Cognitive strategies and school participation for students with learning difficulties.

Abstract

ABSTRACT Students with learning difficulties comprise one of the main groups of children referred for assessment to Australian occupational therapists. Teachers and parents typically express concern regarding difficulty with participation during school occupations. In particular, teachers and parents describe the cognitive aspects of participation as being a challenge. While much research has focused on the concept of participation for students with physical disabilities, little is known about the impact of cognitive dimensions of a learning difficulty on school participation. There are few ecological assessments which document difficulties with the cognitive aspects of school participation relative to the expectations of task performance. Specifically, there is a lack of standardised assessments which utilise the perspectives of teachers and parents. The initial purpose of this study was to explore the concept of participation and how students with learning difficulties used cognitive strategies to participate successfully in school occupations. The second purpose of the study was to develop a teacher and parent questionnaire that might assist in the occupational therapy assessment of the cognitive aspects of a student’s school participation. A review of the literature was motivated by the need to better understand the construct of participation and to determine how best to measure cognitive strategy use as a component of school participation. The subsequent research was then carried out in three phases. Phase One explored difficulties in school participation using a longitudinal retrospective case study of one student with a learning difficulty over 13 years. In addition, 50 teachers and 44 parents were surveyed regarding participation. Data collected from this phase formed the basis of Phase Two in which a teacher and ii parent questionnaire was constructed following principles of questionnaire construction. An instrument, PRPP@SCHOOL-Version 1(Teacher Questionnaire and Parent Questionnaire), was developed which reflected theoretical and empirical descriptions of cognitive strategies and descriptors used in an existing instrument, the Perceive, Recall, Plan, and Perform (PRPP) System of Task Analysis. These questionnaires, designed to form a companion instrument to the PRPP System of Task Analysis, were trialled on 355 children, referred to a private occupational therapy clinic in Greater Western Sydney. Data were analysed to determine measurement viability. Phase Three of the study comprised reliability and validity testing on the PRPP@SCHOOL-1(TQ & PQ). Intraclass correlations indicated excellent test-retest reliability with a high level of agreement for the PQ. Content validity was determined through consumer review, peer review, and an expert panel review. Discriminant validity testing confirmed that the PRPP@SCHOOL-1(TQ & PQ) was able to differentiate between typically developing students and students with learning difficulties. Construct validity was assessed. Five factors emerged from the analysis which also demonstrated that the PRPP@SCHOOL-1(TQ & PQ) was functioning as a multidimensional measure. Findings indicated that for children in this study, participation in school occupations was undermined by challenges with inefficient cognitive strategy use. Teachers and parents were able to observe and clearly identify these difficulties using the PRPP@SCHOOL-1(TQ & PQ). This research adds a companion instrument to the PRPP System of Task Analysis in the form of teacher and parent questionnaires to be used with students who experience school participation difficulties. In so doing, the research contributes to the expansion of occupation-focused, criterion-referenced ecological instruments recommended by the profession as best practice assessment.