Dr Maria Giatsi Clausenmgiatsiclausen@qmu.ac.uk

The Study

“Occupational therapists perceptions of preterm children’s academic difficulties in the early years of mainstream schooling”

Three-stages, mixed methods study (survey, online discussions, semi-structured interviews)

AIM: To investigate the occupational therapists’ role when working with preterm children with academic difficulties in the early years of mainstream schooling

OBJECTIVESTo document the problems/ difficulties healthy children whowere born prematurely present within their school performance as reported by occupational therapistsTo explore assessment procedures, treatment principles and,specific practices that are employed by occupational therapists while working with these children.To explore occupational therapists’ professional judgements onthe clinical significance of occupational therapy intervention for the above populationTo investigate how occupational therapists (OTs) arrive to certaindecisions when clinical outcome data may be lacking

Quantitative phase: Survey

The study investigated the perceptions of paediatric OTs regarding the type of difficulties with which children born preterm present, and explored the role of OT

Paediatric OTs completed a mail questionnaire (N=353)

The survey was also designed to capture:1. information on the extent of this paediatric population within OT

services, and how identifiable and accessible it is2. OT practices when working with these children3. what informs therapists’ clinical decision making

Qualitative phase: Online discussion groups

The second, qualitative part, used asynchronous, onlinediscussions (N=13), by utilising the virtual environment of WebCT,to further explore the topic

The discussion groups provided a forum for OTs’ reflexive comment on the issues emerging from the questionnaire analysis.

Online discussion groups: a “hybrid mode” of communication

Typed (therefore) written language

Exchange of info that is often informal (as in spoken language); transcripts read as if they were spoken conversation

Advantage: interpersonal involvement and interaction of “oral” discussion along with elaboration and expansion that writing provides

Disadvantage: Loss of spontaneity, superficial coverage of topic (stems from distancing thought from speaker)

Background More children in the preterm group, which attended mainstream

education, required some type of educational assistance, had to repeat a class, or used school services (including OT)

Performance on specific school tasks was poorer among the preterm children

Mathematics was almost the only area where these difficulties remained when considering statistical significance levels, or after controlling and adjusting for the IQ of the children

In the only OT-specific study, handwriting legibility and writing speed scores were found to be significantly lower in the preterm group

Findings: Common difficultiesMost common

difficulties children with SLD, born

preterm, present with

“sensorimotor”“attentional”“perceptual”“visuomotor”“behavioural”

“cognitive”“other”

86.285.675.174.645.342

17.1

Difficulties most commonly

affecting school

“attentional”“visuomotor”

“sensorimotor”“perceptual”“cognitive”

“behavioural”“other”

89.569.468.562.840.940.93.9

! Writing difficulties was also the second most common diagnostic label (83.6%;n=138), for children who were referred to OT services with a specific diagnosis

Affected school areas in children with SLD, born preterm

“writing”“reading”“maths”“motivation”“effort”“other”

93.3656558.953.316.8

1681171171069630

Differences between preterm and full-term children with specific learning difficulties (SLD)

29.4% of the participants (N=53) thought that there were distinct differences in the presenting problems of these two groups

These differences were reported in open-ended format; open-ended data were then “quantified” (content analysis) and categories emerging were entered into SPSS as separate variables.

“Sensorimotor”, “attention”, “perceptual”, “cognitive”, “language” or “psychosocial” difficulties: more frequent in the preterm group

More medical issues and a higher comorbidity of SLD with other conditions

Poorer overall developmental picture More severe difficulties (all types) and a slower progress requiring

more intense intervention

Discussion 1Study findings agree with previously conducted research (Feder etal, 2005)48 preterm children at the age of six to seven years were comparedto that of their matched full-term peersLower scores in handwriting legibility (p<.01) and writing speed(p<.005) for the preterm groupThe preterm group also demonstrated significantly lowerperformance in sensorimotor skills (p<.05)Writing linked to sensorimotor difficulties (p<.05), which appears tobe the main type of difficulties with which preterm children present

Discussion 2Some caution should be also exercised in the interpretation of theabove findings.The preponderance of sensorimotor difficulties, as the type ofdifficulties which might mostly handwriting, refers to a group of components, of

which, visuomotor, is only one. The impact of each of those skills on academic performance ingeneral, and on writing specifically, remains to be studied separately.The preoccupation of OTs with sensorimotor difficulties might alsorelate to the theoretical approach of Sensory Integration, which holds a special

meaning for OTsPossible assumption that these children have SI difficulties to whichhandwriting problems can be ascribed