ASD (Garcia-Villamisar & Datillo, 2010; Law, Darrah, Pollock, Wilson, Russell, ... environment (Darrah, Law, Pollock, Wilson, Russell, Walter & Galupp, 2011).
C O N T E X T- F O C U S E D PA R E N T C O A C H I N G I N T E R V E N T I O N : E N H A N C I N G R E C R E AT I O N A L PA R T I C I PAT I O N I N A S D
BACKGROUND Why is Recreation Important? • People with ASD participate in fewer types of activities, closer to their home, and with a narrower range of other people (Hilton, Crouch, & Israel, 2008) and experience poorer quality of life (Beadle-Brown, Murphy, & DiTerlizzi, 2009). • Fulfilling recreational participation is associated with higher quality of life in people with ASD (Garcia-Villamisar & Datillo, 2010; Law, Darrah, Pollock, Wilson, Russell, Walter, Rosenbaum, & Galuppi 2011). • Interventions that comprehensively enhance recreational participation in those with ASD have yet to be designed and studied. Parent Mediated Interventions: Family-centered approach in which a parent carries out intervention with the support of a therapist. Evidence: • Widely studied and generally accepted to be effective (Dunn, Cox, Foster, Mische-Lawson, & Tanquary, 2012; Graham, Rodger & Ziviani, 2014) • Parents felt more competent and children with ASD experienced increased participation in everyday activities following a contextual intervention with parent coaching (Dunn et al, 2012) Occupational Performance Coaching (OPC): OPC is a type of parent mediated intervention. Family-centered strengths-based approach in which the interventionist provides guidance to promote parent reflection and problem-solving in attaining child and family goals (Graham, Rodger, & Ziviani, 2014) Evidence: • Effective in helping parents achieve outcomes that promote increased participation for themselves and their children, while leading to improvements in parental self-competence and confidence (Graham, Rodger, & Ziviani, 2013). Context Therapy (CT): Strengths-based approach focusing on improving functional abilities by altering the task or the environment (Darrah, Law, Pollock, Wilson, Russell, Walter & Galupp, 2011) Evidence:
Context-Focused Parent Coaching Intervention: Enhancing Recreational Participation in ASD •
Enhances participation and increases parental self-competence for children with complex disabilities and ASD (Darrah et al., 2011; Dunn, Cox, Mishe-Lawson & Tanquary, 2012)
STUDY OBJECTIVE 1. Address differences in recreational patterns in children with autism spectrum disorder (ASD) 2. Apply family-centered intervention addressing recreational participation 3. Explore effects of intervention targeting enhancement of recreational participation METHODS This pilot study used a single-subject non-concurrent multiple-baseline design across behaviors (n=3). The behaviors were defined as recreational goals identified through two outcome measures: 1) the Canadian Occupational Performance Measure (COPM); and, 2) Goal Attainment Scaling (GAS). The order in which each goal was targeted for intervention was randomized and staggered in time. A convenience sample was used. Eligibility criteria included: (1) Children ages 7 to 13 diagnosed with ASD; (2) English spoken in the home; and (3) Parent available to participate in intervention. An interventionist met with eligible families to identify and scale the recreational and control goals. Family selection of the goals was imperative, as this increases family participation and implementation of selected strategies (Potvin et al., 2014; Østensjø et al., 2008). Progress on the child’s recreational goals was monitored weekly during the baseline, intervention, and follow-up phases. Secondary outcome tools were administrated to gather information, before and after the intervention, about the child’s social and cognitive skills, the child and participating parent’s satisfaction with the child’s recreational participation, the child and family’s quality of life, and the participating parent’s sense of competence. After a month-long baseline phase, intervention began. The interventionist met weekly with each family in a location convenient to them and meaningful to the recreational goal targeted. Each intervention session was comprised of three parts: (1) Check-in: Collaborative analysis of the strategies implemented since the last intervention session and impression of success toward the recreational goal; (2) Brainstorm: Creative problem solving process to identify possible strategies that may yield recreational goal improvement; (3) Making a plan: Prioritization and narrowing of the brainstormed list of strategies to develop a feasible plan to be implemented during the following week. Visual analysis of GAS graphed data was performed by two independent raters. The pre-post COPM data was analyzed from a summary table. The clinical significance values identified in literature, a change of two points on the COPM and one point on the GAS (Law et al., 2005; McDougall & King, 2007), were used to determine the impact of the intervention. DISCUSSION & CONCLUSION
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Context-Focused Parent Coaching Intervention: Enhancing Recreational Participation in ASD • •
The intervention appears beneficial in supporting families to meet recreation goals for their children with ASD. Results support Dunn’s findings that among children with ASD, contextual intervention is effective in increasing children’s participation in everyday life.
SLP CLINICAL IMPLICATIONS • Child’s expression of preferences to set goals • Social benefits of increased recreational participation • Intervention applicable to self-care and interpersonal relationship goals • Generalization of skills to other areas of participation (e.g., social, communicative) • Consult with SLP on implementing strategies to support child REFERENCES Beadle-Brown, J., Murphy, G., & DiTerlizzi, M. (2009). Quality of life for the Camberwell cohort. Journal of Applied Research in Intellectual Disabilities, 22(4), 380-390. Darrah, J., Law, M. C., Pollock, N., Wilson, B., Russell, D.J., Walter, S.D., Galupp, B. (2011). Context therapy: A new intervention approach for children with cerebral palsy. Developmental Medicine & Child Neurology, 53, 615-620. Dunn, W., Cox, J., Foster, L., Mische-Lawson, L. & Tanquary, J. (2012). Impact of a contextual intervention on child participation and parent competence among children with autism spectrum disorders: A pretest-posttest repeated-measures design. American Journal of Occupational Therapy, 66(5), 520-8. Garcia-Villamisar, D. A., & Dattilo, J. (2010). Effects of a leisure program on quality of life and stress of individuals with ASD. Journal of Intellectual Disability Research, 54(7), 611-619. Graham, F., Rodger, S., & Ziviani, J. (2013). Effectiveness of occupational performance coaching in improving children’s and mothers’ performance and mothers’ self-competence. American Journal of Occupational Therapy, 61(1), 10-18. Graham, F., Rodger, S., & Ziviani, J. (2014). Mothers’ experiences of engaging in occupational performance coaching. British Journal of Occupational Therapy, 77(4), 189-197. Hilton, C. L., Crouch, M. C., & Israel, H. (2008). Out-of-school participation patterns in children with high-functioning autism spectrum disorders. The American Journal of Occupational Therapy, 62(5), 554-563. Law, M., Baptiste, S., Carswell, A., McColl, M., Polatajko, H., & Pollock, N. (2005). Canadian Occupational Performance Measure (4th ed.). Ottawa, Ontario: CAOT Publications ACE. Law, M.C., Darrah, J., Pollock, N., Wilson, B., Russell, D. J., Walter, S.D., Rosenbaum, P., & Galuppi, B. (2011). Focus on function: a cluster, randomized controlled trial comparing child- versus context-focused intervention for young children with cerebral palsy. Developmental Medicine and Child Neurology, 53, 621-629. McDougall, J. & King, G. (2007). Goal attainment scaling: Description, utility and applications in pediatric therapy services, 2nd ed.
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