Peds: Chap.14 & 15 Social Participation and Social Skills & Educational Performance

Environmental Contexts Affecting Social Participation:

• School: Creates new relationships and social expectations, influencing peer interactions and social learning.

• Physical Barriers: Accessibility of spaces impacts social participation. Inclusive environments support engagement.

• Transportation: Affects access to social activities outside the home or school.

• Family: Parental perspectives and expectations can either support or limit social participation.

Goals for Social Participation and Skills:

• Improve Specific Social Skills: Targeting areas like communication, interaction, and appropriate behavior in social contexts.

5 Factors for Social Skills (Elliot & Gresham):

1. Social Awareness

2. Social Knowledge

3. Social Performance

4. Social Adjustment

5. Social Motivation

Intervention Models:

1. Sensory Interventions: Address sensory processing issues to enhance social interactions.

2. Model of Human Occupation: Focuses on volition, habituation, and performance patterns to improve social participation.

3. Self-Determination: Promotes autonomy, choice-making, and self-advocacy in social situations.

4. Social Cognitive Theory: Emphasizes observational learning and self-regulation in social contexts.

5. Behavior Modification: Uses reinforcement and consequences to shape social behaviors.

6. Peer-Mediated Interventions: Involves peers in supporting the development of social skills.

Interventions for Social Skills:

1. Social Coaching: Personalized guidance to improve social interactions and communication.

2. Relationship Development Intervention (RDI): Focuses on improving social and emotional development through structured interactions.

3. Applied Behavioral Analysis (ABA): Uses reinforcement strategies to teach social skills and behaviors.

4. Early Start Denver Model (ESDM): Early intervention for children with autism to improve social, cognitive, and communication skills.

5. PPERS: Promotes social, emotional, and behavioral skills through structured activities.

6. Alert Program: How Does Your Engine Run?: Helps individuals understand and regulate their emotional and sensory states.

7. Social Thinking: Focuses on teaching children to interpret social cues and think about others’ perspectives.

8. Zones of Regulation: A system for teaching self-regulation of emotions and behaviors based on four color-coded zones.

9. Computer-based and Robotic Interventions: Use technology to engage and teach social skills in interactive ways.

10. Video Modeling: Demonstrates appropriate social behaviors via video to enhance learning.

11. Social Scripts: Structured scripts that guide social interactions for individuals with social challenges.

12. Power Cards: Visual cards with rules or prompts to guide behavior in social situations.

13. Social Stories: Short, personalized stories to help individuals understand social situations and expectations.

14. Primary Circles: Helps individuals understand relationships and boundaries through visual tools.

15. Mindreading: Teaches individuals to recognize and interpret facial expressions and emotions.

16. Emotions Charades: A game to practice identifying and expressing emotions through non-verbal cues.

17. Video Detective: Teaches observation and interpretation of social cues using video clips.

Self-Regulation Strategies:

1. Cognitive Reappraisal: Changing the way you think about a situation to alter emotional responses (e.g., viewing stress as a challenge rather than a threat).

2. Mindfulness: Focusing on the present moment, using breathing and relaxation techniques to manage stress and emotions.

3. Stress Thermometer: A visual tool to help individuals assess their stress levels and identify when self-regulation is needed.

4. Incredible 5-Point Scale: A tool to help individuals rate their emotions and responses, promoting awareness and regulation of feelings.

Problem-Solving Strategies

1. Social Autopsies: Reviewing social situations to identify what went wrong and how to improve future interactions.

2. SOCCSS: A strategy to guide social problem-solving (Situation, Options, Consequences, Choices, Strategies, Simulation).

3. Comic Strip Conversations: Using simple drawings to illustrate social situations and help individuals understand different perspectives and emotions.

Chapter Guideline

Occupation of Education:

• Education is the process of acquiring knowledge and skills through structured learning in schools. It involves academic tasks, social interactions, and personal development.

Roles of a Student:

• Roles include being a learner, participating in classroom activities, completing assignments, engaging in social interactions, and developing life skills.

Difficulties Students May Face:

• Difficulties may include challenges with attention, motor skills, sensory processing, social interaction, and academic performance, such as difficulty with handwriting, organization, or following instructions.

How Occupational Therapists Evaluate Students:

• Evaluation includes observing the student’s performance in classroom tasks, using standardized assessments, gathering input from teachers and parents, and assessing sensory processing and motor skills.

How Occupational Therapists Improve Occupational Performance:

• Interventions may include adapting the classroom environment, teaching skills for self-regulation, providing strategies for task management, and working on fine and gross motor skills to enhance academic and social participation.

Education as an Occupation:

• Participation: Involves the student engaging in academic tasks, social interactions, and other school-related activities like following instructions, collaborating with peers, and completing assignments.

• Competence: Refers to the student’s ability to effectively perform these tasks and roles. This includes academic skills, social participation, self-regulation, and other abilities that contribute to successful learning and functioning in the school environment.

Roles of the Student

• Read books: Engaging in literacy activities to gain knowledge.

• Write essays: Expressing ideas through written language.

• Perform math equations: Engaging in problem-solving and calculation tasks.

• Participate in recess: Socializing and engaging in physical activities for development.

• Have lunch in the cafeteria: Engaging in mealtime routines and social interaction.

• Learn literacy skills: Developing reading, writing, and comprehension abilities.

• Communicate: Sharing information, expressing thoughts, and interacting with others.

Performance Skills in Roles

Read Books:

• Cognitive skills: Comprehension, attention, and memory to process and understand text.

• Motor skills: Fine motor control for holding and turning pages.

• Visual-perceptual skills: Visual tracking, focusing, and recognizing letters and words.

Write Essays:

• Motor skills: Fine motor control for writing with a pen or pencil.

• Cognitive skills: Organization, planning, and sequencing thoughts to form coherent essays.

• Sensory processing: Ability to tolerate sensory input (e.g., noise, seating position) in the environment.

Perform Math Equations:

• Cognitive skills: Problem-solving, logical reasoning, and attention to detail.

• Motor skills: Hand-eye coordination for writing and using mathematical tools (e.g., calculator, ruler).

• Visual-perceptual skills: Ability to recognize numbers and align them correctly in equations.

Participate in Recess:

• Motor skills: Gross motor skills for running, jumping, and playing games.

• Social skills: Sharing, turn-taking, and collaborating with peers.

• Self-regulation: Managing excitement, taking breaks, and maintaining focus.

Have Lunch in the Cafeteria:

• Motor skills: Fine and gross motor skills for eating, using utensils, and managing food containers.

• Social skills: Interaction with peers, table manners, and communication.

• Cognitive skills: Understanding social norms and routines around mealtime.

Learn Literacy Skills:

• Cognitive skills: Attention, memory, and language processing to understand and apply literacy concepts.

• Motor skills: Fine motor skills for writing, typing, or using tools (e.g., stylus for tablets).

• Visual-perceptual skills: Letter recognition, reading fluency, and handwriting.

Communicate:

• Cognitive skills: Understanding and processing verbal and non-verbal communication.

• Social skills: Initiating, maintaining, and ending conversations appropriately.

• Motor skills: Facial expressions, eye contact, and gestures for non-verbal communication.

Areas of OT Evaluation in the Schools

Academic:

• Activities directly related to learning and education, such as reading, writing, performing math equations, and participating in class discussions.

Nonacademic:

• Activities that are not directly related to formal learning but are still important for development, such as socializing with peers, lunch, and following classroom routines.

Extracurricular:

• Activities outside of the academic curriculum that support skill development and socialization, like sports, clubs, or music.

Prevocational:

• Activities designed to prepare students for future work, focusing on skills like following instructions, time management, and task completion.

Vocational:

• Work-related activities that focus on developing job-specific skills, such as internships, job shadowing, or actual employment experiences.

Academic considerations include

Reading:

• Skills: Phonemic awareness, decoding, comprehension, fluency, and vocabulary development.

Literacy:

• Skills: Writing, spelling, grammar, and the ability to use language for communication and expression.

Math:

• Skills: Number sense, calculation, problem-solving, and understanding mathematical concepts and operations.

Communication:

• Skills: Listening, speaking, reading comprehension, and expressing ideas clearly through both verbal and non-verbal means.

Social Interaction:

• Skills: Turn-taking, understanding social cues, cooperative play, conflict resolution, and building relationships with peers and adults.

Play:

• Skills: Creative thinking, motor skills (fine and gross), role-playing, and engaging in structured or unstructured play with peers.

Self-Care:

• Skills: Dressing, grooming, feeding, toileting, and managing personal hygiene independently.

Cognitive

Follow Directions:

• Skills: Listening comprehension, memory, and the ability to process and act on verbal or written instructions.

Complete Activities:

• Skills: Persistence, task focus, time management, and the ability to follow through with assignments or projects.

Working Memory:

• Skills: Retaining and manipulating information in short-term memory to complete tasks, such as remembering steps in a multi-step task.

Executive Function:

• Skills: Planning, organizing, decision-making, self-monitoring, and regulating emotions and behavior to complete tasks and achieve goals.

Initiation:

• Skills: The ability to begin tasks independently without external prompts, such as starting homework or a class activity.

Attention:

• Skills: Focusing on tasks or conversations, filtering distractions, and maintaining concentration for sustained periods.

Problem-Solving:

• Skills: Identifying issues, evaluating options, and applying strategies to find solutions in academic or social contexts.

Visual Perceptual

Visual Perceptual Skills:

• Definition: The ability to interpret and understand visual information from the environment.

Visual Spatial Skills:

• Skills: Recognizing the relationship between objects and their position in space, such as determining how far apart items are or how to organize them (e.g., organizing items on a desk or aligning letters on a page).

Visual Analysis Skills:

• Skills: The ability to distinguish and identify visual details, such as recognizing shapes, sizes, or patterns. This is important for tasks like reading, identifying objects, or solving puzzles.

Visual Motor Integration:

• Skills: The coordination of visual information with motor movements. This is needed for tasks like handwriting, drawing, cutting, or catching a ball, where eye-hand coordination is essential.

Self-regulation

• Emotional Control: The ability to manage and modulate emotional responses to situations. This includes recognizing emotions, controlling impulses, and maintaining appropriate emotional responses, especially in challenging or frustrating situations.

Sensory Processing:

• Definition: The ability to receive, interpret, and respond to sensory input from the environment (e.g., sounds, textures, visual stimuli).

• Skills: Includes the ability to filter and integrate sensory information without becoming overwhelmed or under-responsive. This affects how a child behaves in environments that are either overstimulating (e.g., noisy classrooms) or understimulating (e.g., quiet settings).

Motor skill

• Holding: The ability to securely hold an object, like a pencil, without dropping it. This involves grip strength and control.

• Pinching: Using the thumb and fingers to grasp small objects (e.g., picking up a button or turning a key).

• Grasping: The ability to hold objects using different grasps (e.g., a whole-hand grasp or a tripod grasp for writing).

• Tool Use: The ability to use tools (e.g., scissors, toothbrush, or fork) with proper control and coordination.

• Coordination: The ability to use both hands together in a controlled and coordinated manner (e.g., tying shoes or using a spoon).

• Strength: Hand strength needed for tasks such as holding a pencil, using scissors, or pushing a door open.

Gross Motor:

• Skills: Large body movements that involve the use of arms, legs, and torso, such as running, jumping, and climbing.

Handwriting

In-Hand Manipulation:

• Skills: The ability to move and adjust objects within the hand, such as rotating a pencil for writing or shifting a coin to a comfortable position in the hand.

Strength and Pencil Grip:

• Strength: The hand and finger strength needed for activities like writing, cutting, or using utensils.

• Pencil Grip: Proper grip (e.g., tripod grip) for controlled, legible handwriting and fine motor tasks.

Visual Perception:

• Skills: The ability to interpret and make sense of visual information, such as recognizing shapes, reading letters, and understanding spatial relationships.

Visual Motor Integration:

• Skills: Coordinating visual information with motor actions, such as using visual input to guide movements (e.g., writing, drawing, or catching a ball).

Sensory Skills:

• Skills: The ability to process and respond appropriately to sensory stimuli, such as touch, sight, sound, and proprioception. This is important for tasks like focusing during a classroom activity or maintaining posture.

Motor Planning:

• Skills: The ability to plan and execute a sequence of movements, such as dressing, writing, or following multi-step instructions.

Domains of Handwriting

1. Legibility:

   • Definition: The clarity and readability of handwriting. This includes letter formation, spacing between letters and words, and alignment of writing along the lines.

2. Writing Speed:

   • Definition: The rate at which a student can write. Speed should be balanced with legibility and is essential for completing timed assignments or taking notes in class.

3. Ergonomic Factors:

   • Definition: The physical aspects of writing that affect comfort and efficiency, such as posture, pencil grip, and hand positioning. Proper ergonomics can reduce fatigue and improve writing quality.

Intervention Is Educational Settings

Top-Down:

• Approach: Focuses on the person’s occupational roles and participation first, addressing how their environment, context, and skills impact their daily life, rather than focusing solely on specific impairments.

Embed Activities in the Natural Context:

• Strategy: Engaging clients in activities within their everyday environment to make interventions more relevant and functional, improving generalization of skills.

Collaborate with Team:

• Approach: Working together with other professionals (e.g., teachers, doctors, families) to develop and implement holistic, client-centered interventions.

Measure Outcomes:

• Process: Using assessments and data to evaluate the effectiveness of interventions and to track progress over time.

Occupational Performance:

• Definition: The ability to perform activities of daily life, such as self-care, work, and leisure, in a meaningful and efficient way.

Prevention:

• Focus: Interventions designed to reduce the risk of disability, injury, or illness, promoting healthy behaviors and environments before problems occur.

Health and Wellness:

• Goal: Promoting overall physical, mental, and emotional health through balanced activities, self-care, and healthy habits.

Participation:

• Definition: Involvement in meaningful activities in various settings (e.g., school, home, community), which supports social inclusion and personal fulfillment.

Quality of Life:

• Definition: A person’s overall well-being, encompassing health, happiness, and life satisfaction, and influenced by their ability to participate in meaningful occupations.

Role Competence:

• Definition: The ability to successfully perform and fulfill the demands of one’s occupational roles (e.g., student, parent, employee).

Well-Being:

• Focus: The emotional, mental, and social aspects of health that contribute to a person’s sense of fulfillment and satisfaction in life.

Occupational Justice:

• Concept: Ensuring that all individuals have equal access to opportunities to engage in meaningful occupations, regardless of disability, socioeconomic status, or other factors.

Approaches

Remediation:

• Definition: The process of addressing specific deficits or impairments to improve a person’s abilities. The goal is to restore or enhance functional skills, such as improving fine motor skills for handwriting or memory training.

Strategy Use:

• Definition: Teaching clients compensatory strategies or techniques to manage challenges. For example, using organizational tools, self-regulation strategies, or memory aids to support occupational performance.

Environmental Adaptations:

• Definition: Modifying the environment to make tasks more accessible and support participation. This might include adjusting workspaces, using assistive devices, or altering routines to fit the client’s needs (e.g., wheelchair access, quieter spaces, or adaptive technology).

Universal Design for Learning

Remediation:

• Goal: Improve or restore specific skills or functions that are impaired. For example, therapy to improve hand strength or cognitive skills, aiming to return the client to their previous level of functioning.

Strategy Use:

• Goal: Teach clients specific techniques or methods to compensate for difficulties. For example, using a planner to manage time or a specific memory strategy to aid learning.

Environmental Adaptations:

• Goal: Modify the physical or social environment to facilitate participation in activities. This may include adding ramps for wheelchair access, adjusting seating arrangements, or providing assistive technology.

Intervention

Preparatory:

• Goal: Activities or interventions used to prepare the client for engagement in more complex tasks. This may include strengthening exercises, sensory input, or range-of-motion activities to improve readiness for functional activities.

Seating and Positioning:

• Goal: Ensure the client is in a stable, comfortable position to maximize function and minimize fatigue or discomfort. This includes adjusting seating arrangements or using adaptive seating for better posture, alignment, and mobility.

Safety:

• Goal: Minimize risks and prevent injury during daily activities. This includes ensuring the environment is free of hazards, providing adaptive equipment, and teaching safety precautions for self-care or mobility tasks.

Environmental Adaptations:

• Goal: Modify the environment to enhance participation and independence. This might include changes in physical space, like ramps, or using assistive devices to help with mobility, communication, or daily activities.

Focused Areas of Intervention

Hand Skill Development:

• Goal: Improve fine motor skills required for daily tasks, such as gripping, manipulating, and controlling tools (e.g., pencils, scissors).

Handwriting:

• Goal: Enhance legibility, writing speed, and control, addressing issues like letter formation, spacing, and alignment.

Writing Tools, Surfaces, and Positions:

• Goal: Use appropriate tools, such as adapted pens or ergonomic writing surfaces, and adjust seating positions to improve comfort and performance in writing tasks.

Pencil Grips and Paper:

• Goal: Teach proper pencil grasp (e.g., tripod grasp) and adjust paper position (e.g., slant boards) to optimize handwriting skills.

Sensory Considerations:

• Goal: Address sensory needs (e.g., sensitivity to textures, sounds) that may affect attention, task engagement, or emotional regulation in school or therapy settings.

Visual Perceptual Motor:

• Goal: Improve the coordination of visual input with motor responses, essential for tasks like handwriting, drawing, and using tools.

Sensory Regulation:

• Goal: Help the client modulate sensory input (e.g., light, sound) to improve focus, emotional regulation, and participation in daily tasks.

Movement Programs:

• Goal: Integrate physical movement activities to support motor development, coordination, and attention, such as balance exercises or activities that engage both sides of the body.

Mental Health Considerations:

• Goal: Address emotional and psychological factors, such as anxiety, depression, or self-esteem, that may affect participation in tasks like schoolwork, social interactions, or self-care.

Cognitive:

• Goal: Strengthen cognitive skills like attention, memory, problem-solving, and executive function, essential for academic success and daily task performance.