Parents and educators were asked to complete several standardized measures to enable measurement of individual child outcomes. It was hypothesized that children who received the P4C service would have improved individual outcomes.
In Year 2 of the study, when the research team began to collect these measures, we realized that a large number of children in the study had moved to non-P4C schools so were lost to follow up. At the conclusion of Year 2, 89 of the 592 children had moved; 30 of these children were research participants. Almost all of these children moved from Grade 5 or 6 to middle school. If P4C had been available in middle schools, these children would have been able to continue to receive service. This resulted in 216 children remaining as research participants at the end of the study. They did not differ significantly in age, sex, CCAC or school board from the 592 children who were provided with this service so they are believed to be representative of the entire study sample.
Individual Child Outcomes Reported by Parents
Behaviours in the Home
Parents completed the Strengths and Difficulties Questionnaire at the beginning and end of the study. In general, parents reported that their children had low levels of behavioural problems and displayed high levels of prosocial behavior throughout the study period. That being said, parents did consistently note a decrease in hyperactivity and fewer emotional problems over time. While we cannot conclude with certainty that these changes in behavior occurred specifically due to P4C, these outcomes are very encouraging because they indicate that parents saw improvements in their child’s behaviour at home during the time period of this study.
When interpreting these results, it is important to note that children in this study were selected on the basis of observed difficulty with motor-based activities: most children did not exhibit clinically significant behavioural concerns and were considered to be demonstrating positive social behaviours, even at the outset of the study (e.g. generally well behaved; usually does what adults request). This generally positive behavioural profile may reflect, in part, the young age of the participants in this study. Other studies suggest that secondary consequences (including peer and emotional problems) tend to escalate over time. Thus, it may be that these types of issues are less prominent in younger children and, therefore, are less likely to be reported by parents.
Now that this baseline has been established, it will be important to track changes for this group of children over time to determine if there is any change in emotional and peer problems, or if the children who received the P4C service continue to display low levels of behavioural and emotional challenges. This warrants further study.
Strength & Difficulties Questionnaire — Parent Report
These findings also suggest that, while the OT is at the school, the OT should have interaction with parents through family or team meetings. The reduction in subscale scores suggest that gains achieved at school may transfer into success at home. Parents reported fewer problems in all domains, but further research is needed in this area.
Change in Participation in Activities at Home and in the Community
Parents completed the Participation and Environment Measure for Children and Youth (PEM-CY) at the beginning and end of the study. There was a consistent increase in the extent to which children participated in tasks in the home. In particular, children participated in more household chores and tasks involved in preparing for school and organized physical activities. Of great interest, parents reported that their children were doing homework less frequently! Explanations for this finding could include educators having a better understanding of children and their needs or children improving their written productivity and ability to complete work at school.
Change in Participation in Activities in the Home
Parents also reported the frequency with which their child participated in activities in the community. Consistent improvement was noticed in the extent to which children participated in both organized physical activities and unstructured physical activities. Given the high level of obesity that is often secondary to motor coordination challenges, this increase in participation in both structured and unstructured physical activity is very encouraging. There was also positive change in the frequency with which children attended community groups or organizations; however, their participation was still quite low in this category.
Change in Participation in Activities in the Community
Child Outcomes Reported by Educators
Educators also completed questionnaires about the study children. Although only 246 parent packages were completed, 195 educators of the 246 children completed an assessment of the children in the study at three time points: upon referral into the study, the beginning of Year 2, and the end of Year 2. The team felt it was most important to capture change in the second school year when the P4C OT was focusing more on suggesting individualized strategies.
Classroom educators were asked to complete the Strengths and Difficulties Questionnaire (SDQ). Only the SDQ responses that were completed by the same teacher at the beginning and the end of the school year were analyzed. Peer problems were shown to slightly increase over Year 2. In particular, children who had motor challenges were noticed by educators to be more likely to spend time with adults and were more likely to be bullied. Further study of this finding is warranted and suggests that more time could be spent focusing on whole classroom activities to create a more inclusive environment.
Strength & Difficulties Questionnaire — Educator Report
The graph also shows that educators agreed with parents that the greatest challenge for these children was in the area of hyperactivity, and that these children generally had low overall levels of behavioural problems and high levels of pro-social behaviours across the study period.
Educator Report of Children’s Participation in the Classroom
Educators were also asked to complete the School Function Assessment (SFA) (Coster, Deeney, Haltiwanger, & Haley, 1998), a measure of the extent to which the child requires assistance from adults to participate. The SFA helps to identify tasks that either support or hinder participation in the school setting.
In Year 1, educators reported that 179 out of 195 children were in regular classrooms and 14 were in self-contained classrooms (two did not report this information). At the start of the study, children were reported to be having some degree of difficulty participating in school activities without adult assistance.
Change in Participation at School
Relatively little change was seen between entry into the study and the rating of the educator in the next grade in early October. Many children were recruited into the study in the spring of the first year and the OTs concentrated more on universal design for learning and differentiating those in need of service, based on the children’s response to their suggestions. As expected, the only significant increase from Year 1 to the beginning of Year 2 was seen in the rating of each teacher regarding general participation at a whole class level.
A consistent increase was seen from the beginning to the end of Year 2 when OTs were focusing more on individualized strategies and suggestions. Educators reported that almost all children were participating better and that change had been seen in all settings except independence in the bathroom (which was rated as typical for most children at all three points). When considering the child’s ability to participate in all classroom activities, educators indicated much improvement over the time of the study: 39% of children did not show change but 22% of children were already participating fully; 39% of children moved up at least one category suggesting that they required less adult assistance and supervision. By the end of the study, most children were either participating fully or required some modification to the activity but little adult assistance.