Activity of Daily living (ADL) performance in children with attention deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD) and learning disabilities (LD): The use of the Assessment of Motor and Process Skills (AMPS)

2010-2014

Winterthur, Switzerland, Austria, Germany, Slovenia

Introduction. Occupational therapists are concerned with the integration of people with disabilities into community living and the promotion of their full participation in society. That is, through engagement in activities of daily living. Children with attention deficit/hyperactivity disorder (ADHD), developmental coordination disorder (DCD) and learning disabilities (LD) have problems to perform personal ADL and instrumental ADL tasks at home or school. There is a need, therefore, to identify the specific problems of ADL task performance evidenced by children with ADHD, DCD and LD so as to be able to develop interventions. Since the main focus of occupational (OT) is to enable enhanced ability to perform ADL and participation through the therapeutic use of daily occupations, investing in a study which will generate important evidence of the effectiveness of OT with children with ADHD, DCD and LD is critical. Not only does OT, in general, lack fundamental evidence related to the treatment of children with ADHD, DCD and LD , it does also lack on valid occupational-therapy-specific assessment tools for use in Middle Europe. Objective. The overall aim of the research project was to contribute evidence to support the valid use of the Assessment of Motor and Process Skills (AMPS) with children, including children living in Middle Europe. More specifically, we aimed to evaluate validity evidence from different sources related to the use of the AMPS in occupation-based and occupation-focused evaluation and intervention. Method. This research project consisted of four studies, implemented in two phases. Phase one focused on evaluation of a) validity evidence of the AMPS scales in relation to internal structure and stability of item difficulty calibration values for a Middle European sample compared to samples from other world regions (Study I); b) the stability of the mean AMPS measures between typically-developing children from Middle Europe and from other world regions (Study II); and c) the sensitivity of the AMPS measures to discriminate between typically-developing children and children with and at risk for ADHD, DCD, LD, and SI (Study III). Participants for phase one were from both Middle Europe and from other world regions and they were selected from the AMPS database, Ft. Collins, Colorado, USA. Data were analyzed using many-facet Rasch analyses, ANOVAs, regression analyses, related post-hoc tests, and effect size calculations. Phase two of the research project focused on evaluating feasibility of a larger randomized controlled trial (RCT) implemented in a Swiss setting using the of the AMPS and the Canadian Occupational Performance Measure (COPM) as a standardized outcome measures (Study IV). Data were analyzed based on feasibility objectives and the principles of deductive content analysis.

In Study I, data for 1346 participants from Middle Europe and 144,143 participants from other world regions were analyzed. The participants were between the ages of 3 and 103 years, and they were well or had a variety of diagnoses. The results revealed that overall the item difficulty calibration values of the AMPS remained stable and that only one out of 36 ADL items of the AMPS demonstrated differential item functioning (DIF), but this DIF did not lead to differential test functioning (DTF). In Study II, data for 11,189 typically-developing children from Middle Europe and other world regions who were between the ages of 2 and 15 were analyzed. The results of ANOVAs revealed significant effects for mean ADL motor and for ADL process ability measures by region and a significant age by region interaction effect for mean ADL process ability. Out of 168 estimated contrasts between Middle Europe and the other world regions for mean ADL motor and ADL process ability, only seven were statistically significant (4.17%), and only two were more than ±1 SE from the international means. In Study III, regression analyses of data for 10,998 children, 4 to 15 years, who were typically-developing or with ADHD, DCD, LD, and SI, revealed significant age by group interaction effects. Post hoc t tests revealed significant group differences in ADL ability at all ages beyond the age of 4. ADL process ability effect sizes were moderate to large at all ages and ADL motor ability effect sizes were mostly moderate to large age 6 and above. In Study IV, the use of the AMPS within the context of a feasibility study based on data for 17 Swiss children with ADHD, DCD, LD, and SI and 10 occupational therapists was evaluated. The analyses revealed several strengths and problems that were related to the time, equipment, and materials for administering the AMPS, the adherence to standardized administration procedures, the scope of the AMPS as a test of ADL performance, and the reliable rating by the blinded rater.