Date Presented 04/13/21 Because of the key role parenting plays in a child's development, parent-mediated interventions that train one parent are a common approach to intervention for young children with autism spectrum disorder (ASD). However, this approach has resulted in mixed findings and may lead to increased parental stress. The purpose of this study was to examine whether a two-parent occupation-centered intervention using a coaching approach improved the quality of social interactions of a family with a toddler with ASD. Primary Author and Speaker: Abigail M. Carroll Contributing Authors: Emily Anderson, Lindsey Hatton, Mary Ferarro, Elyse C. Kelly, Katherine E. Schlager, Amanda Shea, and Kerianne Watlington

Date Presented 04/9/21 Development in the first years of life is often characterized by a child’s aptitude to complete discrete tasks, such as walking or stacking blocks. True participation requires the child to incorporate skills into everyday activities. This presentation will provide an overview of the Infant Toddler Activity Card Sort, the initial psychometrics, and a Rasch analysis. Primary Author and Speaker: Catherine R. Hoyt Contributing Authors: Ching-Fan Sheu

Date Presented 04/23/21 This scoping review aims to identify current evidence for constraint-induced movement therapy (CIMT) protocols, clinical applications for practice, and gaps in research for CIMT in infants and toddlers with unilateral cerebral palsy. The study will provide an overview of emerging research in CIMT that is critical for providing evidence-based practice. Primary Author and Speaker: Casey Walker Contributing Authors: Danielle Lowinger, Sara Rezak

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. The purpose of this study was to describe the sensory processing abilities of infants and toddlers over time (10-18 months) in a medically underserved area. Neurotypical infant–maternal dyads took part in the IDAHO Mom Study. The data from this cohort of infants and toddlers is similar to the scores of the foundational sample within the Sensory Profile 2 manual and may represent increased measurement reliability of typically developing infants and toddlers. Primary Author and Speaker: Bryan M. Gee Contributing Authors: Nicki Abuchon-Endsley, Abby Prow

Date Presented 04/13/21 The purpose of this study was to explore the relationship between caregiver mental illness, breastfeeding frequency and duration, and infant sleep and sensory profiles. Neurotypical infant–maternal dyads took part in the IDAHO Mom Study. The findings suggest that maternal mental health, actual or perceived, has an influence on sensory processing profiles in infants and toddlers. Primary Author and Speaker: Bryan M. Gee Additional Authors and Speakers: Rachel Allen-McHugh, Kelsey Huss Contributing Authors: Andrew Galvez, Taylor Pirillo, Sabrina DeHerrera, and Jessica Pottebaum

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: In Chinese-speaking societies, a reliable and valid measure is needed to enable early identification of young children’s challenges in sensory processing. Objective: To examine the psychometric properties of the Chinese version of the Infant/Toddler Sensory Profile (ITSP–C) when used with Taiwanese children. Design: Prospective study. Setting: Multiple settings. Participants: Participants were 367 typically developing (TD) infants ages 0–6 mo (mean [M] age = 3.44 mo, standard deviation [SD] = 1.82) and 677 toddlers ages 7–36 mo (M age = 22.33 mo, SD = 8.15), along with 42 toddlers with developmental disabilities (DD; M age = 28.4 mo, SD = 6.7). Outcomes and Measures: The ITSP, a caregiver questionnaire that measures how children respond to sensory events in daily life, was translated and cross-culturally adapted into a Chinese version (ITSP–C). Results: Internal consistency was high for the 0–6 mo subscale (α = .80) and the 7–36 mo subscale (α = .82). Test–retest reliability was excellent for the 7–36 mo subscale (intraclass correlation coefficient = .94). Logistic regression analysis demonstrated that the ITSP–C discriminated between children with DD and TD children. Conclusions and Relevance: The ITSP was successfully adapted to Chinese with similar reliability and validity to the original ITSP. The 7–36 mo subscale had a higher level of reliability than the 0–6 mo subscale, and quadrant scores were more reliable than section scores. Moreover, the ITSP–C discriminated children with DD from TD children on the basis of their sensory processing patterns. What This Article Adds: The ITSP–C has sound psychometric properties and support for its use in early identification of sensory processing difficulties in young Chinese-speaking children.

Date Presented 04/05/19 Play affords the opportunity for children to develop cognitive, motor, and social skills. Gaps exist in the literature related to temporal play characteristics in infants and toddlers. The goal of this study was to track the frequency and duration of different play behaviors. The average duration and average frequency increased for play object choice, play purpose, and play construction. An overall decrease in duration and frequency for play type occurred as the infants and toddlers matured (between 8 and 16 months). Primary Author and Speaker: Bryan Gee Additional Authors and Speakers: Amanda Neilsen

Date Presented 04/04/19 Early intervention therapists rely on developmental milestone-focused assessments to identify deficits and justify services. However, these measures fail to assess a child’s ability to incorporate discrete skills into functional activities. The Infant Toddler Activity Card Sort (ITACS) will meet this need. Primary Author and Speaker: Catherine Hoyt Contributing Authors: Jianna Fernandez, Ashley Chuck, Laura Pilney, Taniya Varughese, Regina Abel, Allison King

OBJECTIVE. Our objective was to determine the extent to which young children at high risk for sensory processing difficulties differed from those who were at low risk. METHOD. We compared high- versus low-risk young children using standardized measures. High-risk participants had older siblings identified as having sensory processing difficulties after a comprehensive occupational therapy evaluation (n = 13); low-risk participants (n = 16) had typically developing siblings and no family history of sensory or other neurological disorders. RESULTS. High-risk infants scored significantly lower on the Language and Cognitive scales of the Bayley Scales of Infant and Toddler Development–Third Edition. The high-risk group presented with more atypical positions on the Toddler and Infant Motor Evaluation and fewer sensation-seeking behaviors on the Toddler Sensory Profile–2. CONCLUSION. Results suggest that sensory, motor, cognitive, and language dimensions may be associated with sensory processing difficulties. Implications exist for the design of future studies and for early intervention.

OBJECTIVE. To explore the relationship between sensory processing patterns and sleep problems in typically developing infants and toddlers. METHOD. A retrospective chart review of 177 infants and toddlers from a community occupational therapy sleep clinic included descriptive and correlational analyses of data from the Infant/Toddler Sensory Profile and Brief Infant Sleep Questionnaire. RESULTS. More than half of participants (55%) demonstrated a pattern of increased sensory processing in one or more quadrants, with sensitivity being most common (36%). We found small but significant correlations between increased seeking and shorter daytime sleep duration (r = −.24, p = .002) and between increased sensitivity and longer time to settle to sleep (r = .27, p < .001). CONCLUSION. This study adds to recent literature linking sensory processing patterns to sleep problems and is the first to demonstrate this relationship in young, typically developing children. Results support the role of occupational therapy in addressing sleep difficulties in children.

OBJECTIVE . The study provides a substantive description of infant and toddler play with everyday objects and independent negotiation of home space. METHOD . A grounded theory approach was used to study 18 typically developing children longitudinally from ages 1 to 18 months. Data from 133 home visits included videotaped self-directed play sessions with usual objects, maternal interviews, and observation records. RESULTS . Infant Space Theory is a substantive theory of infant–toddler interactions with the spaces and objects of the home. This contextualized view of the infant–toddler describes progressions in gaze and visual play, in mapping and ranging home space, in stationary object play, and in the little-described development of mobile object play. CONCLUSION . Therapists providing early intervention services within the home environment may benefit from the theory in their creation and modeling of naturalistic interventions with infants and families.

This study examined the incidence of extreme sensory modulation behaviors in toddlers with autism spectrum disorders (ASD) and investigated the consistency of sensory information across measures. Parent report of sensory behaviors in 101 toddlers with ASD was compared with 100 toddlers who were typically developing matched on chronological age and 99 additional infants or toddlers matched on mental age. Measures included the Infant/Toddler Sensory Profile, Infant–Toddler Social Emotional Assessment, Autism Diagnostic Interview–Revised, and Autism Diagnostic Observation Schedule–Generic. Toddlers with ASD were most distinct from typically developing groups in their high frequency of underresponsiveness and avoiding behaviors and their low frequency of seeking. Within the toddlers with ASD, there were significant associations across sensory parent report measures, but parent report was not correlated with clinical observation. Findings point to the early onset of an extreme sensory profile in ASD. Occupational therapists need to assess multiple domains of sensory behaviors to accurately identify the needs of toddlers with ASD.

Objective. This descriptive study explores motivation of toddlers who are typically developing to persist with challenging occupations. Method. The persistence of 33 children, 12 to 19 months of age (M = 15.7 months), in functional play and self-feeding with a utensil was examined through videotape analysis of on-task behaviors. Results. A modest correlation was demonstrated between the percentages of on-task time in the two conditions (r = .44, p < .01). Although chronological age was not associated with persistence, participants’ age-equivalent fine motor scores were correlated with persistence with challenging toys (r = .39, p < .03) but not with self-feeding with a utensil. Having an older sibling was associated with longer periods of functional play, t(32) = 3.02, p < .005, but the amount the parent urged the child to eat with a utensil was not associated with persistence in self-feeding. Conclusion. The modest association between on-task time for functional play and self-feeding with a utensil reveals that factors other than urge to meet perceptual motor challenges lead to children’s persistence. The results reinforce the importance of considering not only challenging activities, but also the experienced meaning that elicits optimal effort and, thus, learning.

Objective. One purpose of this qualitative study was to describe the work done by mothers as they manage the spaces and objects of the home to support the development of infants and toddlers at play. Method. Eighteen mother–infant dyads participated in the study. Data were collected via monthly in-home videotaping of infants and monthly interviews with mothers, from 1 to 18 months of infant age. Data were analyzed with a grounded theory approach and computer-assisted video and text analysis. Results. The results describe the everyday tasks of mothers of infants and toddlers, such as selecting commercial toys and household objects for play, positioning infants for play, maintaining and making play objects available, furnishing the home with child care equipment, controlling infant access to the spaces of the home, and monitoring for safety. Conclusion. This description contributes to our understanding of maternal work, infant and toddler development in context, co-occupations, and the neglected spatial dimension of occupation.

Objective. The purpose of this study was to determine whether switch control site (hand vs. head) affects the age at which children can successfully activate a computer to play a cause-and-effect game. Method. The sample consisted of 72 participants randomly divided into two groups (head switch and hand switch), with stratification for gender and age (9–11 months, 12–14 months, 15–17 months). All participants were typically developing. After a maximum of 5 min of training, each participant was given five opportunities to activate a Jelly Bean switch to play a computer game. Competency was defined as four to five successful switch activations. Results. Most participants in the 9-month to 11-month age group could successfully use a hand switch to activate a computer, and for the 15-month to 17-month age group, 100% of the participants met with success. By contrast, in the head switch condition, approximately one third of the participants in each of the three age ranges were successful in activating the computer to play a cause-and-effect game. Conclusion. The findings from this study provide developmental guidelines for using switches (head vs. hand) to activate computers to play cause-and-effect games and suggest that the clinician may consider introducing basic computer and switch skills to children as young as 9 months of age. However, the clinician is cautioned that the head switch may be more difficult to master than the hand switch and that additional research involving children with motor impairments is needed.