Dr Tanya Rihtman

Introduction: Climate change threatens the environments in which person-centred occupational therapy occurs. Environmental sustainability is directly linked with the health and wellbeing of current and future generations, presenting occupational therapists with a unique advocacy and activist role. As practitioners of the future, there is an urgent need to understand students’ attitudes, perceptions of, and self-perceived preparedness for, dealing with environmental determinants of health and intergenerational occupational and climate justice. 

Methods: A cross-sectional exploratory descriptive survey collected United Kingdom (UK) based allied health professional students' attitudes, perceptions and self-perceived preparedness for advocating for environmental sustainability in the context of person-centred care.  The survey was distributed to 48 gatekeepers in UK institutions with approved allied health professional training programmes (44 offered occupational therapy); 62 occupational therapy students responded. Descriptive and non-parametric inferential statistics were used to analyse quantitative data. Text and short answers were analysed qualitatively via inductive content analysis.

Consumer and Community Involvement: The study was co-designed and implemented with MSc (pre-registration) occupational therapy students.

Results: 94% of participants expressed concerns for climate change, with 84% feeling responsible for addressing environmental sustainability in healthcare. While 64.5% identified climate justice as a top priority, a perceived challenge emerged between person-centred care and sustainability, with only 18% of participants feeling prepared for environmental sustainability in occupational therapy practice. Participants requested education on personal and professional sustainability practices, as well as collective action. Sharing personal climate change experiences, advocating with family and friends, and facilitating connections for collective action were highlighted as potentially transformative educational tools in this area.

Conclusion: Occupational therapy curricula should address environmental sustainability through pragmatic, critical and ethical lenses to enhance students' preparedness for this advocacy and activist role. Reflection and continuous professional development for environmentally sustainable practices is recommended. 

Background: Pedagogically sound curricula are needed to empower occupational therapy (OT) students to adopt evidence-based practice (EBP) principles and internalise EBP requirements as standard within their futures roles. Exploring how students’ perceptions of this central area of knowledge for OT practice develops can contribute to effective curriculum design. 

Aims/Objectives: To explore the evolution of pre-registration OT student perceptions of research and EBP over the course of their engagement with undergraduate teaching and learning.  

Materials and Methods: A longitudinal Q-sort approach was used; this approach seeks to  synthesise overall viewpoints of different participants regarding a sample of statements, using by-person factor analysis (where respondents constitute the variables, and statements constitute the sample). Final year pre-registration OT students from one educational programme completed the same Q-sort at three timepoints (pre-dissertation [n=18]; post-dissertation submission [n=12]; post-student research conference [n=6]). Q-sort responses were intercorrelated and factor-analysed; extraction of factors with an eigenvalue of ¬>0.9 and varimax rotation identified majority viewpoints. 

Results:  Significant factors were revealed at each timepoint: Point 1: ‘Evidence–inseparable from OT practice’ and ‘Research for research’s sake-inseparable from the occupational therapy identity’, point 2: ‘Who am I to question the gurus?’ and point 3: ‘I can do it with confidence...but so what?’

Conclusions: Opportunities for completing ‘authentic’ student research projects, and taking ‘ownership’ of results, may enhance research and EBP confidence and professional identity.

Significance: Findings expand on current knowledge regarding effective use of pre-registration educational opportunities to support future research and evidence-based practice. 

Aim: This study evaluated the sex-and age-specific usefulness of the Little Developmental Coordination Disorder Questionnaire-Chinese (LDCDQ-CH) in Chinese preschoolers.
Method: A population-based sample of 51,110 children aged 3–5 years was recruited. Internal reliability, construct validity, concurrent validity with the Ages and Stages Questionnaire-third edition (ASQ-3), and discriminant validity with the Movement Assessment Battery for Children-second edition (MABC-2) were assessed. Age and sex effects on LDCDQ-CH scores were analyzed using ANOVA and t-tests.
Results: The LDCDQ-CH exhibited excellent internal consistency and reliability across ages and genders. Confirmatory factor analysis supported the 15-item model’s satisfactory fit. Positive and significant correlations were observed between LDCDQ-CH and ASQ-3 scores, indicating robust concurrent validity. Significant associations were found between LDCDQ-CH and MABC-2 scores. Higher scores were observed in older children and girls, indicating age- and sex-related differences in motor functional  performance.
Conclusion: The LDCDQ-CH is a reliable and valid tool to support early identification of motor coordination difficulty in Chinese preschoolers, and guiding interventions. Findings support its use across ages and  genders, highlighting its potential in the Chinese context. Age- and sex-specific norms are needed for enhanced clinical applicability.

Background. Clinical expertise is the mechanism through which practitioners implement other components of evidence-based practice (EBP). Within occupational therapy practice, intervention approaches that are both closely and loosely aligned with Ayres’ Theory of Sensory Integration are widespread, offering a unique opportunity to investigate the subjective nature of clinical expertise in EBP. Purpose. This qualitative study explored motivations to offer sensory integration-based interventions, and factors informing occupational therapists’ clinical decision making in relation to an arguably contentious evidence base. Method. Six post-graduate sensory integration trained UK occupational therapists participated in individual semi-structured interviews. Interviews were transcribed, member-checked and analyzed using thematic coding analysis. Findings. Despite sound understanding of theory and continuous efforts to develop clinical knowledge, non-traditional hierarchies of evidence notably inform clinical decisions. The clinical expertise required for integration of patient preferences, clinical state and circumstances, and research evidence is informed by pragmatic responses to facilitators and barriers across contexts, combined with unique profession-specific identity factors. Implications. While empirical healthcare research is ideally undertaken under controlled conditions, realities of clinical practice are rarely so clear cut. Study findings highlight important subjective factors that are central to real-world research knowledge translation and further understanding of the clinical expertise component of EBP.

Introduction: There remains a dearth of easily-implemented strategies for translating environmental and sustainability policy into practice within occupational therapy education. In this context, the research-implementation time lag is problematic since time is of the essence when seeking evidence-based educational strategies to address planetary health challenges. The undertaking of practical experimentation to develop strategies for policy implementation and translation is challenged by the urgency of the issues faced.

Purpose: This paper aims to contribute to conversations around translating awareness of planetary health to practical action for occupational therapy education by proposing a framework for practical ‘doing’ skills, based on conceptually sound, theoretical foundations that support likely efficacy.

Methods: Three skills are suggested as a means to close the theory-practice gap while incorporating what is known about educational processes supporting the transition from novice to expert occupational therapy practitioner. The first skill proposed is a rethinking of essential forms of clinical reasoning, with the introduction of environmental and sustainable reasoning as mandatory. Founded in an adoption of ‘two-eyed seeing’, the second skill emphasises bidirectional questioning for climate-just, person-centred care. The third skill explores interprofessional educational collaboration for environmental sustainability.

Conclusions: Acknowledging the centrality of novice practitioner as part of occupational therapy learner professional identity requires appropriate strategies for learning clinical reasoning skills related to environmental sustainability, planetary health and the potential discomfort of authentic bi-directional questioning. Implications of adopting these strategies are discussed in relation to their potential contribution to positive change for the occupational therapy profession and wider society.

Aims. The Little Developmental Coordination Disorder Questionnaire (LDCDQ) is a parental questionnaire designed to identify preschool children at risk of Developmental Coordination Disorder (DCD). This study aimed to translate and cross-culturally adapt the LDCDQ for French European informants (Little Developmental Coordination Disorder Questionnaire – French European [LDCDQ-FE]) and to undertake a pilot examination of its psychometric properties on a French sample. Methods. A thorough process of cultural adaptation was completed. The psychometric properties were examined with a sample of 154 French children aged to 5y11m (control=121; clinically referred=33). A sub-group of 34 children was assessed using the MABC-2 to measure convergent validity. Results. Principal component analysis demonstrated a fourcomponent structure, accounting for 67.5% of the variance. Internal consistency was acceptable to good (α=0.74-0.89). Significant correlation between the LDCDQ-FE and the MABC-2 total
scores showed convergent validity. Discriminant validity was supported by significant score differences between the clinically referred and a matched control sub-group. Using ROC curves, a cut-off of 67 was proposed for a sensitivity of 81.3% and a specificity of 77.8%. Conclusions. Results show initial evidence of the psychometric properties of the LDCDQ-FE and are encouraging of its use to identify young preschoolers at risk for DCD. In future studies, the testretest reliability should be investigated, and study sample sizes expanded.

Introduction: Motor difficulties associated with Developmental Coordination Disorder (DCD) are frequently apparent before the accepted diagnostic age of 5. Tools to support identification of DCD markers would allow provision of early intervention to reduce negative sequelae. Objective: Establish psychometric properties and define preliminary cut-off scores for the Brazilian Little Developmental Coordination Disorder
Questionnaire - Brazil (LDCDQ-BR).

Methods and procedures: Parents of 3- and 4-year-old children (n=312; 154 girls) from Belo Horizonte/MG, Brazil, completed the LDCDQ-BR, the Brazil Economic Classification Criterion and a demographic  questionnaire. One sub-set of children (n=119) was assessed with the Movement Assessment Battery for Children–2 nd Edition; another sub-set (n=77) completed the LDCDQ-BR a second time.

Results: Rasch analysis indicated good item functioning with only one erratic item, suggesting unidimensionality. Item calibration reliability was excellent (0.97), children’s measures reliability was low (0.72), but implying separation of 2.46 motor ability levels. Significant, low correlations were found between the LDCDQ-BR and MABC-2 (r=0.30, p

Conclusion: The LDCDQ-BR shows promising psychometric properties to support early identification of DCD.

Importance: Early identification of young children at risk of developmental coordination
disorder (DCD) can support early intervention and prevent secondary sequelae.
Objective: This study examined the psychometric properties of the translated and
cross-culturally adapted Little Developmental Coordination Disorder Questionnaire-Taiwan
(LDCDQ-TW).

Design: Prospective study.

Setting: Parent respondents, recruited via kindergarten settings. Participants: 1124 parents of typically developing children ages 36-71 months. Children with confirmed developmental diagnoses were excluded.

Outcomes and Measures: The LDCDQ-TW, a 15-item parent questionnaire for identifying children at risk for DCD, and the Movement Assessment Battery for Children (2nd edition) (MABC-2).

Results: Findings revealed excellent test-retest reliability (ICC=0.97) and fair inter-rater reliability (ICC=0.47). Using MABC-2 scores, the non-DCD group (> 15th percentile) scored significantly higher than the DCD and suspect-DCD groups on the LDCDQ-TW, but the latter two groups did not differ. Using the 15th percentile of both the MABC-2 and the LDCDQ-TW, sensitivity was 0.96 and specificity 0.68.

Conclusions and Relevance: While standardized performance-based assessments are required to confirm a DCD diagnosis (typically after the age of 5), the LDCDQ-TW demonstrated sound reliability and validity and can support the early identification of young children at risk of DCD in Taiwan.

What This Article Adds: The LDCDQ-TW questionnaire has sound psychometric properties and can be used to support early identification and monitoring of young children at risk of DCD

Introduction: The social-emotional impacts of Developmental Coordination Disorder (DCD) for children and young people (CYP) are often the most disabling. Occupational therapists (OTs) are central to facilitating holistic service provision for this population. There is a need to understand OTs’ perceptions of providing support for the socialemotional needs of CYP with DCD.

Method: A focus group (n=9) explored issues pertaining to OT support for the social-emotional needs of this population. Qualitative data were analysed following the classic analysis strategy.

Results: Findings suggest that social-emotional support is not explicitly addressed in service provision for CYP with DCD. OTs appear to know what needs to happen to improve social-emotional outcomes, and have
made some progress, but more remains to be done. Holistic service provision depends upon varied factors, many of which are outside individual therapists’ control.

Conclusion: Findings suggest that, in England, OTs working with CYP with DCD may not be providing  targeted social-emotional support, potentially due to service structures that are not geared to supporting these needs. This raises concerns as to whether practitioners are enabled to stay true to holistic principles, as well as concerns related to delivering evidence-based practice in light of growing evidence regarding this population’s social-emotional risks.

Objectives: To investigate the impact of hearing loss (using longitudinal measurements of hearing) on speech outcomes at age 5 (5 years 0 months–5 years 11 months) in children born with cleft palate ± lip. Other variables which may impact upon the speech outcomes at age 5 in this population were also investigated.

Methods: A retrospective longitudinal cohort study of children, without a named syndrome, born with cleft palate ± lip, and treated at a Cleft Centre in the United Kingdom. Data collected from infancy to 5 years 11
months, included hearing test results from three specific time points (7 months–1 year 2 months [age A]; 2 years 0 months–2 years 11 months [age B]; 5 years 0 months–5 years 11 months [age C]) and speech outcome data at age 5 years (5 years 0 months–5 years 11 months). Hearing test results at each age were compared to identify how hearing changes with age. Correlations between hearing test results and speech outcomes at age 5 were analysed.

Results: Hearing loss was frequent but predominantly mild. There were no significant correlations between
speech outcomes and hearing results at any age. Mild hearing loss remained prevalent at age 5, although a
significant age-related hearing improvement was found. A significant relationship between cleft type and cleft
speech characteristics was found (P articulation outcomes.

Conclusion: Although mild hearing loss was common in the cohort, there was no association between hearing loss and the speech outcomes investigated. In contrast, the type of cleft was significantly associated with the presence of cleft speech characteristics. Further longitudinal measurement of hearing is required to  substantiate the findings of this study.

Developmental coordination disorder (DCD) is a condition marked by difficulties in motor skill performance. Formal diagnosis of DCD is not common before the age of 5, yet there is evidence that symptoms of motor difficulty appear prior to this age. The Little Developmental Coordination Disorder Questionnaire (LDCDQ) was developed in Israel, in the Hebrew language, and was found to have strong psychometric properties. However, when adopting instruments for use in different contexts, cultural suitability cannot be assumed, and issues of construct and cultural validity need to be addressed. As part of an ongoing, ethically approved study, this investigation aimed to establish the construct validity of a UK version of the LDCDQ (LDCDQ-UK). Three groups of participants (clinicians n=15; parents n=20; preschool educators n=14) were recruited via convenience and snowball sampling. Participants ranked the suitability of the original LDCDQ items (task and phrasing) to UK culture, for 3 and  4 year old children, and provided qualitative feedback related to further functional activities in which young UK preschoolers engage. Frequencies were calculated for ranking, based on respondent group and for the integrated sample. Results revealed six items that warranted amendment, and these amendments were made based on the qualitative feedback provided. The processes reported here provide evidence of the construct validity of the LDCDQ-UK, and support its use in subsequent stages of psychometric testing.

Background.
There is no consensus in the UK regarding the types of speech samples or parameters of speech that should be assessed at 3 years of age in children with cleft palate ± cleft lip (CP±L), despite cleft units routinely assessing speech at this age. The standardization of assessment practices would facilitate comparisons of outcomes across UK cleft units; earlier identification of speech impairments—which could support more timely treatments; and more reliable recording of therapy impacts and surgical interventions.

Aims.
To explore assessment practices used to assess speech in 3‐year‐old children with CP±L, including speech parameters, methods of assessment and the nature of the speech sample used.

Methods & Procedures.
A broad examination of the literature was undertaken through the use of a scoping review conducted in accordance with Joanna Briggs Institute guidelines. Search terms were generated from a preliminary search and then used in the main search (Medline, CINAHL, Embase, AMED and PsycINFO).

Main Contribution.
A combination of approaches (medical, linguistic, developmental and functional) is required to assess CP±L speech at age 3. A developmental approach is recommended at this age, considering the complexity of speech profiles at age 3, in which typically developing speech processes may occur alongside cleft speech characteristics. A combined measure for both nasal emission and turbulence, and an overall measure for velopharyngeal function for speech, show potential for assessment at this age. Categorical ordinal scales are frequently used; the use of continuous scales has yet to be fully explored at age 3. Although single‐word assessments, including a subset of words developed for cross‐linguistic comparisons, are frequently used, more than one type of speech sample may be needed to assess speech at this age validly. The lack of consensus regarding speech samples highlights a need for further research into the types of speech samples 3‐year‐olds can complete; the impact of incomplete speech samples on outcome measures (particularly relevant at this age when children may be less able to complete a full sample); the impact of different speech samples on the validity of assessments; and the reliability of listener judgements.

Conclusions & Implications.
Whilst a medical model and linguistic approaches are often central in assessments of age‐3 cleft speech, this review highlights the importance of developmental and functional approaches to assessment. Cross‐linguistic single‐word assessments show potential, and would facilitate the comparison of UK speech outcomes with other countries. Further research should explore the impact of different speech samples and rating scales on assessment validity and listener reliability.

Adults with a very tall stature (above the 97th percentile for height) encounter challenges with engagement in everyday occupations. Conversely, work-related opportunities and benefits for the taller worker have been identified. This interpretive phenomenological study captured the occupational narratives of very tall young British adults in relation to how the diversity of their stature affects participation in everyday occupations. Eight participants between the ages of 18 and 40 years engaged in an individual interview to share their experiences. Analysis of the data produced two super-ordinate themes, ‘Fitting into an average height world’ and ‘Playing to Strengths’. Challenges to occupational engagement and performance have necessitated strategies involving compromise. In some instances, reduction in occupational choice has occurred because tall stature has precluded engagement. Conversely, occupations have been chosen by participants for which height is an advantage, thereby making the most of a stature that cannot be changed. Findings imply that very tall stature affects occupational choice, which in turn shapes identity.

Objective. Our aim was to generate a Hebrew translation of the Miller Function and Participation Scales (M–FUN) and assess the validity of U.S. norms for Israeli children.

Method. All components of the M–FUN were translated, and a pilot study revealed a need for further investigation. The Hebrew M–FUN’s fine, gross, and visual–motor (VM) components and M–FUN participation questionnaires were administered to 267 Israeli children (128 boys, 139 girls; mean age = 59.21 mo, standard deviation = 17.84).

Results. Significant correlations supported construct validity between age and all motor and participation scores as well as age-group differences. Significant differences between the U.S. and Israeli samples were found only for the VM score. Participation and motor scores were significantly correlated.

Conclusion. Although VM score results should be interpreted with caution, we provide evidence for use of the fine and gross motor norms and the U.S. criterion-referenced participation scores of the M–FUN with Israeli children.

This prospective, observational study assessed the development of preschool children aged 3-6 years, 11 months (n=124) after in-utero anti-epileptic drug (AED) monotherapy exposure to valproic acid (VPA) (n=30, mean age 52.00[±15.22] months) and lamotrigine (LT) (n=42, mean age 50.12[±12.77] months), compared to non-exposed control children (n=52, mean age 59.96[±14.51] months). As a combined group, AED-exposed children showed reduced non-verbal IQ scores, and lower scores on motor measures, sensory measures, and parent-report executive function, behavioral and attentional measures. When the VPA- and LT-exposed groups were analyzed separately, no cognitive differences were found, but control-VPA and control-LT differences emerged for most motor and sensory measures as well as control-VPA parent-report behavioral and attentional differences. No differences were noted between the VPA and LT groups. These findings suggest that VPA- and LT-exposed children should be monitored on a wider range of developmental measures than currently used, and at differing developmental stages.

There are relatively few studies that have looked at the longer-term developmental effects of intra-uterine topiramate exposure. The purpose of this report is to describe preliminary findings of the developmental outcomes of a group of nine children of preschool age (3-6 years, 11 months), exposed in utero to topiramate (TX) monotherapy, as compared to a control group of 18 children. The groups were compared on developmental measures of visual, fine and gross motor function as well as measures of behavior and cognitive functions. Results showed that the TX group performed significantly worse than the control group for almost all measures, with the most clearly delineated differences in the area of cognitive functioning. While the study group is small, and only preliminary conclusions may be inferred, it appears that TX exposure may have subtle effects on the development of children in a range of areas including motor function, cognition, and behavior.

Purpose: The early identification of motor coordination challenges before school age may enable close monitoring of a child's development and perhaps ameliorate some of the social, psychological and behavioral sequela that often accompany unrecognized Developmental Coordination Disorder (DCD). The purpose of this study was to develop and assess the initial psychometric properties of a screening tool, the Little DCD Questionnaire (Little DCDQ), designed to identify DCD amongst preschoolers aged 3 and 4.

Methods: The suitability of the items of the DCDQ'07 for 3- and 4-year-old children was assessed. Four items were found to be suitable and new items were generated. Content validity was ensured using a Table of Specification and the items were categorized into three sub-categories (Control During Movement, Fine Motor and General Coordination). The Little DCDQ was administered to 146 children (91 boys) aged 3 and 4 (mean age=49.39±7.16 months). Ninety-one typically developing children were included (mean age=47.80±7.05 months; 46 boys) while 55 children had been referred or were being treated for some form of developmental delay (mean age=52.02±6.60 months; 45 boys). Of this sample, 28 parents completed the questionnaire twice within a 2-week interval.

Results: Test-retest reliability was evidenced by moderate to good intraclass correlation coefficient values between scores on the two administrations for the total and the three sub-category scores. Evidence of internal consistency was provided by adequate to high Cronbach's alpha co-efficients calculated for each item, each sub-category score and the total score for the total group, and separately for the control group and the clinically referred group. Validity evidence based on relations to other variables was provided by the finding of significant group differences (clinically referred and control) for the total and sub-category scores for both the age groups and the total group.

Conclusions: Based on the preliminary psychometric evidence, it appears that the Little DCDQ meets many of the necessary standards for validity and reliability as a screening instrument, and shows promise as a useful clinical and research tool.

Aim. There is a lack of investigation into the functional developmental profile of children with Down syndrome. On the basis of current international health paradigms, the purpose of this study was to assess the developmental profile of these children.

Method. Sixty children (33 males, 27 females) with Down syndrome (age range 6–16y; mean age 9y 3mo, SD 28.8mo), who had received standard, holistic, early intervention, were assessed. Of these, 42 (70%) had congenital anomalies, 12 had severe congenital heart defects. Participants were assessed on measures of cognitive function (Beery–Buktenica Developmental Test of Visual–Motor Integration; Stanford–Binet Intelligence Scale) and participation (Vineland Adaptive Behaviour Scales).

Results. No difference was found on any measure on the basis of severity of congenital anomaly. Results showed improvements in age‐related body function and correlations between specific body functions and participation. No decline in IQ was found with age, and significant correlations between IQ and all other measures were noted. Although sex differences were found in the body functions of short‐term memory and motor function, no difference in measures of activity performance and participation was found.

Interpretation. Our findings emphasize the need for paediatric Down syndrome intervention to encourage improved body functions while emphasizing the acquisition of functional skills that enable enhanced participation in age‐appropriate activities.

There is a need, among practitioners and researchers, for a feasible, user-friendly assessment tool that evaluates overall participation and guides intervention. This paper describes the process of construction and development of the Participation in Childhood Occupations Questionnaire (PICO-Q) and the establishment of its primary psychometric properties. The 22-item instrument measures the level, enjoyment, and frequency of performance for children's participation in daily occupations in a variety of environments. The questionnaire was completed by the mothers of 41 children between the ages of 6 and 10 years (24 children with and 17 children without sensory modulation disorder). Cronbach's alpha varied from. 86 to. 89, indicating internal consistency of items. Test–retest reliability varied from. 69 to. 86, indicating that the instrument provides a stable measurement over time. The PICO-Q was found to differentiate between children with and without participation restrictions. The PICO-Q shows initial reliability and validity and has both research and clinical application potential.