Impact of the Application of Behavioral Principles on Children’s Participation in Occupational Therapy From the Therapist’s Perspective

PURPOSE: One of the most prevalent health concerns in children with special needs is decreased participation in daily routines. Occupational therapy practitioners promote engagement in meaningful daily routines with many children receiving therapy to support and develop skills for performance in everyday occupations (American Occupational Therapy Association, 2014). Children with special needs also demonstrate a high prevalence of challenging behaviors that interfere with learning or play and can place them at risk for future developmental, school, or social problems (Bearss et al., 2015; Maternal and Child Health Bureau, 2013). Applied behavior analysis (ABA) is an evidence-based intervention that significantly reduces or eliminates challenging behaviors in children, yet use of this approach in relation to participation and occupational therapy has not been extensively explored in the literature (Welch & Polatajko, 2016). The purpose of this study was to examine pediatric occupational therapists’ application of behavioral principles in therapy sessions as they progressed through a mentoring program emphasizing the use of ABA principles and their perspective on their clients’ participation in therapy sessions throughout the program.

METHOD: Research was conducted over 12 wk using a mixed methods design with survey and grounded theory methodology. Participants (n = 6) were recruited from a larger convenience sample of occupational therapists who attended a continuing education course offered at a rehabilitation facility that provided instruction in basic ABA principles and strategies. Participants were randomized into a mentoring experimental group (n = 3) or a wait-list comparison group (n = 3). The mentoring provided additional training in the application of behavioral principles for use when a child demonstrates challenging behaviors.

A short self-efficacy survey was administered to all participants at the beginning and end of the study. Using a triangulation approach, data were collected from multiple sources in the experimental group: written reflections, group meeting audio transcripts, and field notes from observations. Thematic analysis was conducted using open, axial, and selective coding to identify concepts and relationships as the therapists progressed through the mentoring process.

RESULTS: All participants entered the study reporting high self-efficacy. The wait-list group demonstrated a slight decline in confidence in use of ABA principles over time, whereas the mentoring group reported a dramatic increase. Several themes emerged from the mentored occupational therapists through the process. Initially, feelings expressed were predominantly negative (e.g., uncertainty). Participants used control and minimizing techniques when attempting to address challenging behaviors rather than shaping appropriate behaviors or targeting on-task performance. As the participants incorporated ABA principles into treatment, they demonstrated successful implementation of behavioral strategies, feelings expressed were more positive, and increased participation by the children was reported.

CONCLUSION: Occupational therapists receiving mentoring demonstrated successful translation of knowledge as they were observed to implement ABA principles such as positive reinforcement, visual schedules, and shaping. Participants reported decreased challenging behaviors and increased on-task performance in therapy sessions.

IMPACT STATEMENT: This study contributes to pediatric occupational therapy by demonstrating successful implementation of an evidence-based approach to target challenging behaviors that affect successful participation. By responding quickly and appropriately to behaviors, occupational therapy practitioners can maximize skill development in children to engage in daily routines.

References

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. https://doi.org/10.5014/ajot.2014.682006

Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., . . . & Sukhodolsky, D. G. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. JAMA, 313, 1524–1533. https://doi.org/10.1001/jama.2015.3150

Maternal and Child Health Bureau. (2013). The National Survey of Children With Special Health Care Needs chartbook 2009–2010. Rockville, MD: Health Resources and Services Administration, U.S. Department of Health and Human Services.

Welch, C. D., & Polatajko, H. J. (2016). Applied behavior analysis, autism, and occupational therapy: A search for understanding. American Journal of Occupational Therapy, 70, 7004360020. https://doi.org/10.5014/ajot.2016.018689