INTRODUCTION: This Capstone project provided preliminary data on the OT Feeding Outcome Tool and general data on outcomes of feeding interventions at Children’s Specialized Hospital. The OT Feeding Outcome Tool is an internally developed and utilized tool to assess a wide range of pediatric feeding difficulties, regardless of diagnosis and intervention. THEORETICAL PERSPECTIVE: Sensory Integration and Behaviorism were the major theoretical frameworks. DESCRIPTION OF DOCTORAL CAPSTONE: A literature review, focus groups, interviews, chart audits, an online questionnaire and clinical participation and observation provided quantitative and qualitative data on the current state of the literature, barriers to implementation and outcomes of children who have received feeding therapy at Children’s Specialized Hospital. RESULTS: The majority of pediatric feeding assessments are based in behavioral theory and interventions and fail to capture the multi-faceted etiologies and intervention approaches that are seen in practice. Data analyses revealed children who receive feeding therapy at Children’s Specialized Hospital, regardless of diagnosis or intervention, have positive responses recorded by the OT Feeding Outcome Tool. Major barriers to tool implementation were logistical challenges, forgetting and lack of competency. Most effective education methods of the tool were discussion with colleagues, staff meeting and an education presentation. CONCLUSION: There is a significant lack of feeding assessment tools for pediatric populations in the literature, and specifically a lack of evaluations that incorporate an occupational therapy and sensory integration lens. The OT Feeding Outcome Tool is a promising assessment tool for the evaluation of feeding difficulties in pediatric populations.

This dissertation explores how children with and without developmental coordination disorder (DCD) ‘look’ and ‘see’: how they integrate vision and attention to guide arm and hand movements during a visuomotor task. Chapter 1 provides the thesis context, reviewing the vision and attention literature, outlining the role of these processes in motor performance, and reviewing what is known about vision and attention in children with DCD. Chapter 1 includes a discussion on eye tracking to measure visual attention, and outlines the thesis purpose and objectives.Chapter 2 focuses on children with DCD, detailing their presentation and clinical management. This chapter serves to increase the reader’s understanding of the difficulties children with DCD experience, and to demonstrate the need for intervention to prevent the profound consequences that can impact their quality of life. Chapter 3 presents a study that explores how children with and without DCD employ vision and attention to accomplish a visuomotor task in a natural setting, using a novel eye tracking design. Highlighted here are important differences during visuomotor task performance: compared to their peers, children with DCD did not use predictive gaze to attend to relevant task objects, but rather used vision to guide their arm/hand throughout the task. Chapter 4 outlines lessons learned from using an eye tracker with children with DCD, describing the children for whom eye tracking was not reliable, and discussing equipment and participant factors that impact eye tracker use. Recommendations for future research using eye tracking with the DCD population are provided. Finally, Chapter 5 discusses the clinical and research implications of the studies conducted here. Insights gained regarding visual attention differences between children with and without DCD are discussed in the context of interventions to improve health outcomes in children with DCD and the design of future eye tracking studies. / Dissertation / Doctor of Philosophy (PhD)

<p dir="ltr">Previous wok has established that multiple academic and cognitive skills can contribute to difficulty with mathematics (Bull & Lee, 2014; Morgan et al., 2019; Purpura Day et al., 2017; Schmitt et al., 2017). However, little is known about how using both domain-specific (i.e., numeracy) and domain-general skills (i.e., executive function (EF), language, vocabulary) can help to identify children at risk for mathematics difficulties. Given that an estimated 3% to 8% of children are diagnosed with a math related disability (Desoete et al., 2004) and even more children experience difficulties with mathematics, and that mathematics is an important predictor of academic and career success (Duncan et al., 2007; Watts, 2020) it is imperative to understand how both domain-specific and domain-general skills, along with key demographic factors, can be used to identify children at risk for future mathematics difficulties. <a href="" target="_blank">The current study utilized data from a longitudinal project that assessed children’s academic and cognitive skills over four time points: the fall and spring of preschool and kindergarten</a> in a state in the Midwest of the United States.The analytic sample for this study consisted of 674 children from three cohorts. <a href="" target="_blank">A person-centered latent profile analysis was used to generate profiles of early math learners using children’s early numeracy, math language, executive function (EF), literacy, and vocabulary skills. Based on the model fit statistics and interpretability, a six-profile solution emerged from the data.</a> The latent profile approach was compared to a variable-centered regression for identifying risk for mathematics difficulties. <a href="" target="_blank">Results</a> show that there is variability in performance profiles in a sample at the lower end of mathematics performance. This study <a href="" target="_blank">suggests that domain-general skills such as EF, literacy, and mathematical language skills can help to distinguish between different performance profiles of mathematics learners</a>. <a href="" target="_blank">Results also demonstrate that person-centered and variable-centered approaches should be used in conjunction with one-another to best identify children at risk for mathematics difficulties.</a></p>

Bakgrund Till följd av stroke kan förändringar samt förlust av kroppsliga funktioner uppstå. Förändringar kan på olika sätt påverka personens förmåga att äta och upplevelse av måltiden. Måltiden utgör en integrerad del av det sociala livet och är förknippad med kultur, livsstil, samhörighet och välbefinnande. Ätsvårigheter efter stroke kan därmed få flera psykosociala konsekvenser och inverka på det dagliga livet och välbefinnandet. Syfte Syftet var att belysa psykosociala aspekter av måltidssituationen hos personer med ätsvårigheter till följd av stroke. Metod En icke-systematisk litteraturöversikt utfördes baserat på 15 vetenskapliga originalartiklar med kvalitativ och kvantitativ design. Artiklarna inhämtades från databaserna PubMed och CINAHL med hjälp av utvalda relevanta sökord för syftet. Alla artiklar granskades utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Resultatet sammanställdes och analyserades med en integrerad dataanalys.  Resultat I sammanställningen av resultatet identifierades tre huvudkategorier; En förändrad tillvaro, Främmande känslor och Samspelet med omgivningen. Resultatet visade att ätsvårigheter orsakade olika former av begränsningar i måltidssituationer och det sociala livet. Det krävdes anpassningar för att hantera nya situationer och för det användes olika strategier. Ätsvårigheter framkallade negativa känslor vilket berörde den egna självbilden. Det fanns en strävan att passa in bland omgivningen och interaktionen med omgivningen upplevdes olika. Slutsats Ätsvårigheter hade flera psykosociala konsekvenser vilket inverkade på känslomässiga och sociala processer i det dagliga livet. Ätsvårigheterna orsakade begränsningar i måltiden och måltidsrelaterade aktiviteter där förhållandet till måltiden som en social, kontextuell och njutbar aktivitet kom att förändras. Resultatet tyder på att ätsvårigheter är mycket komplext eftersom det påverkar flera aspekter av att leva och att vara människa. / Background As a result of stroke, changes and loss of bodily functions can occur. The changes can affect the person's ability to eat and the experience of the meal in different ways. The meal is an integrated part of social life and is associated with culture, lifestyle, togetherness and well-being. Eating difficulties after stroke can therefore have several psychosocial consequences and affect daily life and well-being. Aim The aim was to shed light on psychosocial aspects of the mealtime situation in people with eating difficulties following stroke. Method A non-systematic literature review was performed based on 15 original scientific articles with a qualitative and quantitative design. The articles were retrieved from the databases PubMed and CINAHL using selected relevant search terms for the aim. All articles were reviewed based on Sophiahemmet University's assessment basis for scientific classification and quality. The results were compiled and analyzed using an integrated data analysis.  Results In the compilation of the results, three main categories were identified; A changed existence, Unfamiliar emotions and The interaction with the surroundings. The results showed that eating difficulties caused various forms of limitations in meal situations and social life. Adaptations were required to deal with new situations and for that different strategies were used. Eating difficulties evoked negative feelings, which affected one's own self-image. There was a desire to fit in with the surroundings and the interaction with the surroundings was experienced differently. Conclusions Eating difficulties had several psychosocial consequences, which affected emotional and social processes in daily life. The eating difficulties caused limitations during the meal and meal-related activities where the relationship to the meal as a social, contextual and enjoyable activity came to change. The results suggest that eating difficulties are very complex because they affect several aspects of living and being human.

Bakgrund: En av de största orsakerna till funktionsnedsättningar i världen är stroke. Stroke kan orsaka ett flertal komplikationer varav en av de vanligaste är svårigheter med kommunikation. Kommunikation är en viktig del i mötet mellan patient och vårdare och det är centralt för sjuksköterskan att ha kunskap om olika sätt att kommunicera med patienter som har kommunikationssvårigheter. Sjuksköterskan behöver ha kunskap om dessa kommunikationssvårigheter och patientens upplevelse av kommunikation under och efter vårdtiden för att kunna ge en god personcentrerad vård där patientens behov uppfylls.  Syfte: Syftet var att belysa patienters upplevelse av kommunikationssvårigheter till följd av stroke.  Metod: Denna icke-systematiska litteraturöversikt inkluderade 15 vetenskapliga artiklar, av dessa bestod 13 av kvalitativ ansats och två av en mixad metod. Med hjälp av olika kombinationer av sökord inhämtades samtliga artiklar från PubMed och CINAHL. Dessa har sedan utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet genomgått en kvalitetsgranskning. En integrerad dataanalys har använts för att analysera och sammanställa resultatet.  Resultat: Resultatet delades upp i två huvudkategorier; kommunikation i vården och kommunikation efter vårdtiden. Även fem underkategorier har identifierats; tillit och bemötande, självständighet och stöd, sociala aktiviteter och interaktion, hopp och känslor till följd av kommunikationssvårigheter. Resultatet visade både positiva och negativa upplevelser kring kommunikationssvårigheter. Ett mönster som upptäcktes var att negativa känslor var kopplat till den akuta fasen och att positiva känslor uppstod i ett senare skede.  Slutsats: Studien visar att sjuksköterskor behöver bemöta och stötta strokeöverlevare och använda sig av god kommunikation genom att prata direkt till patienten, låta personen tala till punkt, samt lyssna på patienten och anpassa informationen till patienten. Detta kommer stärka patientens tillit till vården, självständighet, sociala förmåga, känsla av hopp samt minska de negativa känslorna som uppstår efter en stroke. / Background: One of the major causes of disability in the world is stroke. Stroke can cause a number of complications, one of the most common of which is difficulties with communication. Communication is an important part of the meeting between patient and carer, and it is cnetral for the nurse to have knowledge of different ways of communicating with patients that have communication difficulties. The nurse needs to have knowledge of these communication barriers and the patients’ experience of communication during and after the period of care in order to provide good person-centred care where the patients' needs are met.  Aim: The aim of this study was to illuminate patients' experience of communication difficulties due to stroke.  Method: This non-systematic literature review included 15 scientific articles, of which 13 consisted  of a qualitative approach and two of a mixed method. Using different combinations of search terms, all articles were obtained from PubMed and CINAHL. These have then undergone a quality review based on Sophiahemmet University's assessment basis for scientific classification and quality. An integrated data analysis has been used to analyze and compile the results.  Results: The results were divided into two main categories; communication in care and communication after the care period. Five subcategories have also been identified; trust and treatment, independence and support, social activities and interaction, hope and feelings as a result of communication difficulties. The results showed both positive and negative experiences regarding communication difficulties. A pattern that was discovered was that negative emotions were linked to the acute phase and that positive emotions emerged at a later stage. Conclusion: The study shows that nurses need to meet and support stroke survivors and use good communication by talking directly to the patient, letting the person speak to the end, as well as listening to the patient and adapting the information to the patient. This will strengthen the patient's trust in care, independence, social ability, sense of hope and reduce the negative feelings that arise after a stroke.

The present study investigated the associations of media use of children, media use of mothers, and parent-child interactions with behavioral strengths and difficulties in children. Screen time of 553 2- to 9-year-old children and their mothers were indicated by the daily durations of their TV/games console/computer/mobile phone use. The amount of parent–child interaction was indicated by the frequencies of shared activities at home. Behavioral strengths and difficulties of children were investigated using the Strengths and Difficulties Questionnaire. Children whose mothers reported high screen times (>/= 5 h/day) were significantly more likely to show high screen times (>/= 2 h/day). High screen time of children was associated with more conduct problems, more symptoms of hyperactivity/inattention and less prosocial behavior. High screen time of mothers was associated with emotional problems, conduct problems, and symptoms of hyperactivity/inattention. In contrast, a higher frequency of parent–child interactions was associated with fewer conduct problems, fewer peer-relationship problems, and more prosocial behavior of children. Children might use the media behavior of their mothers as a role model for their own media use. Furthermore, the findings suggest that media use of children and mothers and parent–child interaction contribute independently to behavioral strengths and difficulties of children.

Background Despite enormous advances in therapy, phenylketonuria (PKU) remains an incurable, inherited metabolic disease requiring life-long treatment with potential to negatively impact quality of life and psychological well-being. Therefore, the aim of this study was to screen early diagnosed and continuously treated children with PKU on psychological strengths and behavioral difficulties. Methods Evaluation of psychological strengths and behavioral difficulties in 49 patients with PKU (23f, 2-17 years) by Strengths and Difficulties Questionnaire (SDQ; self-report 11-17 years and parent-report 2-17 years). Comparison to age, sex and BMI-matched healthy controls (n = 98; 46f). Results In patients with PKU and healthy controls median SDQ Total Difficulties Score and median scores of subscales were within the normal range in parent- and self-report, irrespective of sex and age group (children 2-10 years, adolescents 11-17 years). No influence of long-term metabolic control in PKU on SDQ could be revealed. The 2- to 10-year-old boys with PKU showed significantly higher scores in Prosocial Behavior compared to their healthy peers (P = .032). Likewise, adolescent boys with PKU showed fewer Conduct Problems (parent-report, P = .006). Adolescent girls with PKU rated themselves more often as abnormal in the subscale Emotional Problems compared to their healthy peers (P = .041). This subscale was also responsible for a significantly different Total SDQ Difficulties Score between patients and their parents' report (P = .008). Discussion SDQ represents a suitable instrument within the care for patients with PKU. Specific aspects, however, require separate consideration and evaluation with respect to this chronic disease. Special attention should be paid on adolescent PKU girls who seem to be at risk to develop emotional problem.

Grundläggande förutsättningar för att företag och organisationer ska kunna bedriva en fungerande verksamhet är att det finns personal med rätt kompetens vilket tillgodoses med en väl genomförd rekrytering. Studien hade följande två frågeställningar: Hur arbetar rekryterare under rekryteringsprocessen för att förhålla sig så objektiva som möjligt? Vilka svårigheter finns det under en rekryteringsprocess sett till förhållningssätt i relation till subjektiva och objektiva bedömningar? 10 semistrukturerade intervjuer genomfördes med deltagare som innehar en tjänst med rekryteringsansvar. Intervjuerna tematiserades där sju centrala teman identifierades: Kravprofilen – grunden till det objektiva, standardiserad intervjumall, digital referenstagning, att frångå den subjektiva upplevelsen, tidspress, oärlighet samt språkutmaning. Resultatet visade bland annat att deltagarna upplever flera svårigheter i rekryteringsprocessen, den subjektiva upplevelsen nämndes som en svårighet hos många av deltagarna. Tidigare forskning visar att kravprofilen är en stor källa till objektivitet. Kravprofilen var även något som deltagarna ansåg vara grunden och ett hjälpmedel till det objektiva förhållningssättet. / Basic prerequisites for companies and organizations to be able to run a functioning business are that there are personnel with the right skills, which is met with a well-executed recruitment. The study had the following two questions: How do recruiters work during the recruitment process to be as objective as possible? What difficulties are there during a recruitment process in terms of approach in relation to subjective and objective assessments? 10 semi-structured interviews were conducted with participants who hold a position with recruitment responsibility. The interviews were thematized where seven central themes were identified: The requirements profile - the basis for the objective, standardized interview template, digital reference taking, moving away from the subjective experience, time pressure, dishonesty and language challenge. The results showed, among other things, that the participants experience several difficulties in the recruitment process, the subjective experience was mentioned as a difficulty by many of the participants. Previous research shows that the requirements profile is a great source of objectivity, the requirements profile was also something that our participants considered to be the basis and an aid to the objective approach.

Background: Autism Spectrum Disorder (ASD) is a developmental disorder characterized by difficulties with communication, problems with social interactions, and repetitive patterns. A greater proportion of children with ASD tend to experience nutritional difficulties and feeding issues compared to neurotypical (NT) children; however, limited research has been examined that compares nutritional behaviors between children with ASD and NT youth. Purpose: The purpose of this study was to examine the differences in gastrointestinal issues, weight concerns, and mealtime behaviors in youth with ASD and NT youth. Data was utilized from the 2019 National Survey of Children’s Health which consisted of items related to children’s health and well-being. Parent-reported variables on dietary behaviors, child weight concerns, mealtime behaviors, and food insecurity were compared between children with ASD and NT youth using chi-square analyses. Results: A total of 868 (weighted sample of 2,068,404) children with ASD and 28,441 (weighted sample of 72,451,623) NT children were included in the analysis. A greater percentage of parents of children with ASD reported weight-related concerns about their child (pp=0.57). Conclusion: Children with ASD experience more nutrition-related difficulties than NT youth although there were no differences in family mealtime patterns. Future research should examine food insecurity in families of children with ASD and its relationship with nutritional difficulties in this population.

No description available.