Abstract
Core concepts in occupational therapy have often developed over time with contributions from multiple clinicians and scholars. This makes it difficult to determine exactly from where, or from whom, ideas originated. Without original sources, we cannot chart the historical development of ideas and honor those whose scholarship made it possible. This article documents the process undertaken to properly cite one such common concept in occupational therapy, the just-right challenge; illustrates the value of doing so; and advocates for the importance of thorough historical scholarship.
The authors discuss the process of properly citing the just-right challenge, a core concept in occupational therapy, and highlight the importance of thorough historical scholarship.
Core concepts in occupational therapy, such as the just-right challenge, often have developed over time with contributions from multiple clinicians and scholars. When multiple avenues of thought coalesce, a complex nexus is created that lends itself to continued evolution and growth but also makes it difficult to determine exactly where, or from whom, ideas originated. Therefore, properly citing the original source of concepts or ideas can become a task that necessitates delving deeply into the literature. However, in this age of internet searches that yield hundreds of thousands of hits, an explosion of research literature, scientific concepts being discussed on nonscientific websites, and limited electronic access to historic sources, these deep dives into scholarly literature may be burdensome and infrequent, to the detriment of the profession. Add to this the propensity to cite only current literature (i.e., within the past 5–10 yr; Jhangiani & Chiang, 2015; Santini, 2018; Southern New Hampshire University, Shapiro Library, 2023; The Writing Center, University of North Carolina, 2022), and the origin of concepts can become blurred or completely obscured from view. Without original sources, we cannot chart or map the historical development of ideas. As a result, current understanding, as well as future research and theoretical development, is hampered. However, reviewing original sources upholds the timeless value of our core concepts, which stand in contrast to new ideas that have yet to be thoroughly developed and assessed for their potential value and often are transitory.
This conclusion emerged from our journey to properly cite one such common concept in occupational therapy, the just-right challenge. This concept originally was designed to address the fundamental question of how to best motivate clients to engage in development-facilitating or health-promoting activity (Burke, 1977). We hope that in this column we will build an appreciation of the concept of the just-right challenge and those responsible for its emergence. We also hope that this column will serve as a general call to action for embracing thorough, historical scholarship related to notable concepts in occupational therapy.
The Professional and Scholarly Purposes of Citing Conceptual Origins
The process of properly citing original work has multiple purposes. As a practical matter, one cites to avoid plagiarism. This is the rationale commonly taught to students as they learn the methods of proper citation. However, a broader ethical reason to cite is to rightly honor the work of others in influencing one’s current thought and ability to draw sound conclusions that support one’s own conceptual work. This is a scholarly obligation, or a paying of a debt to those who have influenced one’s thinking (Kennedy & Planudes, 2020).
A less often discussed value of citation, however, is in demonstrating the longevity and importance of an idea to the profession. By referencing essential works, we actively confer value by legitimizing ideas, solidifying theories, and establishing claims as facts (Penders, 2018). As stated in Penders (2018),
Citation practices create value by tying together relevant scientific contributions, regardless of whether they are large or small. In the process, they confer or withhold credit, contributing to the relative status of published work in the literature. . . . Referencing is not a neutral act. Citations are a form of scientific currency, actively conferring or denying value. Citing certain sources—and especially citing them often—legitimizes ideas, solidifies theories, and establishes claims as facts. (paragraph 4)
Some concepts are seen as currently fashionable and sensational, “but they are not necessarily the concepts and results that last and prove truest over time as further research broadens knowledge” (Tetzner, 2021, para. 3). Work that is cited over many years establishes its enduring quality (Luzar et al., 1992), marks a successful scholarly career (Tetzner, 2021), and provides substance for strengthening occupational therapy and occupational science.
When ideas are complex, take years to fully develop, or are influenced by a multitude of individuals and scholars, a quite practical purpose of citation is to allow others to follow the threads through the development of the concept, science, or thought. By going back to original sources, a scholar is best enabled to make their own conclusions about the concept, its meaning, and its impact. One such concept in occupational therapy is the just-right challenge. This term’s undeniable importance to occupational therapy and its continued and evolving impact on practice over the course of decades merits the finding of its origins and properly crediting those who first coined the phrase for an idea that has become so central to our profession.
An Essential Occupational Concept: The Just-Right Challenge
The concept of the just-right challenge provides occupational therapy practitioners a means to convey the complexity of devising therapeutic opportunities for the people they treat and offers occupational scientists a means to create theory and build science. Establishing a just-right challenge concerns the critical practice dilemma of how to address a client’s perception that they cannot participate in an activity or that the activity is too difficult to try. Identification of the just-right challenge engages a client by skillfully combining an understanding of the uniqueness of that individual (including their likes, dislikes, interests, abilities, values, environment, etc.) and the particular difficulty they are facing, with recognition of the next achievable step in gaining skills for that person (Ayres, 1972a; Burke, 1977; Rogers, 1982; Yerxa, 1990, 1998). The just-right challenge is designed to require a level of difficulty that necessitates some persistence but also ensures that the client is motivated and will succeed. The actual practice of clinically implementing a just-right challenge involves an individualized occupational analysis to select or adapt activities to engage a client for maximal participation.
“The just-right challenge” is a ubiquitous phrase in our profession. A quick search in Google Scholar yielded more than 1,000 articles and book chapters that use it either in the title or body of the work. In occupational therapy, the concept has become almost synonymous with therapeutic reasoning for selecting or crafting appropriately difficult activities that will best serve clients. The concept has been discussed by occupational therapists in relation to play and sensory integration for children (Gaylard, 1966; Lindquist et al., 1982; Mack et al., 1982; Michelman, 1974), the flow state (Jacobs, 1994; Rebeiro & Polgar, 1999), as a staple of occupational therapy practice (Burke, 1977; Christie, 1999; Hinojosa, 1994; Rogers, 1982; Yerxa, 1994), and for specific use with adolescent and adult clients (Jackson, 1990; Neistadt & Seymour, 1995; Zemke, 1986). The phrase then migrated outside of the United States and found its way into literature in Scandinavia (Bränholm & Erhardsson, 1994) and Australia (Christie, 1999). It is also used in literature outside occupational therapy, for example, learning (Xu & Metcalfe, 2016), clinical education (Isbel et al., 2021), and dance (Hewston et al., 2022).
Citing the Just-Right Challenge: A Search for Its Origins
Crediting the just-right challenge became a problem for us when we needed to find an accurate and appropriate citation to use for a new textbook (Kuhaneck & Spitzer, 2023). Finding a quote should be a simple, common, and routine task. In this case, it was no ordinary technical task because a single quote alone would belie its true origin. To investigate and better understand the genesis of the term just-right challenge, we reviewed a number of references and had discussions with many of the earliest users of the phrase. Thus, we found ourselves pulled into quite an interesting and complex history regarding the conceptual development of the term.
Our background as pediatric occupational therapists who had specialized in Ayres Sensory Integration® made us most aware of the term’s common attribution to A. Jean Ayres in relation to sensory integration theory and intervention. However, we noticed that none of the citations provided a page number for their support even when using the term just-right challenge within quotation marks. From here, our search took a turn, and we began with reviewing two of Ayres’s original books: Sensory Integration and Learning Disorders (Ayres, 1972a) and Sensory Integration and the Child (Ayres, 1979). The exact phrase was not found in either of these works, although the concept clearly was present. So, we broadened our search.
Looking both forward and backward in time, we searched and examined a variety of texts (published works, unpublished lecture notes, and internet sites), documenting key use of the concept and noting others’ citations (Table 1 lists the core documents), until we identified what appeared to be the first use of the full phrase in print. Although the concept was clearly attributed to Ayres’s work in the early 1960s by Gaylard et al. (1963), and was described by many others throughout the 1970s, the actual term appears to have been used first in a 1981 publication by Yerxa, who cited Burke (1977). It next appeared in print again in a 1982 article by Mack et al., as well as by Rogers (1982). The term was subsequently attributed to earlier works, such as Ayres (1972a), Burke (1977), Michelman (1974), Robinson (1977), and Rogers (1982) by other authors (Dunkerley et al., 1997; Jackson, 1990; Neistadt & Seymour, 1995; Yerxa, 1981). However, as seen in Table 1, the exact term is not mentioned in any of these papers to which it is attributed; instead, various wording is used to describe the concept. The circuitous state of these references left us uncertain about how to properly attribute this concept. Given these unexpected results, we wondered more about the evolution of the concept and how to properly credit its development, which went beyond its quotation.
Foundational Material Documenting the Development of the Just-Right Challenge Concept in Occupational Therapy in Chronological Order, 1963–1982
Note. This table includes identified resources from 1963 to 1982 when the term just-right challenge became established in printed text in occupational therapy.
We contacted six authors of early publications by email. We interviewed some who were available to clarify this history and asked them to review our findings for accuracy. We also corresponded with other colleagues who had worked with early authors, to make sure we had not inadvertently missed any important sources. These conversations yielded descriptions of the theoretical and practical discussions that generated the ideas that crystallized into the concept of the just-right challenge as something occupational therapists strive for in their practice.
Conceptual Origins: A Nexus of Thought
The authors of early publications on the just-right challenge had all been associated with the University of Southern California (USC) Department of Occupational Therapy during the development of the concept. These individuals described the development of the concept from two different vantage points: sensory integration and occupational behavior. Sensory integration was formulated as a theoretical foundation to guide practice with children who demonstrated particular sensory processing difficulties identified through research, at first primarily with children with learning disabilities (Ayres, 1962, 1963, 1964, 1965, 1966a, 1966b, 1966c, 1967, 1969, 1971, 1977). In contrast, occupational behavior was designed as an encompassing paradigm to unify occupational therapy, resurrect its commitment to the original principles that guided the profession, and avoid reductionism (Kielhofner & Burke, 1977; Matsutsuyu, 1971; Reilly, 1962, 1969; Shannon, 1977; Takata, 1980). In the 1960s, the two perspectives were seen as polar opposites, and even in conflict, because of differences in theoretical bases, research emphases, assessments, and treatment methods (Kielhofner & Burke, 1977; Mack et al., 1982). Despite these differences in focus, the profession remained unified in its commitment to addressing occupation and in its appreciation of the essential nature of the just-right challenge in designing interventions to meet individual client needs. Thus, by the mid 1980s to the early 1990s the just-right challenge had become firmly established in the lexicon of occupational therapy, canonized by the early papers. The phrase had emerged as a sort of shorthand, or meme, to represent the ideas being developed and explored by a group of occupational therapists and scientists, which enabled the conceptual development to be shared throughout the profession (F. Clark, personal communication, October 4, 2022).
Occupational Behavior
Occupational behavior created a theoretical foundation for current practice and scholarship. The model was developed by Mary Reilly over several decades and was fueled by the work of her graduate students as they focused on all aspects of the work–play–sleep–rest continuum of occupational behavior (e.g., Florey, 1971; Matsutsuyu, 1971; Shannon, 1977; Sundstrom, 1972, 1983; Takata, 1969, 1971, 1980; White, 1971). In conjunction with this work, during the early 1960s Reilly dramatically redesigned the occupational therapy curriculum at USC to focus on core occupational knowledge and theory rather than just skills and therapeutic techniques rooted in the medical model (Clark, 2012; Clark et al., 1985; Reilly, 1966, 1969, 1971; Yerxa, 1990). The cornerstone of the program was the emerging occupational behavior perspective. Reilly’s and her students’ publications formed a foundation for conceptualizing occupational science as an academic discipline and for implementing occupation-based practice and scholarship nationally and internationally (Clark, 2012; Clark et al., 1985, 1991; Takata, 1980; Yerxa, 1990).
Reilly’s (1969, 1971) vision was to create a foundation for the entire field of occupational therapy, a foundation for the future that was firmly grounded in its founding principles and modernized to reflect current thinking and conceptual ideas from the social sciences. To do this, she encouraged the profession in general and her department, including faculty, alumni, and graduate students, to gather new social science information and, most important, compatible concepts, especially from sociology and cognitive psychology, to infuse into occupational therapy (Burke et al., 1983; J. Burke & F. Clark, personal communication, November 10, 2021; Reilly, 1969, 1971). The theory evolved over time through this process. Various biopsychosocial elements were subjected to a detailed analysis of their compatible view of human behavior as manifested in occupation. Once they had been identified as influencing occupation, the elements were incorporated into models (Burke et al., 1983). Graduate students examined different dimensions of this emerging theory, with a volume on play (Reilly, 1974) presenting a pivotal occupation-focused text in occupational therapy as well as multiple American Journal of Occupational Therapy publications (e.g., Burke, 1977; Florey, 1971; Matsutsuyu, 1971; Michelman, 1971; Robinson, 1977; Shannon, 1977; Sundstrom, 1972, 1983 ; Takata, 1969, 1971; White, 1971). Later, two of Reilly’s students, Kielhofner and Burke (1980), synthesized the bulk of these ideas to develop the Model of Human Occupation and invited their peers, in a series of workshops and conference presentations, to translate into practice the knowledge and occupational behavior concepts they had focused on in graduate work. This framework was intended to integrate all areas of practice holistically while opposing reductionistic perspectives in occupational therapy (Kielhofner et al., 1980; Kielhofner & Burke, 1980).
A critical implication for practice was how to achieve the delicate balance of an optimal activity that simultaneously matched the client’s skills, interests, and needs for challenge to motivate clients. This general idea, including graded activities, was present in the foundation of occupational therapy but was considered more of an isolated skill at the time (Breines, 1986; Creighton, 1992; Dunton, 1915). Occupational behavior expanded this view of intervention by addressing how the work–play continuum and motivation also influenced a client’s willingness to participate and maximize progress.
Reilly directed her students to delve into arousal theory and theories of human motivation, which were then being generated in cognitive psychology (Berlyne, 1950; Bruner, 1973; White, 1959, 1971). According to arousal theory, people are innately driven to perform activities to maintain an optimal level of arousal. Arousal theorists purport that everyone tries to avoid both understimulation (engaging in tasks or situations that are boring or lacking novelty, complexity, etc.) and overstimulation (engaging in activities that are well beyond one’s skill level). Therefore, when skill and challenge levels are delicately matched, optimal levels of arousal are achieved, and anxiety or boredom are escaped. Motivation theory maintains that people are intrinsically motivated to engage in activities in which they feel competent or capable. A merging of these ideas within the growing framework of occupational behavior eventually led to the concept of the just-right challenge (J. Burke & F. Clark, personal communication, November 10, 2021), an essential element of occupational behavior (Burke et al., 1983; Mack et al., 1982).
Ayres Sensory Integration
Sensory integration was developed as an occupational therapy framework by A. Jean Ayres over the course of several decades (Ayres, 1962, 1963, 1964, 1965, 1966a, 1966b, 1966c, 1967, 1969, 1971, 1972a, 1972b, 1977). It was designed to assess and explain observable behaviors related to sensory processing and to guide intervention to improve the child’s functioning. This framework was based in neurophysiology and was the subject of extensive experimental and factor analytic research (Ayres, 1962, 1963, 1964, 1965, 1966a, 1966b, 1966c, 1967, 1969, 1971, 1972b, 1977). The sensory integration framework has continued to amass and integrate extensive research to this day. In fact, randomized controlled trials now provide strong evidence of sensory integration’s effectiveness for people with autism spectrum disorders (Omairi et al., 2022; Schaaf et al., 2013; Steinbrenner et al., 2020). It is now known as Ayres Sensory Integration, to distinguish it from other sensory interventions that lack its comprehensive research and theoretical framework (Smith Roley et al., 2007; Soechting et al., 2009).
Occupational therapists using this framework promote the child’s adaptive response to sensory demands. Such adaptive responses range from righting reactions and grasping to sequencing and sustained social interaction. Although a sensory integration approach was very focused on the discrete mechanisms of change within each session, Ayres’s (1960) early writing indicated that these adaptive responses were performed with the intent of participation in purposeful activity and improved emotional well-being.
The role of the occupational therapist using sensory integration was to create or adapt the activity “with the right combination of challenge and success” (Ayres, 1972a, p. 259). By 1980, Ayres used the term just-right challenge frequently when teaching her seminar on sensory integration and reviewing treatment sessions with graduate students (J. Lindquist, personal communication, November 29, 2021; Mack et al., 1982; Z. Mailloux, personal communication, October 26, 2021; D. Parham, personal communication, October 30, 2021). The just-right challenge remains a central and essential treatment principle for those using an Ayres Sensory Integration approach (Dunkerley et al., 1997; Parham et al., 2007; Schaaf & Mailloux, 2015), with research supporting its use for child engagement (Holland et al., 2018) and playfulness (Tickle-Degnen & Coster, 1995).
Forging a Collaborative Alliance
In some situations, two strong theoretical frameworks developing side by side, such as occupational behavior and sensory integration, can result in a competitive position whereby a profession is fractured into two antagonistic subgroups or one framework wins out and the other is discounted. Instead, both of these theoretical foundations have remained allied within occupational therapy, supporting practice to this day. This is a testament to the occupational therapy scholars involved; the environment they shared and created; active attempts to reconcile these frameworks; and their joint commitment to the research, practice, and conceptual development of occupational therapy.
The context at USC enabled theoretical development to flourish. As director of its graduate program in occupational therapy, Reilly encouraged graduate students to be scholars, to research, write, and develop scholarship. Faculty and students read works from diverse related fields, such as Berlyne’s (1950) work on balancing arousal to promote curiosity and exploration and White’s (1959) on adjusting the level of required competence as a driver for motivation. They shared these works with their colleagues, each influencing each other’s scholarship and theoretical development. The works on arousal theory and motivation were foundational for conceptualizing the just-right challenge in occupational therapy and were relevant to both sensory integration and occupational behavior. The development of these different frameworks ushered in great intellectual, theoretical, and research growth in the profession.
Active attempts to reconcile occupational behavior and sensory integration were also instrumental. In 1976, Florence Clark was recruited as a USC faculty member and tasked with teaching sensory integration within the context of the more general occupational behavior perspective (F. Clark, personal communication, November 5, 2021). What she discovered was that these two seemingly highly divergent perspectives actually incorporated many overlapping concepts, with the notion of a just-right challenge front and center in both. Therefore, she revised what had been a strictly occupational behavior perspective in the flagship human development course into one that emphasized these overlaps in the two perspectives. Three of Clark’s students who had taken this revised course went on to publish two articles proposing that the two frameworks be unified around the concepts of play and the just-right challenge element (Lindquist et al., 1982; Mack et al., 1982). These scholars identified how the commonality of the just-right challenge transcended the two sides. The just-right challenge consequently became recognized as essential to the whole of occupational therapy (Yerxa, 1990), paving the way for its sustained widespread application throughout the profession today.
Understanding the Complex Origins of the Just-Right Challenge: Implications
First and foremost, a better appreciation of where the concept of the just-right challenge originated allows the profession to properly credit and honor the work of those who came before. The concept is clearly attributable to an impressive group of scholars emanating from USC. Tracing and matching the most appropriate citation will depend on the careful analysis and documentation by scholars who are developing their own work. For example, in our project, which specifically used the concept of the just-right challenge in relation to play, we chose to cite Ayres (1972a), Burke (1977), Lindquist et al. (1982), Michelman (1974), and Robinson (1977). However, given our findings, as documented throughout this column, we would recommend those who wish to discuss the just-right challenge in their current work go to the original sources, review the material, and select relevant and useful information from our profession’s past that supports their current work. (Table 1 provides an example of resources that may be relevant to current authors and scholars.) An accurate citation pays homage to those who pioneered our current understanding.
Second, the exploration of this concept helps us preserve and honor our professional history. Many of those in the thick of the work in the 1960s and 1970s have retired, and some are deceased. We were fortunate to hear first-person experiences that helped fill in the gaps of existing publications and enrich our understanding of the development of the just-right challenge. We admire the considerable contributions that undergirded its conceptual development, which reinvigorated our professional pride and confidence in its use. We felt responsible to write this column to document and share this oral history so that it is not lost to the profession and in the hope that it might inspire others.
Third, an examination of the roots of the just-right challenge impels us to consider how it is poised for the future. As with many basic tenets of the profession of occupational therapy, there continue to exist a multitude of unanswered questions that could be addressed with scholarly study. The following are some examples:
▪ How best can we identify and measure the just-right challenge? Sensory integration fidelity work (Parham et al., 2007) provides the groundwork for identifying its presence or absence, but it may need to be adapted for use in other areas of practice and for measurement as a variable in therapy.
▪ Can we measure improved outcomes from therapy that more consistently provide the just-right challenge?
▪ How quickly do therapists grow and change in their abilities to provide the just-right challenge from novice to expert practitioners? What best facilitates those changes?
▪ How can students best learn to provide the just-right challenge? What are the most successful ways for educators to teach students to create the just-right challenge?
▪ How does successful implementation of just-right challenges affect the occupational therapy practitioner? Christie’s (1999) article suggests it may be important for mental health and avoiding burnout, but this should be studied.
▪ Given that other professions have similar concepts, such as educators’ zone of proximal development to describe developmental matching and readiness (Levykh, 2008; Vygotsky, 1978; Wass & Golding, 2014), the following should be considered: ▪ Is the just-right challenge truly a concept that belongs distinctively to occupational therapy? ▪ How do occupational therapy practitioners provide the just-right challenge differently compared with other professionals?
Finally, the history of this concept illustrates who we are as a profession. Both diversity and cohesion exist side by side in our profession. Differing opinions and ideas created conflict between influential occupational therapy scholars and their development of different theoretical foundations, and yet overall they agreed that the just-right challenge was a central tenet of occupational therapy. It seems that the strength and diversity of both theoretical foundations may help us in addressing the complex needs of clients better than one might on its own. The path to a consensus may be emulated in other areas of disagreement within the profession.
Conclusion
Seeking an appropriate citation for the just-right challenge revealed a wealth of unexpected problems and benefits. Finding the term’s first publication in the occupational therapy literature was inadequate, necessitating our communication with first-person historical sources to better understand its conceptual origins. This investigation revealed that, rather than a single source, a significant group of occupational therapy scholars from two distinct theoretical backgrounds was responsible. Drawing from the profession’s foundation, they conceptualized the just-right challenge as central to occupational therapy and the study of occupation. As a consequence, specific citing of the just-right challenge necessitates a closer look at which scholars developed the aspect to which one is referring. The just-right challenge has an impressive history and is a well-founded essential concept that has stood the test of time, fostering professional pride. Future scholarship focused on its tenets offers the opportunity to further enhance and support theory and practice. Uncovering this history and its significance for future work illustrates the gains to be had from searching original sources, which we hope will fuel professional responsibility and the valuing of other primary resources.
Footnotes
Acknowledgments
We extend a sincere thank you to Janice Burke, Florence Clark, Linda Florey, Susan Knox, Jerry Lindquist, and Diane Parham for their input and participation. Drs. Burke, Clark, and Parham provided especially deep reviews and discussions of this column during critical periods in its development.