Abstract
This study highlights the contribution of perceived autonomy in everyday activities to children’s involvement and persistence in cognitive tasks by providing empirical data on children’s persistence regarding executive functions and perceived meaning of occupations. Occupational therapists can promote children’s involvement and persistence by supporting a sense of autonomy in everyday activities, although further study is needed.
Persistence is an intrapersonal mental function, defined as a “disposition to act with an appropriately sustained rather than limited effort” (World Health Organization [WHO], 2007, p. 49). Persistence was recently described as a behavioral component of involvement in activities and therefore may contribute to optimal participation (Imms et al., 2017). In spite of its relevance to participation, a systematic review revealed that no study has yet assessed persistence on task in the context of the occupational therapy literature (Imms et al., 2016). In the social sciences literature, Peterson and Seligman (2004) defined persistence as a voluntary continuation of a goal-directed action despite obstacles, difficulties, or discouragement (p. 229). They highlighted the benefits of persistence on task and its associations with intrapersonal factors such as self-regulation, effortful control, mastery motivation, conscientiousness, and executive function (EF) skills. There is no standardized test for persistence. The examiner usually observes the child performing a challenging task, such as puzzles of increasing complexity and fine or gross motor skill challenges (e.g., Green & Morgan, 2017; Torgrimson, 2018), and records the amount of time spent on on-task or off-task behaviors within a limited time frame, usually no more than 15 min.
EFs are “specific mental functions . . . including complex goal-directed behaviors, such as decision making, abstract thinking, planning and carrying out plans, mental flexibility, and deciding which behaviors are appropriate under what circumstances” (WHO, 2007, p. 57). The components of EFs, such as working memory, planning, and flexibility or shifting, are crucial to the everyday functioning of children and adolescents (Josman & Meyer, 2019). Therefore, the association between EFs and persistence on task is understandably expected. Research has shown that children who had higher scores on a test that involved working memory, inhibition, and shifting persisted longer to solve a complex puzzle (Torgrimson, 2018). However, other variables may contribute to persistence on task as well.
The perceived meaning of occupation is a multidimensional construct that encompasses the emotional and cognitive qualities people attach to their occupations. According to the literature, dimensions of meaning include the perceived importance and difficulty of, and the sense of autonomy and enjoyment experienced by engaging in, activities or occupations (Rosenberg et al., 2019). One can assume that children persist longer on valuable, challenging activities that provide them with a sense of control and autonomy (Vänska et al., 2020) and that the ability to persist—to carry on with task-related behaviors despite difficulties or obstacles—can inspire children to attach positive meaning to their everyday activities and thus contribute to their optimal participation. However, the associations between these constructs have not yet been studied. Therefore, the purposes of the current study were (1) to describe persistent children, in comparison with their less persistent peers, in terms of age, sex, EFs, and their perceived meaning of occupations and (2) to assess whether these intrapersonal factors can predict persistence until the goal has been achieved (task completion). I hypothesized that (1) there would be differences in EFs and perceived meaning of occupations between children who persist and those who do not and (2) intrapersonal factors will predict group membership (task completed or not completed).
Method
Participants
A convenience sampling method was used. Caucasian children (N = 180; 87 boys and 93 girls), with a mean age of 9 yr, 7 mo (SD = 1 yr, 7 mo; range = 6 yr– 12 yr, 6 mo), and their parents were recruited by word of mouth. All of the children were attending mainstream schools (first to third grades, n = 90; fourth to sixth grades, n = 90) in Tel Aviv, Israel. Children with any medical or developmental disabilities, as reported by their parents, were excluded from the study. Most families (78%) lived in the inner city, and 22% lived in the suburbs. Most families (87%) had an average income or higher for the region. Most parents (80%) had an academic degree (M yr of education = 16.33 yr, SD = 2.08).
Measurements
Tower of Hanoi Task
The Tower of Hanoi task (TOH; Borys et al., 1982) is an instrument for studying EFs such as problem-solving and planning abilities. The player must transfer discs from bar to bar to build a tower (of three to seven discs) according to simple rules. The minimum number of moves to solve a problem is 2 n – 1, where n is the number of discs. A computerized version of the TOH was found to have good validity (Robinson & Brewer, 2016).
In the current study, a commercial app for Android or iPhone was used. The first problem, which involved three discs, was used to assess children’s problem-solving and planning abilities. The last problem, which involved seven discs (TOH–7), was used to assess persistence on task. A minimum of 127 steps is required to solve this problem. The two final scores are denoted as follows: (1) TOH–7 completion, a dichotomous variable that indicates whether the child persisted until the task was completed or gave up before achieving the goal, and (2) TOH–7 steps, a continuous variable that indicates the total number of steps performed before the child chose to quit or completed the task (for more details, see the Procedure section).
Perceived Meaning of Occupation Questionnaire
The Perceived Meaning of Occupation Questionnaire (PMOQ; Rosenberg et al., 2019) is a self-report instrument that was designed to assess children’s perceived meaning of everyday activities. The PMOQ uses simple language and visual aids (happy or unhappy faces, stars, and animated clocks) to illustrate possible answers. It contains 30 activities (activities of daily living, instrumental activities of daily living, sleep, social participation, play, leisure, and education). For each activity in which a child participates, they are asked to respond to four questions: (1) “Is this activity important to you?” (rated on a 3-point scale: 3 = very important to me, 2 = not so important to me, 1 = not important to me at all), (2) “Is this activity difficult for you?” (3 = very difficult for me, 2 = not so difficult for me, 1 = not difficult for me at all), (3) “How does the time pass for you?” (3 = time passes quickly, 2 = time passes neither quickly nor slowly, 1 = time passes slowly), and (4) “Did you choose this activity, or were you obliged to do it?”
The PMOQ final scores are as follows: The mean score for importance is designated by the term Value—the sum of importance divided by the number of activities in which the child participated. A higher score indicates that the child attributes greater importance to their everyday activities. The mean score for difficulty is designated by the term Challenge—the sum of difficulty divided by the number of activities in which the child participates. Higher scores indicate that the child perceives their everyday activities as more difficult. Sense of Time is the term designated for the mean score for the perceives sense of time passing. Higher scores indicate that the child experiences time as passing faster while participating in everyday activities. Autonomy is the term designated for the difference between the number of activities a child “chooses to do” and the number of activities they “must do.” Higher scores indicate that the child experiences more autonomy in their everyday activities. The PMOQ’s construct validity was demonstrated by correlations with dimensions of participation (Rosenberg et al., 2019) and associations with the child’s EFs and socioemotional characteristics (Rosenberg & Avrech Bar, 2020). Adequate internal reliability was found for the present sample (Cronbach’s α = .76).
Verbal Working Memory Test
In the Verbal Working Memory test (VWM; Shany & Share, 2011), the respondent is asked to fill in a missing word in a sentence (e.g., “The elephant is big, the mouse is . . .”) and to recall, in the correct order, a set of two to five missing words. The respondent earns 1 point if he or she repeats all the words in the correct order (for a maximum of 12 points). The test ends after two consecutive failures. In this study, the VWM was used as a measure of working memory, a dominant component of EFs.
Procedure
Ethical approval was obtained from the departmental ethics committee at Tel Aviv University. Data were collected by occupational therapy students trained and supervised by me. Parents who agreed to take part in this study gave their informed consent for participation and self-completed a sociodemographic questionnaire at their convenience. Each child was assessed individually in a quiet room at the child’s home using the TOH with three discs (TOH–3), the VWM, and the PMOQ. Finally, to assess persistence on task, the child performed the TOH-7. The children were instructed that they could stop their participation whenever they wished.
Data Analysis
To explore all the research variables, I used descriptive statistics. To test for normality, I used the Shapiro–Wilk test. To test group differences (task completed or not completed), I used a Mann–Whitney U test. A logistic regression analysis was used to predict group membership and to explain the dependent variable as a function of multiple independent variables. Measures that showed a significant difference (p < .05) between the two groups were entered into a logistic regression model (Wald regression model). In the regression model, group (task completed vs. not completed) was the dependent variable, and the independent variables (based on the results of between-groups differences analysis) were child age, TOH–3, VWM, and PMOQ perceived autonomy. The level of significance was set at .05 for all statistical tests.
Results
Descriptive Statistics
Twenty-six children (14%) completed the task. There was no difference between the groups by sex. Eleven boys and 15 girls completed the task, and 76 boys and 78 girls chose to stop before completion of the task, χ2(1) = 0.44, p > .05. The children who completed the task were older than those who did not (M age = 10.35 yr, SD = 1.61, and M = 9.46, SD = 1.60, respectively), t(178) = 2.61, p < .05. The differences between the groups are presented in Table 1. As can be seen, the children who completed the task performed better on EFs tests (TOH–3 and VWM), but they did not perceive their everyday activities as less challenging or more important. However, they experienced more autonomy in their everyday activities.
Median, Range, and Mann–Whitney Test Results for Group Differences
Note. N = 180. Mdn = median; moves = minimum number of moves to solve the problem (2 n – 1, where n is the number of discs); TOH–3 = Tower of Hanoi, three disks; TOH–7 = Tower of Hanoi, seven disks; VWM = Verbal Working Memory test.
p < .01.
p < .001.
Logistic Regression Analysis
Table 2 presents the results of the logistic regression analysis that examined whether child’s age, EFs, and perceived autonomy of occupations predicted group membership (task completed or not completed). The overall model was statistically significant, R 2 = .21, χ2(4) = 22.99, p < .001, and correctly classified 86% of the cases. Only autonomy had a unique statistically significant contribution to the model. The odds ratio was 0.88, meaning that each additional point in the autonomy score increased the probability of persisting at completing the task by 12%. Other independent variables did not contribute significantly to the regression model (see Table 2).
Logistic Regression Model Prediction of Completing or Not Completing the Task
Note. N = 180. CI = confidence interval; TOH–3 = Tower of Hanoi, three discs; VWM = Verbal Working Memory test.
p < .01.
Discussion
The results show that the children who persisted longer and completed the task were older than those who chose to stop before completing the task. Also, they performed better on the EFs tests (TOH–3 and VWM); however, only perceived autonomy of occupations was found to be a statistically significant predictor of group membership.
Previous studies have revealed associations between EFs and persistence on task among children (Oeri et al., 2020; Torgrimson, 2018). Similarly, in the current study children who completed the task needed less time and fewer moves to solve the TOH–3, meaning that they had better planning ability as well as better working memory. Equipped with these skills, the children could persist until they solved the TOH–7 (a minimum of 127 moves). However, the results revealed that EFs (working memory and planning) alone did not predict persistence. In contrast, persistence was predicted by a sense of autonomy in everyday activities.
The current results are compatible with previous findings showing that competence does not promote motivation and persistence unless it is accompanied by a sense of autonomy (Ryan & Deci, 2000). Autonomy, within the very well-known theory of self-determination, is defined as a basic psychological need for feeling agency and choice. The theory was adopted by pediatric occupational therapists to explain occupational development and performance (Smet & Lucas, 2020). A competent child who succeeds in performing a task is more likely to persist. Yet, at least for children in Western cultures, the sense of having a choice can promote motivation to endure (Bao & Lam, 2008).
Of note is that in the current study the perceived meaning of challenge, value, and sense of time experienced while engaging in everyday activities did not predict children’s persistence. Although the children who chose not to complete the task had lower EFs, they did not perceive everyday activities as more challenging or less valuable; neither did they sense the passing of time differently. A possible reason is that all were children with typical development who perceived the challenge in everyday activities as relatively low. Moreover, willingness to persist may not necessarily depend on one’s perceived value of the task at hand or its accompanying enjoyment, reflected by a perceived sense of time. According to previous findings, children may be motivated to engage and persist in activities that are valued by significant others (Bao & Lam, 2008; Smet & Lucas, 2020).
Limitations
In this study, I assessed persistence on only one cognitive task; therefore, I could not control for persistence by activity type. Moreover, the TOH–7 may be too challenging for young children, which may have influenced the results. Further studies should consider children’s age more carefully. In addition, I did not assess intrapersonal factors, such as self-efficacy or perceived competence, that might contribute to a child’s persistence. The generalizability of the findings is also limited because of the participants’ sociodemographic backgrounds. Most of the children had relatively educated parents with an average or above-average income. Further studies with diverse populations are warranted.
Implications for Occupational Therapy Practice
This study has the following implications for occupational therapy practice: Occupational therapy practitioners can promote children’s involvement and persistence on task by supporting their sense of autonomy in everyday activities. Occupational therapy practitioners can consider persistence on task, in terms of time and effort, as an expression of a child’s involvement in the activity and a possible pathway for enabling optimal participation.
Conclusion
Perceived autonomy in everyday activities is crucial for task persistence. Occupational therapy practitioners can promote children’s involvement and persistence in cognitive tasks by supporting a sense of autonomy in everyday activities, although further study is needed.
Footnotes
Acknowledgments
I thank all the parents and children who gave their consent to participate in the study and all the devoted occupational therapy students who took part in the data collection.