"Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Occupational Therapy, Occupational Therapy Department, College of Allied Health and Nursing, Nova Southeastern University." Sensory processing disorder (SPD) has been shown to affect behavior in children. Children spend much of their time in school, where participation and appropriate behavior are expected. Sensory processing challenges may affect a child's ability to participate in school. However, the prevalence of SPD among nondisabled children, and its impact on participation remains poorly understood and understudied. This study sought to determine the prevalence of SPD and its potential impact upon school participation in children enrolled in kindergarten and first grade. Using a descriptive cross-sectional research design, parents of 123 typically developing children from five public and one private elementary school completed questionnaires to measure sensory processing behaviors. A conservative estimate of the prevalence of SPD was calculated at 8.3% within the sample studied, based upon parent report. The second phase of the study examined relationships and differences between children with and without SPD on various measures of participation in school as observed by teachers. Although no statistically significant differences were found between the children on measures of participation, there was very little agreement between parent and teacher perceptions on the presence of SPD for individual children. Further, statistically significant correlations were found between Short Sensory Profile scores and some measures of participation. These results suggest that perceptions of the presence of SPD may be related to the context in which the student is being observed. Results from this study were limited by the small sample size and low response rate.

"Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Occupational Therapy Department, College of Health Care Sciences, Nova Southeastern University." Abstract Background: In 2005, the Centers for Disease Control and Prevention recognized autism as an urgent public health concern understanding families would need supports services at many levels. Parents are the most prominent caregivers of children with disabilities and inadequacy of support services often influences the placement outside of the home. Federal mandates require that states actively avoid placements based on costs, community connections, and least restrictive environments; however, unsustainable family life potentially leads to undesired placements. Mothers with maternal stress raising children with severe autism with behavioral responses at home are at severe risk for social and economic marginalization (Lucenko, Mancuso, & Janssen-Timmen, 2008; Nankervis et al., 2012; Peacock et al., 2012). Placement and respite options are insufficient to meet the current needs for crisis intervention and long-term care, and community health funding has been inconsistent across the states. Literature review: Interdisciplinary and interprofessional literature on placement considerations, autism, and state, national, and global policy documents such as the World Health Organization was searched. Unique to this study was its inclusion of Sen's (1999) development economics capabilities approach in addition to Law et al.'s (1996) occupational therapy model of practice for its congruence with occupational therapy, its support of freedom and choice, and self-determinacy as a necessity for agency or occupational performance. Methods: A qualitative phenomenological approach to gain untapped insights into the occupations and environments influencing mothers' placement considerations. Phenomenology is useful when a deeper understanding is necessary, or to identify a vulnerable group, to shape services, or to develop or revise policies when a change is needed. Results: Data analysis produced six themes (a) feeling judged in their occupational roles as mothers; (b) restricted freedoms and occupational deprivations as a family; (c) the paradox of support services; (d) fears about their families' well-being; (e) occupational injustices revealed through mothers' feelings about placement considerations; and (f) spiritual aspects of childhood placement considerations. Discussion: The mothers' composite themes were discussed in relation to historical and evolving mental health attitudes, practices and policies, the evolving national health insurance policy, and the economy. The influence of contemporary culture on the mothers placement considerations were discussed in regard to Internet and e-health technologies and new ways of knowing, communicating, and decision-making with public health implications. Conclusion: Professional implications for research, practice, and justice issues are discussed.

"July 2005" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Ferol Ludwig This study explored the relationship between occupational performance, occupational satisfaction, social participation, and quality of life for survivors of brain injury participating in a community based program. This research project used multivariate analysis, specifically path analysis to test a proposed model exploring quality of life for individuals living with brain injury. Few research studies have undertaken the task of looking at relationships between social participation and quality of life; even fewer studies have looked at how meaningful occupations influence quality of life. To explore this relationship the Canadian Occupational Performance Measure, Community Integration Questionnaire, and the Wisconsin HSS Quality of Life Inventory were used. A participant pool of 80 survivors of brain injury completed each of the assessments. The findings of this study determined that social participation is a significant predictor of quality of life. The regression model that explored occupational satisfaction and social participation was also found to be significant. Another finding was that social participation significantly influenced the cohort's feelings of love and belonging. Finally, it was found that safety and security is an area of need for this cohort as they attempt occupations in the broader social environment. The findings indicate that social participation has the greatest effect on quality of life in this model; and occupational satisfaction has a slightly weaker effect. The effects of both occupational satisfaction and occupational performance were stronger as they directly influenced quality of life, however, the path model demonstrated that these two variables are influenced by social participation as they influenced quality of life for the survivor of brain injury participating in community programming. These findings are critical to the development of programming by occupational therapists. Finding indicate that social participation, facilitated by satisfaction with desired occupations, should be an important consideration in influencing the quality of life of survivors of brain injury participating in community programs.

"August 2006" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Ferol Ludwig Background and need : Prior research studies on adaptation to low vision have excluded the importance of engagement in occupation to the adaptation process. The purpose of this study was to develop a theory on how visually impaired women achieve adaptation through engagement in occupation. The theoretical framework for this study is occupational adaptation. A premise of occupational adaptation is that the occupational environment, the person, and their interaction are equally important in the adaptation process. Methodology : This qualitative study explored the reflections of seven visually impaired older women, aged 65 to 91, on their adaptation to low vision. I used grounded theory methodology to construct a theoretical model of Adaptation to Low Vision by Seven Older Women. Results : Engagement in meaningful occupations facilitates internal adaptation by increasing participants' self-esteem and motivating them to continue to find methods of doing and in getting help to participate in valued occupations or their abilities. Threats to performance initiate the process of adaptation and abilities serve to motivate participants to continue getting help and finding methods of doing their meaningful occupations. It is through the integration of losses and abilities that adaptation is achieved. Conclusions : The study adds to the knowledge base of occupational therapy by illustrating how integral engagement in occupation is to the process of adaptation. Engagement in meaningful and purposeful occupations supports adaptation to low vision and is an important component of the adaptation process. Results of the study should be considered in the treatment or program planning for the visually impaired. Rehabilitation for the visually impaired could be improved with: (a) education for clients and support persons on available services, (b) provision of opportunities for peer association, (c) use of client-centered practice, (d) training for necessary adaptive equipment, (e) home evaluations, (f) intervention at any point in the adaptation process, (g) therapist familiarity of visual impairment manifestations and effects of concurrent issues, and (h) therapeutic use of occupation to address personal occupational performance challenges.

"February 2008" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Max Ito Older adults may undergo changes in occupational participation patterns due to the process of aging, to institutionalization, or to illness. Measuring occupational participation of older adults using a client-centered approach has become a professional mandate for occupational therapists. The Activity Card Sort was developed to measure the level of client activity participation in instrumental, socio-cultural, and leisure activities. With the authors' permission, a valid method of translation and cultural adaptation of the ACS was developed based on a sample of older Puerto Rican adults and occupations relevant to this population derived from a previous study. The final version used in this analysis included 82 picture cards of older adults participating in typical Puerto Rican occupations which clients were to sort into five categories. The purpose of this study was to determine the validity and reliability of the translated and culturally-adapted Puerto Rican Spanish version of the Activity Card Sort (PR-ACS) for older Spanish-speaking adults living in Puerto Rico. This study included 146 participants, two groups of 106 community-living, healthy older adults aged 60 or older and 40 adults with multiple sclerosis (MS) aged 50 or older. The study explored evidence of validity by examining the relationship of the PR-ACS current activity scores with other variables. Reliability evidence included test-retest and internal consistency. Results showed that the PR-ACS was able to discriminate between clients with different levels of functioning (t = 6.86; p = .00), and was positively associated with the Puerto Rican Version of the RAND 36-Short Form Health Survey (r = 0.66; p = .00). Good test-retest reliability (r = 0.82) and high internal consistency of the total scores of the combined sample (r = 0.91) and the sample of healthy older adults (.91) were demonstrated, as well as good internal consistency of these scores for the sample of individuals with MS (.77). The findings suggest the PR-ACS is a reliable and valid instrument to use with the Puerto Rican elderly population.

"September 2008" A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Occupational Therapy. Typescript Project Advisor : Sandra Dunbar Objective. The purpose of this study was to gain insight regarding mothers' perceptions of their occupations when mothering a child with feeding and eating difficulties. This research study examined the following research questions. What is the perception of life satisfaction in mothers of young children who demonstrate difficulties in the occupations of feeding and eating as compared to that of mothers whose children are typically developing? What is the perception of stress in mothers of young children who demonstrate difficulties in the occupations of feeding and eating compared to that of mothers whose children are typically developing? What are mothers' perceptions of their occupations when mothering a young child with feeding and eating difficulties? Method. The design for this study was mixed methodology, specifically a triangulation design: convergence model (Creswell & Plano-Clark, 2007). In this method, both quantitative and qualitative data are collected simultaneously. In the quantitative portion of the study, two groups of women (34 mothers of typically developing children and 29 mothers of children with feeding difficulties) were surveyed utilizing the Parental Stress Scale (PSS) and the Life Satisfaction Index for Parents (LSI-P). In the qualitative portion of this study, five women from the group of mothers of children with feeding difficulties were interviewed using phenomenological inquiry. Results. Overall, there was no statistically significant difference between groups in terms of life satisfaction. However, in one of the five LSI-P categories, that of leisure and recreation, there was a statistically significant difference between groups (p value = .019). Data analysis revealed no statistically significant difference between the groups on the PSS. The qualitative data analysis revealed the following themes: feeling supported, seeking support, the range of emotions/feelings, the complexity of feeding, and dealing with the system. Mixed methods comparison of the quantitative and qualitative data offered further exploration and illumination of both data sets. Conclusion. With regard to the first research question concerning the issue of life satisfaction, the qualitative data provided further insight into the results of the quantitative data analysis. The qualitative data analysis revealed significant statements related to all five of the domains of the LSI-P. In terms of the second research question concerning the issue of stress, the qualitative data analysis provided further insight into the results of the quantitative data analysis. The qualitative data analysis shed light on the issue of stress, revealing that mothers of children with feeding difficulties do experience concerns that result in feelings of stress, anxiety, difficulty, and worry. The final mixed methods data analysis revealed the complex nature of the interaction between mothering occupations and mothering a child with feeding concerns. The additional occupations and challenges that mothers of children with feeding difficulties face often result in feelings of decreased life satisfaction and stress.

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