Performance Measure (COPM) was used prior to initiation of the program as part of a comprehensive evaluation. A trauma-informed framework was applied to analyze the areas of occupation identified as most problematic.
RESULTS: Participants prioritized 14 activities that they perceived as difficult to perform (M = 3.29, range = 1–7) and rated their current satisfaction with performance (M = 1.56, range = 1–5). Of these, 13 (46%) were in the COPM area of self-care, seven (25%) in productivity, and eight (29%) in leisure. The lowest mean rating of performance was found in the leisure subgroup (M = 2.88). However, the lowest satisfaction with current performance derived from the self-care subgroup (M =1.31).
CONCLUSION: Families of children with emotional and behavioral special needs can experience problems with all types of daily activities; however, social participation both within and outside of the family, mealtime, and transitioning between environments were identified by multiple participants as areas of low performance and satisfaction. By combining the knowledge of neurodevelopment and activity analysis in response to each area of occupation, intelligibility regarding the function of the child’s behavior and the supports needed can promote improved family occupational performance as the parents are able to see through the behavior and meet the deeper needs of their child through connection and empowerment.
References
Perry, B. D. (2008). Child maltreatment: A neurodevelopmental perspective on the role of trauma and neglect in psychopathology. In T. Beauchaine & S. P. Hinshaw (Eds.), Child and adolescent psychopathology (pp. 93–129). Hoboken, NJ: Wiley.
Purvis, K. B., Cross, D. R., Dansereau, D. F., & Parris, S. R. (2013). Trust-Based Relational Intervention (TBRI): A systemic approach to complex developmental trauma. Child and Youth Services, 34, 360–386. https://doi.org/10.1080/0145935X.2013.859906
Purvis, K., Mittie, S., Kellermann, G., & Cross, D. (2011). Neurotransmitter levels in at-risk adopted children. In National Council for Adoption (Ed.), Adoption factbook V (pp. 491–496). Alexandria, VA: National Council for Adoption.
Thomas, H. (2015). Occupation-based activity analysis (2nd ed.). Thorofare, NJ: Slack.
