Importance: Children with autism spectrum disorder (ASD) may experience sleep difficulties that worsen into adulthood and negatively influence both child and family, yet the experience is not well understood. Understanding the family’s experience can inform occupational therapy providers, future research, and practice guidelines. Objective: To examine experiences surrounding sleep for families raising a young adult with ASD (YA-ASD). Design: Qualitative study in the phenomenological tradition of Moustakas (1994) . Experienced researchers analyzed transcripts from in-depth, in-person interviews to triangulate data, distill themes, and construct the essence of family experience. Trustworthiness was established through member checking, audit trails, and epoché diaries that were maintained throughout data analyses. Setting: Community setting (large city in the northeastern United States). Participants: People who self-identified as living in a family arrangement that included a YA-ASD age 15–21 yr, able to verbally participate in English. Families with children diagnosed with developmental disabilities other than ASD were excluded. Results: Six eligible families identified through volunteer sampling participated. The participants’ sociodemographic diversity was limited across household income, education level, and ethnicity. All YA-ASD in this study were limited verbally and unable to contribute. Analyses of interview transcripts revealed five themes that form the essence of the families’ experience surrounding sleep. Conclusions and Relevance: Sleep issues for YA-ASD continue into adulthood and affect the entire family because of continuous co-occupation; occupational therapy support is therefore important for families of YA-ASD. The lack of effective evidence-based interventions supporting the YA-ASD population also reveals an area for growth. What This Article Adds: The results indicate the importance of addressing sleep for YA-ASD and their families in occupational therapy practice because of its considerable impact on family life.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The research study was conducted to identify how disruptions in sleep affect daily occupational performance after brain injury and to acknowledge of the role of OT in addressing sleep deficits through semistructured interviews and a multicomponent sleep program. The study was one of few studies to document the effectiveness of OT-directed sleep interventions, offering support for future OT practitioners and researchers to address sleep. Primary Author and Speaker: Brandi Fulwider

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study's purpose was to explore the effects screen time has on college students' occupational performance. The mixed-methods design utilized a quantitative online survey and qualitative face-to-face interviews. Results indicated a majority of respondents used their phones for social media or web browsing throughout the day or briefly during class; however, the notable limitations of screen time involvement are its impact on interactions with family and peers, academics, and sleep. Primary Author and Speaker: Grace Fisher Additional Authors and Speakers: Shelby Abraham, Ashley Dunteman, Lydia Stassel, and Kyle Thomas

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Sensory over-responsivity (SOR) is associated with increased arousal levels and decreased quality of sleep. TouchPoints are wearable devices that deliver alternating bilateral tactile stimulation. The manufacturers claim that TouchPoints interfere with the brain’s stress response, leading to a decrease in arousal levels and improvements in sleep and self-regulation. The purpose of this study was to examine the effectiveness of TouchPoints on improving sleep quality in children with SOR. Primary Author and Speaker: Stacey Reynolds Additional Authors and Speakers: Kaelah Pou, Emily Kidney Contributing Authors: Katherine McGhee, Heather Pruyn Bouley

Date Presented 04/13/21 This study examines the current practices of OTs in the treatment of sleep difficulties in children. The study used a survey design to explore assessment methods, interventions, and preparedness of pediatric OTs in addressing sleep. The study lays the foundation for the need for future research in effectiveness of sleep interventions in the pediatric population. Primary Author and Speaker: Aimee Piller Additional Authors and Speakers: Kimberly Lieberman, Abraham Kim, Erin Thrasher, and Theresa Guzaldo

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This research presentation provides information on daytime and nighttime activity of boys with DMD in their everyday lives and while enrolled in a 12-month clinical trial. This research addresses the gap in knowledge regarding community-based outcomes in DMD, such as daily activity and sleep, and how therapeutic interventions may affect these outcomes. Primary Author and Speaker: Roxanna Bendixen Additional Authors and Speakers: Sarah McKendry, Natalie Silverman Contributing Authors: Amy Gore Hartman

Prolonged symptoms from the novel coronavirus disease 2019 (COVID-19), otherwise known as long COVID, postacute sequelae of COVID-19 (PASC), or post-COVID syndrome, are affecting an increasingly high number of patients after severe, moderate, and mild acute COVID-19 infections. Using evidence-based practice strategies, this case report describes occupational therapy evaluation and treatment approaches, plan of care, and associated outcomes for one client experiencing long COVID symptoms in the outpatient setting.

Importance: Chronic conditions often cause functional impairments in activities of daily living (ADLs) and rest and sleep, leading to decreased independence and self-efficacy. Objective: To aid occupational therapy practitioners in making informed decisions regarding self-management interventions to improve ADLs and rest and sleep for community-dwelling adults with chronic conditions. Data Sources: We identified literature published from 1995 to 2019 through searches of the Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, CINAHL, and OTseeker. Study Selection and Data Collection: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to abstract and assess data quality and validity. The review followed American Occupational Therapy Association Evidence-Based Practice Project methodology. Studies addressing self-management interventions for community-dwelling adults ages 18 and older with chronic cardiovascular disease, Type 2 diabetes, heart disease, hypertension, chronic respiratory problems, or kidney disease were included. Findings: Fifteen articles met inclusion criteria and were categorized into ADLs and sleep. Strong evidence supports education to improve diabetic foot self-care. Low evidence addresses exercise and education to improve ADLs for people with heart disease and chronic obstructive pulmonary disease. Moderate evidence supports mind–body self-care education to enhance sleep. Conclusions and Relevance: Occupational therapy practitioners working with adults with diabetes are encouraged to routinely offer education that includes discussion of risk factors and daily foot inspections and hygiene. When addressing sleep, education that addresses sleep hygiene, nutrition, relaxation techniques, and physical activity should routinely be provided to adults with chronic conditions. Further research is needed to understand the dosage needed. What This Article Adds: This systematic review supports the role of occupational therapy in providing self-management interventions to address ADLs and sleep for adults with diabetes and other chronic conditions.

Evidence Connection articles provide a clinical application of practice guidelines developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Program. Each article in the series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. The articles illustrate how the research evidence from the practice guidelines can be used to inform and guide clinical decision making. In this Evidence Connection article, we describe a case report of a child receiving occupational therapy services and summarize the evaluation and intervention processes for supporting sleep, activities of daily living, and social participation. The practice guideline on this topic was published in the July/August 2020 issue of the American Journal of Occupational Therapy ( Cahill & Beisbier, 2020 ).

Importance: People with Parkinson’s disease (PD) commonly experience difficulty in performing activities of daily living (ADLs), which affects their perceived quality of life. Objective: To examine the evidence for the effectiveness of interventions within the scope of occupational therapy to improve performance and participation in ADLs, rest, and sleep in adults with PD. Data Sources: Databases searched were MEDLINE, PsycINFO, CINAHL, OTseeker, and Cochrane Collection. Included articles were published between January 2011 and December 2018. Study Selection and Data Collection: Articles describing Level 1b, 2b, and 3b studies that examined outcomes related to ADLs, rest, and sleep in people with PD were included following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Findings: Forty-five articles (10 Level 1b, 27 Level 2b, and 8 Level 3b) met the inclusion criteria. Conclusions and Relevance: Strong strength of evidence was found to support inpatient multidisciplinary intensive rehabilitation treatment (MIRT) to improve ADLs, and moderate strength of evidence that MIRT improves sleep performance. Low strength of evidence was present for outpatient occupational therapy to improve ADL and sleep outcomes. Low strength of evidence was found for resistance exercise programs to improve ADLs, but moderate strength of evidence indicates that multimodal exercise programs and targeted exercise programs can improve ADLs. Low to moderate strength of evidence suggested that alternative therapies and cognitive–behavioral therapy have a positive impact on ADLs and sleep. These results can be used to inform evidence-based occupational therapy practice. What This Article Adds: This article provides information for practitioners on the effectiveness of interventions within the scope of occupational therapy practice to improve ADLs and sleep.

Importance: Typically developing children who are sensitive to sensory stimulation appear to have more sleep difficulties than children with average sensory sensitivities; however, at what age sleep difficulties emerge and whether they extend to children outside of sleep clinics are unclear. Objective: To investigate cross-sectional and longitudinal relationships between sleep and sensory processing in typically developing infants and toddlers. Design: Observational; cross-sectional and longitudinal. Setting: Community. Participants: Children (N = 160) enrolled in a larger four-armed randomized controlled trial of overweight prevention in infancy (40 randomly selected from each arm). Outcomes and Measures: Parent-reported sleep patterns at ages 6 mo, 1 yr, 2 yr, and 2.5 yr. Sensory Processing Measure–Preschool questionnaire covering five sensory systems and higher level functions: praxis and social participation at age 2.5 yr. Relationships between sleep and sensory variables were analyzed using multiple linear regression models. Results: More problematic sleep at age 2.5 yr was associated with more difficulties in social–relational skills (p < .001), a finding supported by the longitudinal data. Longer settling times were associated with higher vision (p = .036) and touch (p = .028) sensitivities at age 2.5 yr; in the longitudinal data (ages 6 mo–2.5 yr), longer settling times were associated with more sensitive hearing (p = .042). Conclusions and Relevance: Results support a link between sleep patterns and sensory processing difficulties in toddlers that, in some, can emerge in infancy. Practitioners should be alert to this association in young children presenting with sensory sensitivity or sleep challenges. What This Article Adds: Study findings illustrate that bedtime challenges in typically developing toddlers could be related to sensory processing. A possible way to assist more sensitive children in settling to sleep is to pay attention to visual, tactile, and auditory stimuli that potentially interfere with sleep onset.

Importance: Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth. Objective: This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5–21 yr at home, at school, and in the community. Method: The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5–21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research. Results: One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners. Conclusions and Recommendations: On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence. What This Article Adds: When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5–21 yr.

Evidence Connection articles provide clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of an older adult who was referred to outpatient occupational therapy services due to chronic back pain from herniated discs. Findings from the systematic review of occupational therapy for community-dwelling older adults were published in the July/August 2018 issue of the American Journal of Occupational Therapy ( Berger et al., 2018 ; Elliott & Leland, 2018 ; Hunter & Kearney, 2018 ; Liu et al., 2018 ; Smallfield & Lucas Molitor, 2018a , 2018b ) and in the American Occupational Therapy Association’s Occupational Therapy Practice Guidelines for Productive Aging for Community-Dwelling Older Adults. Each article in the Evidence Connection series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making.

OBJECTIVE. This systematic review evaluates the evidence for the effectiveness of interventions within the scope of occupational therapy to improve and maintain performance and participation for people with serious mental illness. Areas included in this review are activities of daily living, instrumental activities of daily living, leisure, social participation, and rest and sleep. METHOD. Databases searched included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews. Reviewers read and assessed citations, abstracts, and full-text articles for inclusion and analysis. RESULTS. Sixty-one articles were selected for inclusion. The review yielded strong evidence for psychoeducation and occupation- and cognitive-based interventions, moderate evidence for skills-based interventions, and limited evidence for technology-supported interventions. CONCLUSION. Results of this review support use of evidence-based practice within the scope of occupational therapy, inclusion of occupational therapy practitioners as mental health service providers, and continued research.

Because of age-related changes in sleep patterns, older adults may get less sleep than the recommended amount and experience decreased performance in daytime activities as a result. This article examines the evidence for the effectiveness of interventions within the scope of occupational therapy addressing sleep. Thirteen Level I studies met inclusion criteria and were categorized into three themes: (1) one-to-one single-component interventions, (2) one-to-one multicomponent interventions, and (3) group multicomponent interventions. Strong evidence supports cognitive–behavioral intervention strategies for older adults that include relaxation, sleep hygiene education, problem solving, and physical exercise, among others, delivered one to one or in a group. Routine use of these interventions is recommended.

Women with a high-risk pregnancy on hospitalized bedrest engaged in relaxation interventions, including guided imagery, visual imagery, and listening to music. Qualitative interviews gathered their perspectives on the effects of hospitalized bedrest on well-being and the subjective experiences related to the relaxation interventions. Benefits identified included improved physical well-being and sleep. Such relaxation interventions were concluded to have the potential to positively influence the occupational well-being of this population, resulting in more positive outcomes for mothers.

OBJECTIVE. The relationship between sensory processing factors and the sleep habits and patterns of typically developing children ages 8–12 yr was investigated. METHOD. Forty-five typically developing children and their parents or caregivers took part. Parents completed the Sensory Processing Measure–Home Form, Children’s Sleep Hygiene Scale, and Children’s Sleep Habits Questionnaire, and the children completed the Children’s Report of Sleep Patterns. Spearman ρ correlation and linear regression analyses were completed with the children’s sleep habits and patterns as the dependent variables and the sensory processing factors as the independent variables. RESULTS. Sensory processing factors were significantly associated with the children’s sleep habits and patterns, as reported by parents and children. Predictive relationships were established between the children’s sensory processing factors and sleep habits and patterns. CONCLUSION. Occupational therapy practitioners should consider sensory processing factors when working with children who present with suspected sleep problems.

Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association’s (AOTA’s) Evidence-Based Practice Project. In this Evidence Connection article, we describe a case report of a person with Alzheimer’s disease. The occupational therapy assessment and intervention process in the home setting is described. Findings from the systematic reviews on this topic were published in the November/December 2017 issue of the American Journal of Occupational Therapy and in AOTA’s Occupational Therapy Practice Guidelines for Adults With Alzheimer’s Disease and Related Major Neurocognitive Disorders. Each article in this series summarizes the evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical reasoning.

In the same way the human body requires food, hydration, and oxygen, it also requires sleep. Even among healthy people, the amount and quality of sleep substantially influence health and quality of life because sleep helps regulate physiological functioning. Given the impact of sleep on participation, the American Occupational Therapy Association reclassified sleep from an activity of daily living to an occupational domain. Poor sleep is a frequent medical complaint, especially among populations with neurological impairment. Occupational therapy practitioners should consider routinely screening for factors affecting their clients’ sleep. By addressing such factors, as well as related routines and habits, practitioners can enhance the effectiveness of rehabilitation, promote health and well-being, and increase engagement and life quality. Practitioners should acknowledge the importance of sleep in practice, and the study of sleep should be prioritized by researchers in the field to meet client needs and establish evidence for interventions.

OBJECTIVE. The purpose of this systematic review was to describe the evidence for the effectiveness of interventions designed to establish, modify, and maintain occupations for adults with Alzheimer’s disease (AD) and related neurocognitive disorders. METHOD. Titles and abstracts of 2,597 articles were reviewed, of which 256 were retrieved for full review and 52 met inclusion criteria. U.S. Preventive Services Task Force levels of certainty and grade definitions were used to describe the strength of evidence. RESULTS. Articles were categorized into five themes: occupation-based, sleep, cognitive, physical exercise, and multicomponent interventions. Strong evidence supports the benefits of occupation-based interventions, physical exercise, and error-reduction learning. CONCLUSION. Occupational therapy practitioners should integrate daily occupations, physical exercise, and error-reduction techniques into the daily routine of adults with AD to enhance occupational performance and delay functional decline. Future research should focus on establishing consensus on types and dosage of exercise and cognitive interventions.