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Occupational Therapy with Children andYoung People: A Perspective from theUnited KingdomCarolyn Dunford a , Christine Owen b & Janet Kelly ca Faculty of Health and Life Sciences , York St. John University ,York, England, United Kingdomb Occupational and Arts Therapy , Queen Margaret University,Musselburgh , East Lothian, Scotland, United Kingdomc Aneurin Bevan Health Board , Llanfrechfa Grange Hospital , Wales,United KingdomPublished online: 14 Jun 2010.

To cite this article: Carolyn Dunford , Christine Owen & Janet Kelly (2010) Occupational Therapy withChildren and Young People: A Perspective from the United Kingdom, Journal of Occupational Therapy,Schools, & Early Intervention, 3:2, 187-196, DOI: 10.1080/19411243.2010.491021

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Journal of Occupational Therapy, Schools, & Early Intervention, 3:187–196, 2010Copyright © Taylor & Francis Group, LLCISSN: 1941-1243 print / 1941-1251 onlineDOI: 10.1080/19411243.2010.491021

GLOBAL VIEWS & PERSPECTIVESBEYOND BORDERS

Edited by Ted Brown & Rachael McDonald

Occupational Therapy with Children and YoungPeople: A Perspective from the United Kingdom

CAROLYN DUNFORD, DipCOT, MSc, PhD,1 CHRISTINEOWEN, BSc, MSc,2 AND JANET KELLY, DipCOT, MSc3

1Faculty of Health and Life Sciences, York St. John University, York, England,United Kingdom2Occupational and Arts Therapy, Queen Margaret University, Musselburgh, EastLothian, Scotland, United Kingdom3Aneurin Bevan Health Board, Llanfrechfa Grange Hospital, Wales, UnitedKingdom

Occupational therapy practice in the United Kingdom is well established and contin-ues to evolve. Traditional methods of service delivery and intervention techniques havedeveloped into more unified services, integrating child and family-centered approaches,which are often occupation-focused. This article details a historical perspective ofthe development of occupational therapy services shaped around the development ofeducational, health, and social care models that are in place today within the UnitedKingdom. An overview of occupational therapy as a profession defines practice beforefocusing on the development of children’s occupational therapy services. The devel-opment of policy and legislation within the United Kingdom provides a framework foroccupational therapy provision, alongside occupational therapy models of practice.Information is provided regarding predominant service delivery models that are cur-rently in use to support children and families. A range of diagnostic groups are seen byoccupational therapists in the United Kingdom. Information is presented that detailsassessment and interventions that are often utilized by occupational therapists workingin these areas. The article provides an insight into these issues and current occupationaltherapy practice with children and young people within the United Kingdom to date.

Keywords Occupational therapy, children and young people, United Kingdom

Address correspondence to Carolyn Dunford, York St. John University, Lord Mayor’s Walk,York, UK YO30 7EX. E-mail: c.dunford@yorksj.ac.uk

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Introduction

The United Kingdom (UK) of Great Britain and Northern Ireland includes four coun-tries: England, Wales, Scotland, and Northern Ireland. It is in the northwestern part ofEurope and is a member of the European Union. Parliament sits in London, England, butsome aspects of government have been devolved to the Scottish Parliament, the NationalAssembly for Wales, and the Northern Ireland Assembly since 1999. The Office forNational Statistics (ONS) estimated the population to be 61,383,000 in mid-2008, withchildren younger than 16 representing around one in five of the total population (ONS,2009). Eighty-four percent of the population lives in England, 8% in Scotland, 5% inWales, and 3% in Northern Ireland. The UK is often described as a multicultural society,with 7.9% of people belonging to a non-Caucasian ethnic group (ONS, 2001).

Education

Education is compulsory and free from 5 to 16 years of age, with two-thirds of 3- to 4-year-olds also attending school. Independent, fee-paying schools are also available for thosewho choose not to access the state education system. The National Curriculum sets stan-dards for a broad and balanced education for all children. Each of the four countries hasits own National Curriculum defining core subjects and expected attainment targets to bereached at key stages. Children’s and young people’s occupational therapists are rarelyemployed by the public education system but frequently work in schools as part of theirhealth role, which has been a requirement of various government policies across the UK.In 1978, the report on educating children and young people with special needs, known asthe Warnock Report, resulted in a major shift in the provision of education services forchildren and young people with special educational needs (Department of Education andScience, 1978). At that time in the UK, children and young people with special needs werestill referred to as handicapped, as was evident in the title of the report. This heralded theintegration of children and young people with special educational needs into mainstreameducation rather than placement in special schools, as was the typical custom and practiceat that time. The original intention was for all children and young people to be integratedwithin the mainstream school system, but, more latterly, there has been recognition for aneed for some specialized provision for children and young people with complex needs.

Integrating children and young people with special education needs into mainstreamschools has had a major impact on occupational therapy services. First, there were moreschools to visit as not all the children and young people were placed in one school, and,second, the staff in mainstream schools often had little knowledge of or experience withworking with children and young people with special needs. The occupational therapyrole in schools also includes educating staff about a child’s condition and advising onadapting the environment or recommending equipment to facilitate learning for individualchildren. In many areas, they also provide input into the special schools for the childrenwith complex needs. In both cases, the occupational therapist works alongside educationstaff, supporting children and young people with special educational needs or additionalsupport needs to participate and access the curriculum.

Health Services

The National Health Service (NHS) provides the bulk of health care to UK residents andis a publicly funded health care system. The four countries manage their own health care

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policy and funding. The Department of Health is responsible for health care in the UK,with devolved powers to the Scottish Government’s Health and Well-Being Directorate, theWelsh Assembly, and the Northern Ireland Executive Health Department. All UK residentsare entitled to access the NHS, which is free at the point of delivery. This includes accessto children’s and young people’s occupational therapy services. There are also independentoccupational therapy practitioners who provide services independently for a fee. The NHSimprovement plan introduced a target that, by 2008, all outpatients should be seen within18 weeks of referral (Department of Health, 2004). Waiting times in Wales are 14 weeks forcomponent waits, which relates to individual therapy services, and even shorter for referralto treatment times, where referral to a therapy service is part of a 26-week patient path-way. This has put enormous pressure on occupational therapy services to assess childrenand young people quickly, particularly as many UK children and young people’s occupa-tional therapy services have historically had long waiting lists (Dunford & Richards, 2003).In addition, within Scotland the introduction of the Additional Support for Learning Act(Scottish Executive, 2004) meant that an assessment of a child, from an occupational thera-pist or other allied health professional, could be requested as part of determining whether achild or young person may have additional support needs (special educational needs withinEngland), or could meet the criteria for a coordinated support plan.

Children’s and young people’s occupational therapists are often based in child devel-opment centers or child and adolescent mental health (CAMHS) teams where they work aspart of multi-disciplinary and sometimes multi-agency teams. In the UK, health servicesare generally divided into physical and mental health services, with occupational therapistsin children’s centers normally referred to as child health occupational therapists and thoseworking in mental health as CAMHS occupational therapists. There has been a move awayfrom using the term pediatric to apply to children’s and young people’s occupational ther-apy, as this sites the practice of these therapists, who work across health and social careservices, too much within the medical model. Wheelchair services are also provided fromwithin the NHS, with therapists working alongside rehabilitation engineers to give adviceon mobility seating, including powered wheelchairs. In the past decade, occupational ther-apy services have also become established in neonatal intensive care units, and this role isevolving (Gibbs, Boshoff, & Lane, 2010).

Social Services

The Department of Social Services is a government-funded body that provides a range ofservices to children and young people and families through local authorities. They have aduty to provide services for children and young people in need, and this includes childrenand young people with disabilities. Local authorities employ occupational therapists towork within children with disability teams, and much of their work is related to provisionof advice and equipment and the sometimes lengthy process of Disabled Facilities Grantapplications for housing adaptations. Occupational therapists working in health and socialservices often collaborate, pooling their expertise to make recommendations for equipmentand housing adaptations and providing integrated health and social care services to childrenand young people in need and their families.

Integrated Services

The growth of integrated health and social care and sometimes CAMHS services is oneof the most important developments in children’s and young people’s services during the

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past few years. Integration is used to describe a seamless service provision across agencyboundaries, wherein the client is truly placed at the center of the intervention and thereis less emphasis on which agency employs the occupational therapist. The philosophyof integration encourages children’s and young people’s occupational therapists to takea more holistic perspective in relation to the needs of children and young people referredand the nature of the child’s and families primary difficulties. It also encourages a sharingof knowledge, skills and experience across CAMHS, children and young people’s childhealth and social care occupational therapists. For example, local authority children’s andyoung people’s occupational therapists may implement aspects of sensory integration the-ory with autistic children and young people whereas in the past they would have referredto health occupational therapists for this. The skills that local authority occupational ther-apists gain from undertaking sensory integration and autism training may enable them toconsider a Disabled Facilities Grant request for a break-out room for a child at home withan improved understanding of the nature of the child’s condition and how that need mightbe met by providing a suitable environment. In a similar vein, health-based occupationaltherapists may look at behavior alongside physical disability and consider the mental healthneeds of children and young people with disabilities. Integrated services are intended tobe more holistic, with one occupational therapist providing as much of the occupationaltherapy care to the child as possible. For example, CAMHS occupational therapists under-taking handwriting remediation as part of a program to enhance a child’s confidence andself-esteem, referring onto their colleagues in the children’s centers only where absolutelynecessary. This not only provides a more timely and seamless service to a child and his orher family but impacts on waiting lists as children and young people waiting on more thanone occupational therapy waiting list is to be avoided. Single point of access into fully inte-grated children’s and young people’s services managed under one umbrella is the ultimatelong-term goal but in many areas has not been achieved yet.

Development of Occupational Therapy in the United Kingdom

The first mention of occupational therapy in the UK was in the British Medical Journal in1924, and the first training school for occupational therapists was set up in Bristol, England,by Dr. Elizabeth Casson in 1930. In 1936, the Association of Occupational Therapistswas formed, followed by the British Association of Occupational Therapists (BAOT) in1974. Subsequently, the British Association of Occupational Therapists and College ofOccupational Therapists were formed in 1978 and are currently the professional body forall occupational therapy staff in the UK. The BAOT is the professional body and tradeunion and wholly owns the College of Occupational Therapists (COT) as a subsidiary.The COT, a registered charity, publishes a monthly peer-reviewed periodical called theBritish Journal of Occupational Therapy that is received by more than 29,000 occupationaltherapists and students across the UK and internationally.

During the First and Second World Wars, there was a shift from occupation asa means of developing or maintaining health to occupation as a means of enhancingbio-medical outcomes. To achieve bio-medical outcomes, many occupational therapistsdeveloped skills and knowledge in the component aspects of performance rather thandealing with occupational performance itself. The component categories related to sen-sorimotor, physical, cognitive, and psychosocial elements of performance, whereas theoccupational performance categories related to issues of self-care, productive activity,social participation, rest, sleep, play, and leisure. There have been several calls for a shift in

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practice in the UK away from component-based assessment and intervention toward moreoccupation-focused approaches (COT, 2002; Dunford, 2005; Payne, 2002).

There are currently 22 places to study occupational therapy in England, three inScotland, three in Wales, and one in Northern Ireland. The COT (2009) states that “occupa-tional therapy enables people to achieve health and well-being and life satisfaction throughparticipation in occupation” and that occupational therapy is embedded within a philoso-phy of client-centered practice and working in partnership with service users (p. 1). TheCOT (2009) reports that “occupational therapy enables people to achieve health, well-beingand life satisfaction through participation in occupation” (p. 1) with the core skills of occu-pational therapy built around occupation and activity. In 2002, the COT launched a strategicplan to promote the principles and contribution of occupational therapy to integration ofhealth and social care services across the UK. Within the framework, a commitment wasmade to promote the importance of occupation for the health and well-being of the popula-tion, exemplifying occupation in its widest sense, including work and recreation, allowingindividuals to engage in occupations of their choice, fulfilling their chosen role withinsociety. The five core skills of occupational therapy include collaboration with clients;assessment; enablement, problem solving, using activity as a therapeutic tool; group work;and environmental adaptation (COT, 2009). All occupational therapists have to be regis-tered with the Health Professions Council (HPC) to be eligible to practice in the UK. TheHPC sets standards and regulates professional conduct, with 30,122 occupational therapistsregistered with the HPC in the UK.

Children’s and Young People’s Occupational Therapy

UK government legislation ensures provision of health, social, and educational servicesthat are free at the point of delivery. The main legislative documents that define serviceprovision for children and young people in the UK are the Children Acts of 1989 and2004; the Housing (Financial and Miscellaneous Provisions) Act of 2003; the Education(Scotland) Act of 1981; and the Education Disability and Discrimination Act of 1996. TheChildren Acts of 1989 and 2004 express the values underpinning health and social servicesas family-centered care, with the welfare of children and young people seen as paramount.

The COT has several specialist sections representing various areas of practice of occu-pational therapy. There is a dedicated specialist section for occupational therapists whowork with children and parents. The COT specialist section of Children, Young Peopleand Families has more than 700 members and is the largest specialist section within theCOT. However, not all children’s and young people’s occupational therapists are neces-sarily members, as membership is voluntary and paid for by individuals. The ChildrenYoung People and Families specialist section organizes conferences and produces a jour-nal. Regional groups operate around the UK, designed to share information across clinicalnetworks, host study days, and support best practice.

Children’s and young people’s occupational therapists work in a wide range of settingsincluding Child Development Centers, CAMHS, community services, education/schools,acute hospitals, independent practice, learning disability services, local authority healthand social care services, wheelchair services, and the voluntary sector. A retrospectivesurvey questionnaire in 2002 (Dunford & Richards, 2003), with 134 responses representing47% of Health Authorities/Boards in the UK, found the majority of services were beingdelivered from Child Development Teams followed by school-based services, community-based services, and CAMHS teams. Several services operated out of more than one typeof service setting. In 2002, the mean waiting time for an initial assessment was 46 weeks,

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with a span that ranged from 1 week (one service) to 2 to 4 years (eight services). However,recent political pressures to reduce waiting times are pushing services to ensure no onewaits for more than 18 weeks for an outpatient appointment, which includes referrals tochildren’s and young people’s occupational therapists.

The majority of models used in the UK have their origins in the United States andCanada, as the UK does not have its own model of occupational therapy practice. A rangeof models are being used in the UK, the most common being the Model of Adaptation(Reed & Sanderson, 1992) and the Model of Human Occupation (Keilhofner, 2008),according to Howard (2002). However, more recent years have seen the rise of other mod-els such as the Canadian Model of Occupational Performance and Engagement (1997;Townsend, 2002; Townsend & Polatajko, 2007) and the Person–Environment–OccupationModel (Law et al, 1996), which has been used in a range of settings including neonatalintensive care units (Gibbs et al., 2010). Some child and adolescent services do not adhereto any particular occupational therapy model (Howard, 2002).

Children and young people with disabilities in the UK generally want similar thingsas their able-bodied peers. A survey of 105 disabled children and young people ages 5to 25 in Wales, including children and young people with autism, cerebral palsy, atten-tion deficit hyperactivity disorder, learning disabilities and difficulties, Down’s syndrome,mobility and access difficulties, sensory disabilities (primarily speech and hearing impair-ments), mental health difficulties, and chronic illness, asked what these children and youngpeople wanted from the services provided for them (Turner, 2003). The children and youngpeople reported that the attitudes and behavior of staff had the greatest impact on them, andthey placed significant importance on being listened to and treated with understanding andrespect by professionals who work with them. They wanted to be provided with informa-tion, as there were gaps in their understanding of their disability, care, treatment, and theroles and responsibilities of professionals who come into contact with them (Turner). Theydid not want to receive information second-hand from parents or carers. They wanted tobe involved in decisions made about their care and the services provided for them. Theyidentified transport as a key issue in accessing services and wanted a greater choice oflocal leisure services. Barriers to participation in daily activities included difficulties withphysical access and the attitudes of the people they came into contact with (Turner).

Children’s and young people’s occupational therapists can work with any child oryoung person from birth to 18 years of age who presents with occupational deficits,although some services restrict access to their service by diagnosis or age. The commonconditions seen are developmental coordination disorder (DCD), cerebral palsy, atten-tion deficit hyperactivity disorder, global developmental delay (referred to as intellectualdisability or mental retardation in other countries), syndromes, autistic spectrum disor-ders, arthritis, developmental delay, conduct disorders, and eating disorders. Referrals arereceived from a range of professionals including consultants, school doctors, physiothera-pists, speech and language therapists, health visitors, and school nurses. Referrals are alsoreceived via the education system. A national survey reviewed the evidence and models ofpractice employed by allied health professionals working with children with developmen-tal coordination disorder in Scotland, where it was found that more than 80% of referralsaccepted by occupational therapists were made by community pediatricians, compared toonly 40% of occupational therapists accepting referrals by education and 21% acceptingreferrals initiated by parents (ACHIEVE Alliance, 2007).

Assessments take place in a variety of settings including clinics, schools, andchildren’s home. A combination of standardized, non-standardized, and observation assess-ment techniques are used. Payne (2002) reported on a small survey of children and young

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people’s occupational therapists working in the UK and found that the tests most frequentlyused were the Movement Assessment Battery for Children (Henderson & Sugden, 1992)and the Goodenough-Harris Drawing Test (Goodenough & Harris, 1963), followed by theTest of Visual Perceptual Skills (Gardner, 1996) and the Developmental Test of VisualMotor Integration (VMI; Beery, Buktenica, & Beery, 2006). In Scotland, occupationaltherapists stated that five of the most frequently used assessment tools when workingwith children and young people with coordination difficulties were the VMI, MovementAssessment Battery for Children (Henderson & Sugden, 1992, (2007), and informal clin-ical observations along with Tests of Visual Perception (ACHIEVE Alliance, 2007). TheMovement Assessment Battery–Second Edition and the Test of Visual Perceptual Skillhave been revised.

The largest group of children and young people seen by most occupational therapyservices are those with DCD. Children and young people with DCD comprised 30% ofoccupational therapists’ caseloads and 62% of the children and young people waitingfor assessment (Dunford & Richards, 2003). In Scotland, 73% of occupational therapistsworking with children and young people said that they had input with children and youngpeople with DCD (ACHIEVE Alliance 2007). The COTs are currently preparing a positionstatement in respect of diagnosing DCD to support and define the occupational thera-pists role in this specialist area of assessment and intervention. Services generally applythe Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (DSM-IV-TR)diagnostic criteria (American Psychiatric Association, 2000) when assessing this condi-tion. Many occupational therapists are guided by the Leeds Consensus Statement whenconsidering assessment, diagnosis, and intervention for children and young people withDCD (Sugden, 2006). However, practice varies around the country in terms of the multiprofessional team involved in diagnosing DCD and may involve input from pediatricians,physiotherapists, educational psychologists, and teachers.

Common assessment tools used with children with coordination difficulties arethe Movement Assessment Battery for Children (Henderson & Sugden, 1992, 2007);Bruininks-Oseretsky Test of Motor Proficieny–Second Edition (2005); the VMI; and thePerceived Efficacy and Goal Setting System (Missiuna, Pollock, & Law, 2004). Childrenand young people with DCD in the UK often set their own self-care and leisure goals fortherapy, which relate to tying shoelaces, cutting up food, playing games and sports, andriding a bike (Dunford, 2005). School-based occupations of importance to UK childrenand young people with DCD include handwriting, finishing work on time, and cutting withscissors (Dunford). Many services now run occupation-focused groups providing interven-tions related to self-care skills, bike riding, and football skills. These groups are often runin community centers in collaboration with other professionals such as physiotherapists,speech and language therapists, physical education teachers, coaches, and disability sportsofficers.

Children and young people with cerebral palsy (CP) are commonly seen by occupa-tional therapists at key stages or transition periods throughout their lifespan. Occupationaltherapists work alongside their colleagues in multi-agency teams to enable children andyoung people with CP to participate in daily occupations across the home–school–leisure interface, wherein interventions promote and enable independence in self-care,schoolwork, play, and leisure. Occupational therapists frequently work alongside theirphysiotherapy colleagues to develop 24-hr postural care packages for children and youngpeople with severe and complex postural needs. Children and young people with hemi-plegia may be offered a range of interventions such as bimanual training, splinting, orconstraint-induced therapy wherein the child’s nonaffected arm is put in a sling or glove

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to encourage using the affected upper limb. Occupational therapists work with orthope-dic surgeons and physiotherapists after botulinum toxin injections to the upper limb toreduce impairment, increase activity levels, and enable achievement of goals (Hoare et al.,2010). Occupational therapists enable children and young people to access various formsof assistive technology to enable them to participate in all occupational performance areasbut particularly in the areas of education, communication, and play activities for childrenand young people with disabilities. Occupational therapists work with wheelchair services,rehabilitation engineers, and physiotherapists to enable children and young people with CPto achieve maximum functional mobility.

Children and young people with autistic spectrum disorders are referred to occupa-tional therapists in health and CAMHS services. Some children and young people requireenvironmental adaptations to enable them to participate in occupational self-care andleisure related activities. In the UK, occupational therapists from health, CAMHS teams,and social services often collaborate to provide effective, integrated services for childrenand young people with complex needs. This can involve analyzing the environment andadvising on housing adaptations. In a single case study of a child with autistic spectrumdisorder, it was found that dedicated physical space at home affected behavior, sleep, andoccupational engagement and had a positive effect in reducing parental stress (Pengelly,Rogers, & Evans, 2009).

There is a broad range of intervention approaches used in the UK. Berry and Ryan’sUK survey of 120 occupational therapists working with children and young people foundthat 91.7% of the respondents stated they used an eclectic approach (Berry & Ryan,2002). Commonly used approaches included occupation-focused, ecological, child- andfamily-centered, sensory integration, sensory processing, and Bobath neuro-developmentaltreatment. A survey of 500 UK pediatric occupational therapists by Kelly in 2004 foundthat 61% of occupational therapists stated they used sensory integration as an interventiontechnique. The use of sensory integration techniques is evolving in the UK as elsewhere andconsiders how sensory processing issues are impacting on everyday functioning (e.g., self-care, school skills, or social engagement). Occupational therapists use their skills of activityanalysis to identify the specific issues and how they are influencing children’s behavior.They work alongside families and other professionals to enable an understanding throughparent/teacher education and promoting use of general supports and strategies throughconsultation. Sensory Integration is a theory, a model of assessment, and a form of therapy.Sensory processing disorders (Miller, Schoen, James, & Schaaf, 2007) is the proposed newdefinition, and an application has been made for it to be part of the DSM-V . This modelof practice is used with a range of diagnostic groups including attention deficit hyperac-tivity disorder, DCD, autism spectrum disorder, learning disability, and mental health. Itis continuing to evolve and is now more often clearly linked to functional outcomes andoccupational performance.

Conclusion

Occupational therapy practice in the UK is well established and continuing to evolve.Traditional methods of service delivery and intervention techniques are developing intomore integrated services and occupation-focused, child- and family-centered approaches.The drive for integrated services is helping to bring together occupational therapists andother professionals from health, local authority, CAMHS, education, and the voluntarysectors to provide seamless services for children and young people with disabilities.

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Intervention approaches applied to children and young people with disabilities in the UKincludes both top-down and bottom-up approaches (Green & Dunford, in press). Manyservices have moved to a more occupation-focused approach as a response to dealing withthe government’s demands and drives to reduce waiting lists, and many have subsequentlyfound this to be a more effective way of working. Clinical guidelines and governmentpolicies and legislation are there to support the redesigning of services that are child- andfamily-focused and which are also consistent with occupation approaches to intervention.It is, therefore, envisaged that occupational therapists working with children and youngpeople in the UK who are referred to services will continue to develop innovative and cre-ative interventions that will promote participation in meaningful and valued occupations,thereby improving the life opportunities for disabled children and young people.

References

ACHIEVE Alliance. (2007). Developmental co-ordination disorder: A review of evidence and modelsof practice employed by allied health professionals in Scotland [Electronic version]. RetrievedJuly 20, 2007, from http://www.nhshealthquality.org/nhsqis/3153.html

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders(4th ed., text rev.).Washington, DC: Author.

Beery, K. E., Buktenica N. A., & Beery, N. A. (2006). Beery-Buktenica Developmental Test of Visual-Motor Integration (5th ed.). Los Angeles: Western Psychological Services.

Berry, J., & Ryan, S. (2002). Frames of reference: Their use in paediatric occupational therapy.British Journal of Occupational Therapy, 65, 420–427.

Bruininks, R. H., & Bruininks, B. D. (2005). Bruininks-Oseretsky Test of Motor Proficiency(2nd ed.). Bloomington, MN: Pearson

College of Occupational Therapists. (2002). From interface to integration. London: Author.College of Occupational Therapists. (2009). Definitions and core skills for occupational therapy.

London: AuthorDepartment of Education and Science. (1978). Report of the Committee of Enquiry into the education

of handicapped children and young people London. London: HMSO.Department of Health. (2004). NHS Improvement Plan. London: HMSO.Dunford, C., & Richards, S. (2003) “Doubly disadvantaged”: Report of a survey on waiting lists and

waiting times for occupational therapy services for children with developmental coordinationdisorder. London: College of Occupational Therapists

Dunford, C. (2005). Children and young people’s occupations. British Journal of OccupationalTherapy, 68, 1.

Gardner, M. (1996). Test of Visual Perceptual Skills (non-motor)–Revised manual. Hydesville, CA:Psychological and Educational Publications.

Gibbs, D., Boshoff, K., & Lane, A. (2010). Understanding parent occupations in neonatal intensivecare: application of the Person–Environment–Occupation model. British Journal of OccupationalTherapy, 73, 55–63.

Goodenough, F., & Harris, D. (1963). Goodenough-Harris Drawing Test manual. San Antonio, TX:Psychological Corporation.

Green, D., & Dunford, C. (in press).Why is it spelled paediatric? Working with children in the UnitedKingdom. In A. Bundy & S. Lane (Eds.), Kids can be kids. Philadelphia: F.A. Davis.

Henderson S. E., & Sugden, D. A. (1992). Movement Assessment Battery for Children. London: ThePsychological Corporation/Harcourt Brace and Co.

Henderson, S. E., & Sugden, D. A. (2007). Movement Assessment Battery for Children–2. London:Harcourt Assessment

Hoare, B. J., Wallen, M. A., Imms, C., Villanueva, E., Rawicki, H. B., & Carey, L. (2010). Botulinumtoxin A as an adjunct to treatment in the management of the upper limb in children with spastic

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196 C. Dunford et al.

cerebral palsy (UPDATE). Retrieved January 3, 2010, from Cochrane Database of SystematicReviews.

Howard, L. (2002). A survey of paediatric occupational therapists in the United Kingdom.Occupational Therapy International, 9, 326–343.

Kelly, G. (2004). Paediatric occupational therapy in the 21st century: A survey of UK practice.NAPOT Journal, 8(3), 17–19.

Kielhofner, G. (2008). Model of human occupation (4th ed.). Baltimore: Lippincott, Williams andWilkins

Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactive approach to occupational performance. Canadian Journal ofOccupational Therapy, 63, 9–23

Miller, L. J. Schoen, S. A. James, K., & Schaaf, R. C. (2007). Lessons learnt: A pilot study on occu-pational therapy effectiveness for children with sensory modulation disorders. American Journalof Occupational Therapy, 61, 161–169

Missiuna, C., Pollock, N., & Law, M. (2004). Perceived Efficacy and Goals Setting System (PEGS)with children with disabilities, their parents and teachers. San Antonio, TX: PsychologicalCorporation.

Office of National Statistics. (2001). Census. London: HMSOOffice of National Statistics. (2009). Population estimates. London: HMSOPayne, S. (2002). Standardised tests: An appropriate way to measure the outcome of paediatric

occupational therapy? British Journal of Occupational Therapy, 65, 117–122Pengelly, S., Rogers, P., & Evans, K. (2009) Space at home for families with a child with autistic

spectrum disorder. British Journal of Occupational Therapy, 72, 378–383Reed, K. L., & Sanderson, S. R. (1992). Concepts of occupational therapy. Baltimore, Williams and

WilkinsScottish Executive. (2004). Education (Additional Support for Learning) (Scotland) Act. Edinburgh,

UK: Crown Copyright.Sugden, D. A. (Ed). (2006). Developmental coordination disorder as specific learning difficulty.

Leeds Consensus Statement (ESRC Seminar Series, 2004–2005). Cardiff, UK: Dyscovery Trust.Retrieved May 26, 2010, from http://www.dcd-uk.org

Townsend, E. (2002). Enabling occupation: An occupational therapy perspective. Ottawa, Ontario,Canada: CAOT.

Townsend, E. A., & Polatajko, H. J. (2007). Enabling Occupation II: Advancing an occupationaltherapy vision for health, well-being and justice though occupation. Ottawa, Ontario, Canada:Canadian Association of Occupational Therapists Publications ACE.

Turner, C. (2003). Are you listening? What disabled children and young people in Wales think aboutthe services they use. Cardiff, UK: Children First Team.

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