Occupational Therapy Delineation Model of Practice for Children with Attention Deficit Hyperactivity Disorder
This model of practice is based on the theoretical concepts relating to the child, environment, task, and the interaction among these key factors and the child’s participation in different occupations. A goodness-of-fit of those factors is necessary for successful participation in occupations. It aims to help clinicians in understanding the following: the child’s problems at different levels of dysfunction (neurological, psychological, and behavioral), the effect of different environmental factors, the demands of the task selected, and the child’s level of participation in different occupations, which are purposeful and meaningful within different situations and with different levels of family support. This model starts with family support, and with environment, task demands, and the child as the components in between, with interactions with each other. Successful participation in occupations is the end-product and the ultimate goal of this model. It also suggests appropriate assessment tools that can be used to evaluate the primary behavioral features of the child, to identity different neurological and psychological correlates to behavioral patterns. It purposes a multidimensional evaluation and multifaceted intervention. The model illustrates the application of some of those evaluation procedures within the model and suggests several relevant standardized scales for each component, for example, to use the School Function Assessment to assess task performance or the Sensory Profile to assess neurological level of the child. The application of some of those intervention strategies is also illustrated within the model, such as environmental adaptation on the child’s environment or the use of sensory integrative therapy for intervening neurological level of the child. It also emphasizes the importance of empowering and enabling parents and teachers through the family-centered care approach. The positive outcomes from the approach contribute to the ultimate success of the intervention.
Attention Deficit Hyperactivity Disorder
Domain of occupation
The model highlights a new understanding of Attention Deficit Hyperactivity Disorder as complex, multifaceted clusters of impairments in the neurological, psychological and behavioral domains.
Chu, S., & Reynolds, F. (2007). Occupational therapy for children with Attention Deficit Hyperactivity Disorder (ADHD), part 1: A delineation model of practice. British Journal of Occupational Therapy, 70(9), 372-383.
The Dunn’s Model of Sensory Processing proposes four basic patterns of sensory processing which are emerged from the interaction of the neurological threshold and self-regulation. Neurological threshold is a personal range of threshold for noticing and responding to different sensory events in everyday life. People who have low sensory threshold would notice and respond to stimuli more often because their neurological system activates easier and more readily to sensory events.
Sensory Integration Theory aims to explain behaviors, plan intervention, and predict behavioral change through intervention, and provide specific intervention strategies to remediate the underlying sensory issues that affect functional performance. It purposes therapeutic interventions that incorporate sensation to affect multi-sensory perception to influence learning and behavior, as the central nervous system does not process sensory information in isolation.
This frame of reference adapts a top-down approach to identify visual perceptual factors that limit an individual’s daily participation, and adaptive and compensation approaches are used to facilitate engagement in meaningful occupation. It uses theories from cognition, developmental psychology, education, and Warren’s developmental hierarchy of visual perceptual skills. Visual Perceptual skill development is viewed to be developed from a hierarchy, starting from oculomotor control, visual fields, visual acuity.
Moyers Model is a model that helps to treat people with alcohol dependence. This model suggests that alcohol dependence is resulted from a complex interaction of causal factors. These factors may include genetic predisposition, negative character development/experience in family history, which lead to impaired interpersonal and coping skills, availability of alcohol, peer group affiliation and social norms that accept and promote use of alcohol.
This model aims to describe the symbiotic relationship between occupation and the brain, as a chaotic, self-organized, and complex system. It assumes that changes in human condition do not follow a linear path. The model views occupational therapy as a complex intervention and a result of dynamic integration of several factors and unpredictable outcomes. The concept of neuro-occupation is complex and holistic, and aims to help occupational therapists to apply the non-linearity principles.