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Key words: everyday activities, participation, pediatric assessment
ABSTRACT
Measuring the participation of preschoolers (children between 3 and 6 years of age) with disabilities in everyday activités has become a professional mandate for occupational therapists. This study outlines the development of the Preschool Activity Card Sort, which can establish a child's occupational profile through parent interview. Six of the nine International Classification of Functioning, Disability and Health activity and participation domains are included in the Preschool Activity Card Sort. A literature review and an analysis of parent time logs were used to compile photographs of preschoolers engaged in typical activities. Parents respond to these photographs during discussion about their child's participation in these everyday activities. When a child does not participate in age-appropriate activities, the Preschool Activity Card Sort helps determine whether it is due to child, family, or environmental banters. Identifying these banters assists the therapist and the family in determining therapeutic goals.
Participation reflects the core values of occupational therapy, which include being a client-centered process focused on choice and satisfaction. When measuring participation, individualized efforts are profiled, making independence or comparison to a normative sample unnecessary. Additionally, environmental resources and barriers outside the individual are considered influential to participation (Gray & Hendershot, 2001; Law et al., 1999). Expanding our view beyond person and impairment is supported by those advocating a top-down assessment approach (Weinstock-Zlotnick & Hinojosa, 2004), and by theorists who look at parent scaffolded development (Vygotsky, 1978), community environments, and cultural routines (Bronfenbrenner, 1979; Weisner, 2002a, 2002b).
Occupational therapists have become alarmed by a reductionistic-impairment focus to the assessment process for children with disabilities and have advocated a more holistic occupational focus (Baum & Law, 1997; Coster, 1998; Trombly, 1993). Assessments of children with disabilities must reflect therapeutic intentions to facilitate outcomes that target client-centered participation (Law, 2002; Townsend, 1998). The purpose of this article is to describe the development of a new pediatric assessment tool that focuses on preschool-aged children's participation in everyday activities.
Literature Review
The World Health Organization's International Classification of Functioning, Disability and Health (ICF) offers a common language used across disciplines and integrates body systems, activity, and participation within an individual's specific environmental context (American Occupational Therapy Association, 2000; World Health Organization, 2001). Participation is defined...