Dr Maria Giatsi Clausen

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

OBJECTIVES To document the problems/ difficulties healthy children who were born prematurely present within their school performance as reported by occupational therapists To 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 on the clinical significance of occupational therapy intervention for the above population To investigate how occupational therapists (OTs) arrive to certain decisions 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 is 2. OT practices when working with these children 3. what informs therapists’ clinical decision making

Qualitative phase: Online discussion groups The second, qualitative part, used asynchronous, online discussions (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 difficulties Most common difficulties children with SLD, born preterm, present with “sensorimotor” “attentional” “perceptual” “visuomotor” “behavioural” “cognitive” “other” Difficulties most commonly affecting school “attentional” “visuomotor” “sensorimotor” “perceptual” “cognitive” “behavioural” “other” ! 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”

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 1 Study findings agree with previously conducted research (Feder et al, 2005) 48 preterm children at the age of six to seven years were compared to that of their matched full-term peers Lower scores in handwriting legibility (p<.01) and writing speed (p<.005) for the preterm group The preterm group also demonstrated significantly lower performance in sensorimotor skills (p<.05) Writing linked to sensorimotor difficulties (p<.05), which appears to be the main type of difficulties with which preterm children present

Discussion 2 Some caution should be also exercised in the interpretation of the above findings. The preponderance of sensorimotor difficulties, as the type of difficulties 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 in general, and on writing specifically, remains to be studied separately. The preoccupation of OTs with sensorimotor difficulties might also relate to the theoretical approach of Sensory Integration, which holds a special meaning for OTs Possible assumption that these children have SI difficulties to which handwriting problems can be ascribed