Executive functioning in children and youth: Development of occupational therapy competencies

Abstract

Purpose: This thesis focuses on the development of occupational therapy competencies to enable executive occupational performance with school-aged children and youth. Methods: Three studies were structured according to the knowledge inquiry, synthesis, and product stages of the Knowledge To Action cycle (Graham et al., 2006). A scoping review in Phase One explored how executive functioning is described in the occupational therapy literature. In Phase Two, a qualitative study was conducted to determine how occupational therapists who have worked with children and youth perceive executive functioning to be understood and addressed. Phase Three used established competency development processes to produce an occupational therapy competency model and framework for enabling executive occupational performance. Results: Although there is little consensus on how executive functioning is understood, literature reviewed in Phase One demonstrated its pervasive effect on performance of complex, novel, and goal-directed occupations. Emerging themes suggest that assessment requires occupational, dynamic, and performance-based approaches, with interventions rooted in metacognitive frameworks. The Phase Two qualitative study suggested that, although there are challenges to being able to “see” executive functioning, it is necessary to explicitly and systematically consider executive functioning during clinical reasoning. Learning to “see” through the executive functioning lens is a complex process. The competency framework development process utilized in Phase Three yielded the Competencies in Context Model. Responding to series of contextual challenges related to system, client, and occupational therapist factors, professional assessment, intervention, iii knowledge acquisition, and knowledge translation competencies are used to organize 16 specific occupational therapy practice competencies. Conclusion: Points of tension within the literature and the field have implications for occupational therapy curricula, research, practice, and professional development. Executive functioning issues have wide reaching effects on occupational performance of children and youth that have not been adequately recognized or explored in the occupational therapy literature. The competency model and framework developed through this research make a substantive contribution to the field in beginning to redress the dearth of occupational therapy-specific models, resources, and tools designed to support occupational therapists’ acquisition or implementation of the executive functioning perspective.