ADHD occupational therapy assessment

1. Case Study Presentation
Assessments
OT6091
Under Dr. Judi Pettigrew
Assignment 2 - November 16th 2016
By Camilla Mahon, Andrea O’Sullivan, Laura Butler, Paula Monaghan, Claire Barrett & Jessica O’Neill

2. Sean is four - youngest of 4 boys and 1
girl
Diagnosed with ADHD - parents
question this believing he is too
intelligent to be quiet
His parents are unemployed and
together take care of the children
Sean is not yet in school
The family live in a caravan on an
unofficial halting site
He spends his time playing outside
-football & climbing trees

3. He has no interest in table top
activities
-difficulty holding attention
Sean attempts to dress himself
-wears same clothes for days,
-does not care if they are back to
front or inside out
Public Health Nurse is concerned as
Sean is due to start school in 6
months
She is not confident he will manage
the transition
She has referred Sean to occupational
therapy for assessment

4. Referral (Case Study)
Information Gathering
Initial interview
OT Model (P.O.E)
OT Frame of reference (Person Centred)
Assessments
Goal setting and plan
Evaluate
Repeat or discharge meeting & planning

5. Person, Environment, Occupation:
Focused on behaviour; motivations for activities,
emotional response to situations and level of
independence
“the context within which occupational
performance takes place and it is categorized
into cultural, socioeconomic, institutional,
physical and social”
Ramafikeng (2011)
Person centred frame of reference:
Preventing through early intervention, initial or
further impairment,
Holistic approach,
Meaning and motivation for engaging in
occupations of daily living,
Day-to-day routines and various interests and
motivation
Shenai (2012)

6. Irish travelers are a small nomadic group that have been apart of Ireland
since the middle ages
2011 Census: total number of Irish travelers 29,573
Despite The Housing (Traveller Accommodation) Act, many travellers
remain in unofficial accommodation
Within the travelling community there is a strong stigma attached to
mental health problems which impacts on travellers ‘help-seeking
behaviour’

7. ADHD
Attention deficit hyperactivity disorder
DSM-5 (Diagnostic and statistical manual of mental disorders)
• Predominantly inattentive
,difficulty sustaining attention in tasks or play, does not seem to
listen when spoke to directly,
does not follow through on instructions
• Predominantly hyperactive/impulsive
fidgets with hands or feet,
leaves seat in classroom,
runs about or climbs excessively
• Combined
characteristics from both

8. ADHD and Occupational Therapy
DSM-5 states that impairments:
“reduce the quality of social, academic and occupational
functioning”
Case Study suggests Sean is exhibiting combined ADHD
• spends his time playing outside
-football & climbing trees
• He has no interest in table top activities
-difficulty holding attention
• Sean attempts to dress himself
-wears same clothes for days,
-does not care if they are back to front or inside out

9. Occupational Rights:
“The right of all people to engage in meaningful occupations that contribute
positively to their own wellbeing and the wellbeing of their communities”
Hammel (2008)
Violations of occupational rights
One of occupational therapy’s core assumptions is engagement in meaningful
occupations influences health and wellbeing
Human wellbeing cannot be achieved sole by enhancing abilities
Address inequalities people face
Requires consideration of environment - school adaptions to accommodate Sean
Right to education

11. Assessments chosen
MOHO SCOPE - Semi-structured interview
COSA - Non-standardised observation
Revised KNOX Preschool Play Scale

12. Gaining insight
-Public health nurse
-Culturally sensitive
Building rapport is
essential
-Explain ADHD
-Explain Occupational
Therapy & role
-Gaining consent & assent

13. Semi- structured interview based on the MOHO
SCOPE
-Less formal
-Allows for open communication (phenomenological
data)
Sidney chu and Francis Reynolds
-Use with children that are not good candidates for
criterion referenced or norm referenced assessments

14. The SCOPE has 4 formats
for interviewing parents
Non-judgemental questions
‘tell me about the physical space
of your home and how it meets
your child’s needs’
TO
‘Does Sean like to be outside or
inside?’

15. Talking to Sean - Assent
Semi structured interview
Informal measure & skilled
observations
(Parham and Fazio 1997)
Sean’s behaviour, behaviours of
other people around him and his
environment – could be distractions
(Chu and Reynolds, 2007)
Incorporating play

16. Child Occupational Self-Assessment (COSA)
Self-reported questionnaire
Gives clients a voice about their own problems, strengths
and desires
Important because children have a right to be involved in
making decisions that affect their lives.
Two areas:
1. How the child feels about their skills in communication,
interaction, motor control and environment.
2. How important an activity is to them.

17. Pictures taken from COSA

18. Adaptation for Sean - GAME
-Importance of play for children
Draw on Ethos of COSA and use any relevant questions
Games build rapport with children while also using
observation skills and occupational analysis to get the
information needed
('Pediatric Skills for Occupational Therapy Assistants' 2006)

20. Outcomes based on COSA
What does Sean need help in that is important to him
-priority
What is important to Sean that he does well?
What does Sean do well, but is not important to him?
What does Sean need help in that is not important to him?
May not be important to Sean at this point in his life, but may be necessary
for him to learn for his future
-school
Parents may think it is important, might be culturally important
Consult the parents
-culturally sensitive
-motivation

21. Semi Structured interview with constant observation
How Sean interacts with occupational therapist and
others
His movement patterns
Can he follow instructions
How he participates in and attends to tasks
What motivates him
Not just the answers that he gives me in the interview
that are important, but his behaviour during the whole
process
(Miller-Kuhaneck et al. 2010).

22. Unstructured
Semi-structured
Structured

23. The Five facets of play relevant to an
occupational therapist
Skills children use in play
Approach to playfulness
Play activities
Environmental supportiveness
Source of motivation for play
(Mackenzie and O’Toole 2001)

24. Background:
developed in the United states by Susan Knox 1968
Knox modified the preschool play scale in 1997
Purpose:
Observational assessment
Developmental description of typical play
behaviour from 0-6 years.
Developmental age measured in 6 month
increments from 0-3 and yearly from 3-6 years
Describes play across 4 dimensions and 12
categories from a developmental perspective
Provides therapists with useful information to set
goals, plan and implement interventions

25. Format:
Takes place in natural
environment,
-Two 30 minute observation
both indoor and outdoor
settings,
-Peers present,
-Self directed & spontaneous
play with little adult
direction
-Play assessment in
community
-Play varies in different
environments.
(Stagnitti 2004)

26. Psychometric Validation:
Bledsoe and Shepherd (1982) collected normative data on 90
children and conducted reliability and validity studies.
Harrison and Kielhofner (1986) conducted reliability and
vailidity studies on a population with disabilities.
Both studies showed statistically significant reliability and
validity of the Pre-school play scale.
Jankovich et al. (2006) examined interrater reliability and
validity of the revised pre school play scale (Interrater
agreement within 8 months on the overall playscale was 90%)
(Jankovich et al. 2008)
It has also been used in assessing the effectiveness of various
treatments and for screening children for research projects

27. Play is a fundamental child occupation
• (Parham and Prime 1997)
The Revised pre-school play scale is helpful for children who are not
testable on standardised tests.
• (Knox, 1997)
It correlates significantly with developmental age.
Strengths and weaknesses outside of the 4 dimensions can also be observed.
Sean's preferred activities can be determined which will be useful for
intervention and goal setting.
It doesn’t require specialised toys or equipment.
Natural behaviours in everyday life and environment
Provide the therapist with a developmental description of Sean, while
observing play will also allow therapists to observe the other facets of play

28. Limitations
The measurements are in large increments, which can be a
problem if the assessment is used as an outcome measure, as a
child can make significant improvements but may still fall
within the same age range.
Developed in United States of America, like many assessments
it is based on western criterion and values and developmental
criteria.
The assessment is carried out in both indoor and outdoor
setting, which may be difficult due to space limitations (Sean’s
preference for outdoors)

29. Norm Referenced:
Typically seek to compare an individual’s performance to
another individual
Criterion Referenced:
Compares an individual’s performance to a set of
standards
The SCOPE is neither norm nor criterion referenced
Focuses on ‘individual developmental trajectory’

30. Background
The SCOPE (version 2.2) was developed by Bower et al.
MOHOST did not meet needs of paediatric evaluation
Developed for use from birth to 21 years
Used across practice contexts and settings
Schools
Acute care
Clinics
Home

31. Purpose
Describe a child’s occupational
participation irrespective of
symptoms, diagnosis, age or
setting
Capture strengths as well as
challenges
Assess factors of skill, volition,
habituation and environment
Identify areas needing further
assessment
Support occupation
-Focused intervention
Assess changes in child’s
occupational participation over
time in order to evaluate therapy
outcomes

32. Rating
Information is gathered through;
Informal/formal observation
Interview with child/parents
Teachers
Multidisciplinary team
Reading case notes/medical records
Completing other formal assessments
Domains covered;
Volition
Habituation
Communication
Interaction skills
Process skills
Motor skills
Environment

33. Consists of 25 Items:
F: Facilitates occupational participation
A: Allows occupational participation
I: Inhibits occupational participation
R: Restricts occupational participation

34. Culture and the SCOPE:
Individual developmental trajectory
The SCOPE assessment user guide discusses the impact of culture and a child’s
individual developmental trajectory on rating scores
Considers the child’s and family’s culture and context
What is appropriate within the culture
Avoid imposing one’s own individual cultural views when making ratings
Appreciate the cultural perspectives that shape the ways in which children and
families live

35. Strengths:
Top down nature
Identify child’s strengths
Standardised assessments often identify only
delays and challenges
Holistic
Does not reduce each child down
Concerned will all area that could potentially
affect participation
Provides interaction with family and improves
family centred care
Easy to report and explain to caregivers
Limitations:
Information is best gathered through
conversations with parents
Can be challenging in certain
circumstances
Other professionals’ lack of familiarity
with the SCOPE and underlying theory of
MOHO

36. 1. Sensory Profile (Dunn, 1999)
1 in 6 children with ADHD display sensory symptoms which impact aspects of every day
functioning
(Pfeiffer et al. 2015)
Care giver report consisting of 125 questions
30-60 minutes to complete
Involves the reporting of the frequency which their child responds to various sensory experience
Better suited for when Sean starts school - completed by teacher
2. Behaviour rating inventory of executive function (BRIEF)
(Gioia et al. 2000)
Also a parent or teacher rated assessment
For 5+ years of age
Assesses executive functioning behaviours

37. 3. School Functional Assessment
4. Millers Pre school Kit
5. Behavioural Assessment of Dysexecutive function for Children
(BADS)
6. Sensory Integration and praxis test Test for everyday attention for
Children (Tea-ch)

38. The the process was;
Top down Approach
Supported by the P.E.O model
Focuses on Sean's context and
narrative
Determines what is important to Sean
Focuses on strengths
Occupation focused
Focuses on everyday roles, needs and
values
Less concerned with medical diagnosis
and deficits

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43. Any Questions?
Thank you for listening