Date Presented 4/21/2018
The FITTED approach was the basis for an individualized evaluation and intervention program that emphasizes personal strengths and weaknesses in daily functions among adolescents with neurodevelopmental disabilities who experience executive function deficits.
Primary Author and Speaker: Yael Fogel
Contributing Authors: Sara Rosenblum, Naomi Josman
PURPOSE AND BACKGROUND: The purpose of this study was to demonstrate the efficiency of the Functional Individualized Therapy for Teenagers with Executive Deficits (FITTED) model for evaluation and intervention to improve achievement of daily goals among adolescents with executive function (EF) deficits who display functional difficulties in all performance areas: daily functions, learning, play, leisure activities, and social participation. A gap has been identified between occupational therapy practitioners’ knowledge about EF and daily functioning and their ability to apply this knowledge to a model of practice (Cramm et al., 2016). The gap is even more pronounced in practice with adolescents who have neurodevelopmental disabilities such as learning disabilities, motor clumsiness, and attention deficits. Difficulties in metacognitive components, particularly EF, may be the underlying mechanisms of these disabilities and challenge the everyday functioning of this population (Cramm et al., 2016; Mann & Snover, 2015). Occupational therapy practitioners lack an evidence-based approach to intervention that combines knowledge about EF with clinical practice. Therefore, this study examined the effectiveness of the FITTED approach among adolescents with neurodevelopmental disabilities.
METHOD: For this randomized, controlled, crossover trial, 41 participants were recruited. Participants were adolescents aged 10–18 with EF deficits identified by parents using the Behavior Rating Inventory of Executive Function (score of ≥65 in one of the indexes). The study was carried out by two researchers; one performed the assessments and the other executed the intervention processes according to a uniform and structured intervention protocol. Each adolescent chose the goals he or she wanted to achieve and, with mediation, created strategies for achieving them. Parents took an integral part in the evaluation and intervention process.
Data were collected before intervention, at the end of intervention, and at 3-mo follow-up. Participants’ demographic information, health status, and development history were obtained from parents via questionnaires. The main measure of therapeutic effectiveness was perceived performance in daily activities in response to the treatment goals, measured using the Canadian Occupational Performance Measure (COPM) Performance and Satisfaction scales (Law et al., 2005). Repeated measures analyses of variance were performed to measure change in COPM scores before and after intervention and at follow-up.
RESULTS: The FITTED approach was found to be effective in promoting achievement of the treatment goals selected by adolescents. The intervention groups showed significantly better self-perceived performance and satisfaction: for Group A, F(3, 17) = 12.03, p < .001, η2 = .83; for Group B, F(3, 15) = 23.64, p < .001, η2 = .92.
CONCLUSION: FITTED was found to be an effective approach. The intervention was based on a uniform and structured protocol that allowed expression of the individual differences of each adolescent and effectively met their specific needs.
IMPACT STATEMENT: The main contribution of this study is in highlighting the integration of EF in daily functioning, reinforcing the work of occupational therapy practitioners, and providing more scientific evidence supporting that adolescents can be treated by occupational therapy practitioners. Additionally, the study promotes the issue of adolescent care a step further, which may lead to preventive programs in the education and health systems. Finally, this study provides an approach that enables understanding of the components that underlie adolescents’ functioning. Thus, occupational therapy practitioners can direct interventions that are more effective and better adapted to the individual needs of these clients.
References
Cramm, H., Krupa, T., Missiuna, C., Lysaght, R. M., & Parker, K. C. H. (2016). The expanding relevance of executive functioning in occupational therapy: Is it on your radar? Australian Occupational Therapy Journal, 63, 214–217. https://doi.org/10.1111/1440-1630.12244
Law, M., Baptiste, S., Carswell, A., McColl, M. A., Polatajko, H., & Pollock, N. (2005). The Canadian Occupational Performance Measure (4th ed.). Ottawa: CAOT Publications.
Mann, D. P., & Snover, R. (2015). Executive functioning: Relationship with high school student role performance. Open Journal of Occupational Therapy, 3(4), Article 2. https://doi.org/10.15453/2168.1153
Toglia, J. P. (2011). The Dynamic Interactional Model of Cognition in cognitive rehabilitation. In N. Katz (Ed.), Cognition, occupation, and participation across the life span: Neuroscience, neurorehabilitation, and models for intervention in occupational therapy (pp. 161–202). Bethesda, MD: AOTA Press.
