An occupational therapy delineation model of practice is presented, which guides a multidimensional understanding of the psychopathology of attention deficit hyperactivity disorder (ADHD) and its management. Previous research has established that occupational therapists lack detailed training or theory in this field. The delineation model of practice is based on a literature review, clinical experience and a consensus study carried out with occupational therapists to determine their priorities for the evaluation of, and intervention with, children with ADHD.
Part 1 of this article presents the model and examines its implications for evaluation and intervention at the levels of child, task and environment. A family-centred assessment and treatment package, based on the delineation model, is described. Part 2 of this article will report the results of a multicentre study, which was designed to evaluate the effectiveness of this package.
American Academy of Child and Adolescent Psychiatry (1997a) Summary of the practice parameters for the assessment and treatment of children, adolescents and adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 36 (9), 1311–17.
2.
American Academy of Child and Adolescent Psychiatry (1997b) Practice parameters for the assessment and treatment of children, adolescents and adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 36 (10), Supplement, 85S–121S.
3.
American Academy of Pediatrics (2000) Practice Guideline — Diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder (AC0002). Pediatrics, 105 (5), 1158–70.
4.
American Academy of Pediatrics (2001) Clinical Practice Guideline — Treatment of school-aged child with attention-deficit/hyperactivity disorder. Pediatrics, 108 (4), 1033–44.
5.
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th ed.Washington, DC: APA.
BarkleyRA (1995) Taking charge of ADHD — the complete, authoritative guide for parents. New York: Guilford Press.
8.
BarkleyRA (1997) ADHD and the nature of self-control. New York: Guilford Press.
9.
BarkleyRA (1998) ADHD: a handbook for diagnosis and treatment. 2nd ed.New York: Guilford Press.
10.
BarkleyRAEdwardsG (1998) Diagnostic interview, behaviour rating scales, and the medical examination. In: BarkleyR, ed. ADHD — a handbook for diagnosis and treatment. 2nd ed.New York: Guilford Press, ch. 8.
11.
BarkleyRAMurphyKR (1998) Attention deficit hyperactivity disorder — a clinical workshop. 2nd ed.New York, NY: Guilford Press.
12.
BeeryKEBeeryNA (2004) The Beery-Buktenica Developmental Test of Visual-Motor Integration. 5th ed.Minneapolis, MN: NCS Pearson.
13.
BhataraVClarkDLArnoldLE (1978) Behavioural and nystagmus response of a hyperkinetic child to vestibular stimulation. American Journal of Occupational Therapy, 32, 311–16.
14.
BhataraVClarkDLArnoldLEGunsettRSmeltzerDJ (1981) Hyperkinesis treated by vestibular stimulation — an exploratory study. Biological Psychiatry, 16, 269–79.
15.
British Psychological Society (1996) Attention deficit hyperactivity disorder (ADHD): a psychological response to an evolving concept. Leicester: British Psychological Society.
16.
BrownSMHumphryRTaylorE (1997) A model of the nature of family-therapist relationships: implications for education. American Journal of Occupational Therapy, 51 (7), 597–603.
17.
BrownTE (2000) Attention-deficit disorders and comorbidities in children, adolescents, and adults. Washington, DC: American Psychiatric Press.
18.
BundyACLaneSJMurrayEA (2002) Sensory integration — theory and practice. 2nd ed.Philadelphia, PA: FA Davis.
19.
BurchamBCarlsonLMilichR (1993) Promising school-based practices for students with attention deficit disorder. Exceptional Children, 60 (2), 174–80.
20.
Case-SmithJ (2001) Development of childhood occupations. In: Case-SmithJ, ed. Occupational therapy for children. 4th ed.St Louis, MO: Mosby.
21.
CastellanosFX (1997) Toward a pathophysiology of ADHD. Clinical Pediatrics, 36 (7), 381–93.
22.
CermakS (1988a) The relationship between attention deficit and sensory integration disorders — Part I. AOTA Sensory Integration Special Interest Section Newsletter, 11 (2), 1–4.
23.
CermakS (1988b) The relationship between attention deficit and sensory integration disorders — Part II. AOTA Sensory Integration Special Interest Section Newsletter, 11 (3), 3–4.
24.
CHADD (2000) The CHADD information and resource guide to AD/HD. Landover, MD: Children and Adolescents with Attention-Deficit/Hyperactivity Disorder (CHADD).
25.
ChuS (2003a) Occupational therapy for children with ADHD: a survey on the level of involvement and training needs of therapists. British Journal of Occupational Therapy, 66 (5), 209–18.
26.
ChuS (2003b) Attention deficit hyperactivity disorder (ADHD), part one: a review of literature. International Journal of Therapy and Rehabilitation, 10 (5), 218–26.
27.
ChuS (2003c) Attention deficit hyperactivity disorder (ADHD), part two: evaluation and intervention. International Journal of Therapy and Rehabilitation, 10 (6), 254–62.
28.
ChuS (2005) Developing a model of occupational therapy practice for children with attention deficit hyperactivity disorder (ADHD). Unpublished PhD thesis. Uxbridge, Middx: School of Health Sciences and Social Care, Brunel University.
29.
CokerKHThyerBA (1990) School and family based treatment of children with attention deficit hyperactivity disorder. Families in Society, 71, 276–82.
30.
ColarussoRPHammillDD (2003) Motor Free Visual Perception Test — third edition (MVPT-3). Novato, CA: Academic Therapy Publications.
31.
ConnersCK (2001) The Conners Continuous Performance Test — II. North Tonawanda, NY: MultiHealth Systems.
32.
CorkumPRimerPSchacharR (1999) Parental knowledge of attention deficit hyperactivity disorder and opinions of treatment options: impact on enrolment and adherence to a 12-month treatment trial. Canadian Journal of Psychiatry, 44, 1043–48.
33.
CosterWDeeneyTHaltiwangerJHaleyS (1998) School Function Assessment (SFA). San Antonio, TX: Psychological Corporation.
34.
CummingsJC (1993) Frontal-subcortical circuits and human behaviour. Archives of Neurology, 50 (8), 873–80.
35.
DawsonPGuareR (2004) Executive skills in children and adolescents — a practical guide to assessment and intervention. New York, NY: Guilford Press.
36.
DowdyCAPattonJRSmithTECPollowayEA (1998) ADHD in the classroom: a practical guide for teachers. Austin, TX: PRO-ED.
DunnW (2000) Best practice occupational therapy: in community service with children and families. Thorofare, NJ: Slack.
39.
DunnWBennettD (2002) Patterns of sensory processing in children with attention deficit hyperactivity disorder. Occupational Therapy Journal of Research, 22 (1), 4–15.
40.
DuPaulGJPowerTJAnastopoulosADReidR (1998) ADHD Rating Scale — IV. New York: Guilford Press.
41.
DuPaulGJStonerG (2003) ADHD in the schools: assessment and intervention strategies. 2nd ed.New York, NY: Guilford Press.
42.
FeaverSCreekJ (1993) Models for practice in occupational therapy: part 2, what use are they?British Journal of Occupational Therapy, 56 (2), 59–62.
43.
FioreTABeckerEANeroRC (1993) Research synthesis on education interventions for students with ADD. North Carolina: Research Triangle Institute.
44.
FisherAGBryzeK (1998) School AMPS: School Version of the Assessment of Motor and Process Skills. 2nd research ed. Fort Collins, CO: Three Star Press.
45.
FrickSHackerC (2000) Listening with the whole body. Hugo, MN: PDP Press.
46.
GioiaGAIsquithPKGuySCKenworthyL (2000) Behaviour Rating Inventory of Executive Function (BRIEF). Odessa, FL: Psychological Assessment Resources.
47.
GuevremontDC (1993) Social skills training: a viable treatment for ADHD. ADHD Report, 1 (1), 6–7.
48.
HarrisonCSofronoffK (2002) ADHD and parental psychological distress: role of demographics, child behavioural characteristics, and parental cognitions. Journal of the American Academy of Child and Adolescent Psychiatry, 41 (6), 703–11.
49.
HendersonSESugdenDA (2007) Movement Assessment Battery for Children. 2nd ed.Sidcup, Kent: Psychological Corporation.
50.
HillPCameronM (1999) Recognising hyperactivity: a guide for the cautious clinician. Child and Adolescent Mental Health, 4 (2), 50–60.
51.
HinojosaJSproatCTMankhetwitSAndersonJ (2002) Shifts in parent-therapist partnerships: twelve years of change. American Journal of Occupational Therapy, 56 (5), 556–63.
52.
HinshawSPMelnickS (1992) Self-management therapies and attention deficit hyperactivity disorder: reinforced self-evaluation and anger control interventions. Behaviour Modification, 16, 253–73.
53.
HozaBOwensJSPelhamWESwansonJMConnersCKHinshawSPArnoldLEKraemerHC (2000) Parent cognitions as predictors of child treatment response in attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 28, 569–83.
54.
HumphryR (2002) Young children's occupations: explicating the dynamics of developmental processes. American Journal of Occupational Therapy, 56 (2), 171–79.
55.
HumphryRCase-SmithJ (2001) Working with families. In: Case-SmithJ, ed. Occupational therapy for children.4th ed.St Louis, MO: Mosby, ch. 5. JohnstonC, FreemanWS (2002) Parents' beliefs about ADHD: implications for assessment and treatment. ADHD Report, 10 (1), 6–9.
56.
JonesCBJSearightHRUrbanMA (1999) Parent articles about ADHD. San Antonio, TX: Communication Skill Builders.
57.
KantnerRTaccoAM (1980) Comparison of vestibular stimulation effects on classroom behaviour of two hyperactive children with different hyperactive characteristics. Perceptual and Motor Skills, 50, 766.
58.
KielhofnerG (1992) Conceptual foundations of occupational therapy. Philadelphia: FA Davis.
59.
KielhofnerG (1995) A Model of Human Occupation: theory and application. 2nd ed.Baltimore, MD: Williams and Wilkins.
60.
KingSRosenbaumPKingG (1995) The Measure of Processes of Care (MPOC): a means to assess family-centred behaviours of health care providers. Hamilton, ON: McMaster University.
61.
KingSRosenbaumPKingG (1998) The Measure of Processes of Care – 20-item version (MPOC-20). Hamilton, ON: McMaster University.
62.
KortmanB (1994) The eye of the beholder: models in occupational therapy. Australian Occupational Therapy Journal, 41 (3), 115–22.
63.
KraussKE (1987) The effects of deep pressure touch on anxiety. American Journal of Occupational Therapy, 41 (6), 366–73.
64.
LaneSJMillerLJHanftBE (2000) Toward a consensus in terminology in sensory integration theory and practice. II: Sensory integration patterns of function and dysfunction. Sensory Integration Special Interest Section Quarterly, 23, 1–3.
65.
LawMCooperBStrongSStewardDRigbyRLettsL (1996) The person-environment-occupation model: a transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63 (1), 9–23.
66.
LouHC (1996) Etiology and pathogenesis of ADHD: significance of prematurity and perinatal hypoxic-haemodynamic encephalopathy. Acta Paediatrica, 85 (11), 1266–71.
67.
MangeotSDMillerLJMcIntoshDNMcGrath-ClarkeJHagermanRJGoldsonE (2001) Sensory modulation dysfunction in children with attention-deficit/hyperactivity disorder. Developmental Medicine and Child Neurology, 43, 399–406.
68.
McEwenM (1990) The human-environment interface in occupational therapy: a theoretical and philosophical overview. In: SISIS Standing Committee, ed. Environment: implications for occupational therapy practice — a sensory integrative perspective. Rockville, MD: American Occupational Therapy Association, ch. 1.
69.
MissiunaCPollockNLawM (2004) The Perceived Efficacy and Goal Setting System (PEGS). San Antonio, TX: Harcourt Assessment.
70.
NackleyVL (2001) Sensory diet applications and environmental modifications: a winning combination. AOTA Sensory Integration Special Interest Section Quarterly, 24 (1), 1–4.
71.
National Institutes of Health (2000) Consensus Statement: Diagnosis and treatment of attention deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 39 (2), 182–93.
72.
OetterP (1986a) Assessment: the child with ADD. AOTA Sensory Integration Special Interest Section Newsletter, 9, 6–7.
73.
OetterP (1986b) A sensory integrative approach to the treatment of attention deficit disorder. AOTA Sensory Integration Special Interest Section Newsletter, 9, 1–2.
74.
OetterPRichterEFrickS (1995) MORE: Integrating the mouth with sensory and postural functions. 2nd ed.Hugo, MN: PDP Press.
75.
OvermeyerSTaylorE (1999) Annotation: principles of treatment for hyperkinetic disorder: practice approaches for the UK. Journal of Child Psychology and Psychiatry, 40 (8), 1147–57.
76.
PelhamWEGnagyC (1999) Psychosocial and combined treatments for ADHD. Mental Retardation and Developmental Disabilities Research Reviews, 5, 225–36.
77.
PetersonCQ (1993) ADHD: evaluation and treatment. AOTA Developmental Disabilities Special Interest Section Newsletter, 16 (1), 2–4.
78.
PiekJPPitcherTMHayDA (1999) Motor coordination and kinaesthesis in boys with ADHD. Developmental Medicine and Child Neurology, 41, 159–65.
79.
RosenbaumPKingSLawMKingGEvansJ (1998) Family-centered service: a conceptual framework and research review. Physical and Occupational Therapy in Pediatrics, 18 (1), 1–20.
80.
SchaafRSAnzaloneME (2001) Sensory integration with high-risk infants and young children. In: RoleySSBlancheEISchaafRC, eds. Understanding the nature of sensory integration with diverse populations. San Antonio: Therapy Skill Builders, ch. 14.
81.
ScheererCR (1992) Perspectives on an oral motor activity: the use of rubber tubing as a ‘chewy’. American Journal of Occupational Therapy, 46 (4), 344–52.
82.
SchillingDLWashingtoKBillingsleyFFDeitzJ (2003) Classroom seating for children with attention deficit hyperactivity disorder: therapy balls versus chair. American Journal of Occupational Therapy, 57 (5), 534–41.
83.
ShafferRJJacokesLECassilyJFGreenspanSITuchmanRFStemmerPJ (2001) Effect of interactive metronome training on children with ADHD. American Journal of Occupational Therapy, 55 (2), 155–62.
84.
SheridanSMDeeCCMorganJCMcCormickMEWalkerD (1996) A multimethod intervention for social skills deficits in children with ADHD and their parents. School Psychology Review, 25, 57–76.
85.
TannockR (1998) Attention deficit hyperactivity disorder: advances in cognitive, neurobiological, and genetic research. Journal of Child Psychology and Psychiatry, 39 (1), 65–99.
86.
TaylorEDopfnerMSergeantJAshersonPBanaschewskiTBuitelaarJCoghillDDanckaertsMRothenbergerASonuga-BarkeESteinhausenH-CZuddasA (2004) European clinical guidelines for hyperkinetic disorder — frist upgrade. European Journal of Child and Adolescent Psychiatry, (Suppl. 1), 13, 1/7–1/30.
87.
TaylorESergeantJDoepfnerMGunningBOvermeyerSMobiusHJEisertHG (1998) Clinical guidelines for hyperkinetic disorder. European Journal of Child and Adolescent Psychiatry, 7, 184–200.
88.
VandenBergNL (2001) The use of a weighted vest to increase on-task behaviour in children with attention difficulties. American Journal of Occupational Therapy, 55 (6), 621–28.
89.
VoellerKS (2001) Attention-deficit/hyperactivity disorder as a frontal-subcortical disorder. In: LichterDGCummingsJL, eds. Frontal-subcortical circuits in psychiatric and neurological disorders. New York, NY: Guilford Press.
90.
WatsonDELlorensLA (1997) Task analysis: an occupational performance approach. Bethesda, MD: American Occupational Therapy Association.
WhitmontSClarkC (1996) Kinaesthetic acuity and fine motor skills in children with ADHD: a preliminary report. Developmental Medicine and Child Neurology, 38, 1091–98.
93.
WilbargerP (1995) The sensory diet: activity programs based on sensory processing theory. AOTA Sensory Integration Special Interest Section Newsletter, 18 (2), 1–4.
94.
WilliamsMSShellenbergerS (1992) An introduction to ‘How does your engine run?’: the Alert Program for Self-Regulation. Albuquerque, NM: Therapy-Works.
95.
WilliamsMSShellenbergerS (1994) How does your engine run? A leader's guide to the Alert Program for Self-Regulation. Albuquerque, NM: Therapy-Works.
96.
WilliamsonGGAnzaloneME (2001) Sensory integration and self-regulation in infants and toddlers: helping very young children interact with their environment. Washington, DC: Zero to Three.
97.
WilsonBNKaplanBJCrawfordSGCampbellADeweyD (2000) Reliability and validity of a parent questionnaire on childhood motor skills. American Journal of Occupational Therapy, 54, 484–93.
98.
WodrichDL (1994) ADHD — what every parent wants to know. Baltimore: Paul H Brookes Publishing.
99.
WoodrumSC (1993) A treatment approach for ADHD using the Model of Human Occupation. AOTA Developmental Disabilities Special Interest Section Newsletter, 16 (1), 1–2.
100.
ZentallSS (1993) Research on the educational implications of attention deficit hyperactivity disorder. Exceptional Children, 60 (2), 143–53.
