Abstract
This poster depicts a feasibility and preliminary effectiveness study of the Zones of Regulation©. In addition, it describes development of a coregulation curriculum for parents. Single subject multiple baseline data indicated increased ADL independence for study participants. The coregulation curriculum includes modules on easing transitions and eliminating meltdowns. This poster provides a firm foundation for future study of OT treatment for self-regulation deficits in children.
Primary Author and Speaker: Michelle Suarez
Additional Authors and Speakers: Ben Atchison, Elsie Bush
The purpose of this poster is two-fold. First, it depicts the results of a feasibility study of a self-regulation treatment provided at a university clinic. Second, it describes the development of a co-regulation curriculum for parents to supplement clinic treatment. Self-regulation is a foundation skill necessary for success in all aspects of life. The Zones of Regulation © (Zones) (Kuypers, 2011) is a cognitive behavioral program to improve self-regulation skills in children. Currently, there is widespread use of this approach in occupational therapy (OT) (Crooke, nd). However, there is no peer-reviewed research supporting its use. There is a dire need to determine the effectiveness of the Zones. In addition, the results from this study provided a springboard for the development of parent education related to co-regulation for skill generalization to the home.
The study used a single-subject multiple baseline across participants design. Participants were drawn from those enrolled in a faculty led clinic that provides a Level I Fieldwork for OT students. All of the participants scored above the clinical concern range for behavior and/or emotional regulation on the Behavior Rating Inventory of Executive Function and were between the Zones recommended ages of 6-14 years.
The Self-Regulation for ADL Independence Measure was the outcome measure developed for this study. This instrument was constructed by modifying the Functional Independence Measure (FIM) (Granger et al., 1993). The FIM has excellent validity and reliability across a range of diagnostic groups and is often used to measure changes in functioning pre and post treatment for many neurological conditions (Corrigan, et al., 1997). The FIM was modified to allow for parent completion based on observations of their child’s weekly ADL performance during baseline and treatment phases. To improve construct validity, this instrument was reviewed by two experts in OT practice and modified until these professionals approved.
Consistent with single subject analysis methods (Kennedy, 2005), data from this study was graphed for visual analysis of differences in level, trend, and variability between baseline (BL) and treatment (TX) conditions (Byiers, Reichle, & Symons, 2012). The percentage of non-overlapping data (PND) was calculated as the metric for effect size.
All four participants demonstrated a level change between the BL and TX phases that indicated greater self-regulation after the initiation of treatment. Data trends included BL slopes that were flat (n=2), positive (n=1) and negative (n=1) and TX slopes that were positive (n=3) or flat (n=1). Variability in the BL data was low (n=4) and variability in the TX data was medium (n=2) or high (n=2). The percentage of non-overlapping data, a measure of effect size, was large (PND=86.67). After implementation of the Zones program, a need for supplemental formalized parent education was identified. Topics were outlined and a curriculum was developed. Topics included: Co-Regulation and Connection, Easing Transitions, and Preventing Melt-Downs.
This study demonstrated the feasibility of studying the Zones in a university clinic. In addition, preliminary evidence indicated that the Zones has promise for increasing independence in ADL’s for children with regulatory issues. There is a need for study replication using additional valid and reliable outcome measures, measurement of outcomes using blind observers, and a measurement of treatment fidelity. Future studies may include the implementation of the Co-Regulation Curriculum for generalization of self-regulation skills to the home environment. This poster provides information that will lay the groundwork for future study of OT treatment for self-regulation deficits in children.
Kuypers, L. (2011). The zones of regulation: a curriculum designed to foster self-regulation and emotional control. San Jose, CA: Think Social Publishing.
Granger, C., Cotter, A. C., Hamilton, B., & Fiedler, R. C. (1993). Functional assessment scales: a study of persons after stroke. Archives of Physical Medicine and Rehabilitation, 74, 133–138.
Corrigan, J.D., Smith-Knapp, K. & Granger, C.V. (1997). Validity of the functional independence measure for persons with traumatic brain injury. Arch Phys Med Rehabil, 78, 8, 828-834.
Kennedy, C.H. (2005). Single-case designs for educational research. Boston: Pearson Education.