Recent work from OTD students
2024
Taryn Brown, OTD/S ‘25 and Seth Lewis, OTD/S ‘25
Sarah Cheatham Oberle, OTD, OTR/L
Abstract:
Title: Enhancing Executive Function: The Influence of the Train Your Brain MasterMinds Metacognitive Training Program on Children and Caregivers
PURPOSE: Early difficulties with executive function (EF) impact many common childhood diagnoses, like autism spectrum disorder and attention-deficit/hyperactivity disorder (Zelazo, 2020). EF skills are necessary for intentional action, deliberate reasoning, complex social functioning, emotional regulation, and adaptation to change (Zelazo, 2020). Metacognitive training has shown to be an effective intervention for children with EF difficulties (Hahn-Markowitz et al., 2020). The purpose of the present study was development, implementation, and assessment of feasibility of a five-week pilot metacognitive training program to support EF skills in children and caregivers.
DESIGN: In order to determine feasibility, we performed programmatic evaluations that included formative, process, and impact evaluations.
METHOD: We performed a formative evaluation of previous Train Your Brain (TYB) programs to create a novel small group session called MasterMinds. Process evaluation was performed throughout implementation to make adjustments as needed. Children ages 9-12 with EF difficulties who previously participated in TYB programs and their caregivers were recruited. After program implementation, an impact evaluation was performed in order to determine efficacy and future programmatic changes. Impact evaluation included 1) qualitative parent feedback via virtual interviews, 2) child’s cognitive strategy use per parent report (pre/post), 3) and child satisfaction survey.
RESULTS: Three families (3 children, 4 caregivers) completed a five-week metacognitive training program (1x/wk for 2 hrs) focusing on individual and family goal-setting and monitoring. All participants completed all assessments. Descriptive analysis of cognitive strategy use revealed a positive trend in strategy utilization, with the greatest impacts in planning and listing. Child surveys revealed that they enjoyed the activities and found the program to be helpful. Parent interviews were conducted separately due to scheduling conflicts. Parent feedback for programmatic development included high levels of satisfaction with real world application as the primary adaptation requested. Both qualitative and quantitative data informed modification of the MasterMinds program.
CONCLUSION: Pilot program data supports the feasibility of the MasterMinds small group metacognitive training program for a small cohort. Further analysis will be completed with larger cohorts as the program continues. Establishing efficacy of the MasterMinds program with larger cohorts will lead to manualization and dissemination, which will support children with EF difficulties and their caregivers on a larger scale.
Select References:
Dawson, D.R., McEwen, S. E., and Polatajko, H.J. (Eds.). (2017). Cognitive Orientation to daily Performance in Occupational Therapy. Bethesda, MD: AOTA Press.
Hahn-Markowitz, J., Berger, I., Manor, I., & Maeir, A. (2020). Efficacy of Cognitive-Functional (Cog-Fun) Occupational Therapy Intervention Among Children With ADHD: An RCT. Journal of attention disorders, 24(5), 655–666. https://doi.org/10.1177/1087054716666955
Zelazo, P. D. (2020). Executive function and psychopathology: A neurodevelopmental perspective. Annual Review of Clinical Psychology, 16(1), 431-454. https://doi.org/10.1146/annurev-clinpsy-072319-024242
Cite:
Brown, T.; Cheatham Oberle, S.; Lewis, S. (2024, April 26). Enhancing executive function: The influence of the pilot Train Your Brain MasterMinds metacognitive training program on children and caregivers. [PowerPoint Slides]. https://sites.wustl.edu/trainyourbrain/files/2024/09/Brown-and-Lewis-Scholarship-Day-Presentation_2024.pdf
Sandy Wang, OTD/S ‘25
Sarah Cheatham Oberle, OTD, OTR/L
Abstract:
Title: Expansion of a Professional Development Program Providing Cognitive Strategies for Teachers and Parents Through Social Media
PURPOSE: The purpose of the study is to create resources for teachers of the Deaf (TOD) in order to increase capacity for implementation of executive functioning (EF) strategies in the classroom. Because of the close cerebral and functional development of language and cognition, children who are Deaf and hard of hearing (D/HH) are at increased risk of experiencing difficulties with EF skills (Figueras et al., 2008). Despite TODs being experts in Deaf education, this educational and developmental issue has not received much attention in TOD training (Hall et al., 2018). Previous data supported the efficacy of teacher training in EF strategies (Kienholz, 2023) but also highlighted the need for more easily accessible resources due to decreased capacity (time, physical resources, etc.). Having these resources will provide a wide variety of choices for teachers to utilize in classrooms to increase the support for children with EF skills.
DESIGN: This project is a continuation of a professional development program for TODs that was implemented in summer 2022. Both formative and process evaluations were performed to guide program implementation.
METHOD: Utilizing teacher feedback from last year’s professional development program, we formulated an initial plan. A project outline was created, delineating subtopics, strategies, and a timeline for resource allocation. The plan underwent revision and refinement in order to ensure its relevance and effectiveness in addressing the needs of the TOD population. As resources were created according to the project outline, members of the lab offered feedback and edits to enhance clarity and efficacy. Finally, the resources were disseminated via Instagram.
RESULTS: Following feedback from last year’s professional development program, we adopted a metacognitive framework to guide the creation of EF support materials. Despite initial delays in accessing the Instagram platform due to institutional requirements, we successfully began disseminating resources in February 2024. As of this writing, we have created 45 Instagram posts, documents, and reels and 12 support documents. Documents are avialable on the TYB lab website, and we maintain a consistent engagement strategy by posting on Instagram weekly.
CONCLUSION: Development of EF resources for teachers has been successful, and dissemination has been initiated. We have encountered limitations, notably barriers to dissemination, and obtaining feedback from teachers. Recognizing this gap, we plan to implement mechanisms for collecting feedback in the future, ensuring that our resources remain responsive to the needs of our diverse audience. The impact of this program is that the platform has grown to encompass parents and the OT community, broadening the scope and impact of our initiative.
Select References:
Figueras, B., Edwards, L., & Langdown, D., (2008). Executive function and language in deaf children, The Journal of Deaf Studies and Deaf Education, 13(3), 362–377. https://academic.oup.com/jdsde/article/13/3/362/375441
Hall, M. L., Eigsti, I. M., Bortfeld, H., & Lillo-Martin, D., (2018). Executive function in deaf children: Auditory access and language access. Journal of speech, language, and hearing research : JSLHR, 61(8), 1970–1988. https://doi.org/10.1044/2018_JSLHR-L-17-0281
Cite:
Cheatham Oberle, S.; Wang, S. (2024, April 26). Expansion of a professional development program providing cognitive strategies for teachers through social media. [PowerPoint Slides]. https://sites.wustl.edu/trainyourbrain/files/2024/09/Wang_SD-Poster-2024.pdf
2023
Erin Furney, OTD/S ‘24 and Delaney Jordan, OTD, OTR/L
Sarah Cheatham Oberle, OTD, OTR/L
Abstract:
Title: Participation in Occupations of School-Aged Children Who are Deaf and Hard of Hearing: A Case Comparison
PURPOSE: Previous studies have found that children with sensorineural hearing loss (SNHL) demonstrate lower levels of participation in physical activity and fewer activities outside their homes compared to typically hearing (TH) children (Engler-Yeger & Hamed-Daher, 2013; Xu et al., 2020). Current research is limited in scope and sample size with little data outlining comprehensive participation patterns of children with SNHL. The purpose of the ongoing study is to compare the participation patterns between children with SNHL and TH children. The current project takes two participants, one with SNHL and one TH peer, to present a descriptive case comparison. Participation in typical childhood activities is important for developing skills in social interaction, executive function, and emotional well-being. Understanding participation patterns can assist occupational therapists in identifying barriers to meaningful engagement and developing interventions to support participation.
DESIGN: This descriptive case comparison is an excerpt from a larger, ongoing case-control study. Participants were recruited using the following criteria: children and adolescents ages 6 to 17 with or without a diagnosis of SNHL who use listening and spoken language. Exclusion criteria were a diagnosis of developmental disability or delay. Recruitment methods included flyers, brochures, referral, word of mouth, and an alumnae database at a school for children with hearing loss.
METHOD: The assessment used to collect data in this study was the Children’s Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities for Children (PAC), referred to together as the CAPE/PAC. The CAPE is a structured questionnaire that measures various aspects of children’s participation in 55 activities. The CAPE sub categories include Diversity, Intensity, With Whom, Where, and Enjoyment. The PAC measures a child’s preferences for participation in the same 55 activities. PAC scoring is divided into subcategories of Recreational Activities, Physical Activities, Social Activities, Skill-Based Activities, Self-Improvement Activities, and an Overall Score. Results from this study include two participants: one with SNHL and one TH peer matched for age and sex. Percentage difference scores were found for 3 of 5 CAPE subcategories and for 5 of 5 PAC subcategories. Frequencies were found for 2 of 5 CAPE subcategories.
RESULTS: The child with SNHL had lower scores in Diversity (8% less), Intensity (22% less), and Enjoyment (17% less). For With Whom data, 4 of 5 categories showed little to no difference, but the SNHL subject participated in 4 more activities alone. More score variability was found in the Where data, with the greatest difference being the child with SNHL participating in 5 more activities beyond his community. The SNHL participant had lower scores for desired participation with recreational (4% less) and physical activities (13% less), higher scores for social (4% more) and skilled-based activities (33% more), and equal scores for self-improvement activities (0%).
CONCLUSION: Even with two participants, the child with SNHL participated in less activities, less frequently, with lower levels of enjoyment and a desire to participate more when compared to his TH peer. If these differences hold for the overarching study, then children with SNHL may be missing opportunities for desired and meaningful participation important for social, emotional, and cognitive development.
Select References:
Engel-Yeger, B., & Hamed-Daher, S. (2013). Comparing participation in out of school activities between children with visual impairments, children with hearing impairments and typical peers. Research in Developmental Disabilities, 34(10), 3124–3132. https://doi.org/10.1016/j.ridd.2013.05.049
Xu, W., Li, C., & Wang, L. (2020). Physical Activity of Children and Adolescents with Hearing Impairments: A Systematic Review. International journal of environmental research and public health, 17(12), 4575. https://doi.org/10.3390/ijerph17124575
Cite:
Cheatham Oberle, S.; Furney, E.; Jordan, D. (2022, April 28). Participation in occupations of school-aged children who are deaf and hard of hearing: A case comparison. [PowerPoint Slides]. https://sites.wustl.edu/trainyourbrain/files/2024/09/Scholarship-Day-Presentation-1.pdf
Kathryn Keinholz, OTD/S ‘24
Sarah Cheatham Oberle, OTD, OTR/L
Abstract:
Title: The Development and Dissemination of Educational Modules for Teachers of the d/Deaf to Support Students’ Executive Functioning
PURPOSE: Executive functioning (EF) skills are foundational for academic success, work performance, and lifelong health and well-being (Center, 2012). Because many d/Deaf and hard of hearing (DHH) children demonstrate challenges with EF (Kronenberger, 2019), the Deafness Occupational Therapy Support (DOTS) Lab at Washington University in St. Louis works with a community partner to provide EF programming for DHH students. A previous DOTS Lab study found that teachers of the d/Deaf (TOD) at the partner organization felt they would benefit from additional support from occupational therapy (OT) practitioners to enhance their students’ EF skills (Morgan, 2021). In response, the DOTS Lab shared written feedback forms with TOD to promote carryover of EF strategies from the OT-run EF support program into the classroom; however, varied and inconsistent feedback from TOD indicated a need for further development of resources to support them (Michel, 2022). Therefore, this project served two purposes: (1) to develop and disseminate educational modules for TOD to equip them with knowledge and skills for supporting EF development and (2) to establish effective, efficient communication with TOD to contribute to program evaluation and improvement.
DESIGN: The focus of this study was programmatic evaluation. Continuous process evaluation was utilized throughout the development of educational modules to assess and improve the content. After the delivery of each educational module, impact evaluations were conducted via survey to better understand participants’ experiences. Participants included TOD at the partner organization who attended regular staff meetings.
METHOD: To address the first objective of this project, educational modules were developed and disseminated to staff at the partner organization. Based on the areas of concern reported by TOD in Morgan, 2021, topics included an introduction to EF, organization, planning, time management, and working memory. Current literature and expertise from DOTS Lab members informed the creation of educational videos and corresponding handouts. The videos and handouts were uploaded to a DOTS website and shared with a leader from the community partner, who then presented the modules to staff at monthly meetings.
To facilitate participant feedback, surveys were designed and administered. Each survey asked participants if the video was helpful or not, as well as provided a four-point Likert scale for self-rating one’s understanding of, knowledge about, and capacity for supporting students’ EF. An optional fifth question collected qualitative feedback on the modules. After watching the video component of each module, TOD completed the associated survey; surveys were then collected by the community partner leader and returned to DOTS Lab members. Descriptive analyses were performed.
RESULTS: Data collection remains ongoing. Thus far, TOD have viewed 4 of 5 educational modules. 100% of participants have reported that the video component of each module was helpful. Data regarding TOD’s understanding, knowledge, and capacity will be presented.
CONCLUSION: This study achieved its aim of supporting TOD with education on EF. As a result, TOD at the community partner have received helpful education on the importance of EF skills and concrete strategies for supporting EF development. These results support the possible expansion of this educational format for supporting professional development of more classroom teachers who work with students with EF delays.
Select References:
Center on the Developing Child at Harvard University (2012). Executive function: Skills for life and learning (InBrief). Center on the Developing Child. https://www.developingchild.harvard.edu/resources/inbrief-executive-function/
Kronenberger, W. G. (2019). Executive functioning and language development in children with cochlear implants. Cochlear implants international, 20(Suppl 1), 2–5.
Michel, A. (2022, Apr. 29). Evolution and utility of a teacher feedback system for an after-school executive functioning program [Oral presentation]. Washington University Program in Occupational Therapy Scholarship Day, St. Louis, MO, United States.
Morgan, L. (2021, Apr. 30). Understanding teachers’ of the d/Deaf experience with executive function and occupational therapy in a site-based school program [Virtual presentation]. Washington University Program in Occupational Therapy Scholarship Day, St. Louis, MO, United States.
Cite:
Cheatham Oberle, S.; Kienholz, K. (2023, April 28). The development and dissemination of educational modules for teachers of the d/Deaf to support students’ executive functioning. [PowerPoint Slides]. https://sites.wustl.edu/trainyourbrain/files/2024/09/Kienholz-Scholarship-Day.pdf
Alison Martin, OTD/S ‘24
Sarah Cheatham Oberle, OTD, OTR/L
Abstract:
Title: Executive Functioning Program Evaluation for Students Who Are d/Deaf or Hard-of-Hearing
PURPOSE: Executive functioning (EF) skills are critical for making decisions, planning ahead, managing involvement in society, and organizing one’s daily life (Harvard University, 2019). Train Your Brain (TYB) is a clinically-based, EF support program that was created to help children with executive dysfunction. TYB currently runs in 3 formats: a summer camp, an after-school program, and an in-school curriculum. The after-school program is in its 2nd year and focuses on supporting EF skills for children who are d/Deaf or hard-of-hearing (D/HH). D/HH children tend to perform less effectively at EF skills in comparison to their typically hearing (TH) peers (Mason et al., 2021). TYB needs quality, program-specific data to discern its effectiveness, so the purpose of this project is to design a pre/post-test experiment to determine the efficacy of TYB in supporting EF skills of children who are D/HH.
DESIGN: This project involved the design and planning of an experimental pre-/post-intervention study.
METHOD: A literature search revealed 17 EF assessments used with children, including questionnaires, functional assessments, and skill-based assessments. The assessments were screened for applicability for children ages 8-12, accessibility to the D/HH population, and the EF domain assessed (i.e., working memory, planning, attention, etc.). Eight assessments failed to meet this inclusion criteria. With the remaining nine assessments, manuals were analyzed and a pros and cons list was created. Next, four additional assessment criteria were added: must have access to the assessment through Washington University resource library, must address the parent/teacher’s perspective of the child’s EF abilities, must engage the child in a performance-based assessment, and must be accessible to D/HH children who use both American Sign Language (ASL) and Listening and Spoken Language (LSL).
RESULTS: Two assessments were selected for use in the study. These include the Behavior Rating Inventory of Executive Functioning (BRIEF)-2 screener and three subtests from the National Institutes of Health (NIH) Toolbox: Cognition Battery; the Flanker Inhibitory Control and Attention Test, List Sorting Working Memory Test, and Dimensional Change Card Sort (measures one’s ability to plan, organize, and task-monitoring). The BRIEF-2 Screener is a 12-item questionnaire that is completed by the parent, teacher, or student that is used to identify students that are at risk for EF difficulties. Subtests of the NIH Toolbox: Cognition Battery are measured on a touchscreen device (i.e., iPad).
CONCLUSION: Through the use of inclusion criteria and a diligent selection process, the two best assessments were chosen to gather data for this study. The BRIEF-2 Screener and the three subtests from the NIH Toolbox: Cognition Battery present with reliability, validity, and are accessible to the D/HH population, thereby making them the assessments of best fit. Outcomes will be reliable in showing if there is a change in EF skills from the beginning to the end of TYB’s after-school program. This will allow for D/HH students to have an enriching resource to improve EF skills and help support meaningful participation.
Select References:
Harvard University. (2019, February 22). A Guide to Executive Function. Center on the Developing Child at Harvard University. https://developingchild.harvard.edu/guide/a-guide-to-executive-function/
Mason, K., Marshall, C. R., & Morgan, G. (2021). Executive function training for deaf children: Impact of a music intervention. The Journal of Deaf Studies and Deaf Education, 26(4), 490–500. https://doi.org/10.1093/deafed/enab026
Cite:
Cheatham Oberle, S.; Martin, A. (2023, April 28). Executive functioning program evaluation for students who are d/Deaf or hard-of-hearing. [PowerPoint Slides]. https://sites.wustl.edu/trainyourbrain/files/2024/09/Scholarship-Day-Presentation-Martin.pdf
2022
Ariana Michel, OTD, OTR/L
Sarah Cheatham Oberle, OTD, OTR/L
Abstract:
Title: Evolution and Utility of a Teacher Feedback System for an After-School Executive Functioning Program
PURPOSE: Children who are d/Deaf or hard-of-hearing (D/HH) consistently perform below hearing peers on executive function (EF) tasks despite similar or higher IQs (Botting, 2017). To address this discrepancy, the authors facilitated an after-school, EF support program called Train Your Brain (TYB) for children who are D/HH in a Missouri public elementary school. Though designed for student participation only, classroom teachers reported interest in learning EF strategies taught in TYB through previous research conducted in the lab (Morgan, 2021). The purpose of this project was (1) to promote carry over of skills learned in TYB into the classroom by designing and implementing a teacher communication form and (2) to evaluate teachers’ perceptions and use of the feedback forms.
DESIGN: This study utilized both process and impact evaluations. The process evaluation included the design, use, and editing of the teacher feedback form for the TYB program. The impact evaluation was used with the teacher survey to investigate teacher perceptions and use of the feedback forms.
METHOD: Teacher feedback forms were designed for use after each program session and included 4 open-ended sections: description of session, strengths, areas for growth and strategies. Facilitators ran each 1-hour long program, then filled out one teacher feedback form per student present in that session. Feedback forms were filled out by 1 facilitator and then reviewed by 1-2 other facilitators to assure comprehensive feedback was provided. Forms were then given to the administrator of the D/HH program at the community partner school to distribute to teachers the following day. Halfway through the program, facilitators began including copies of the PowerPoints and/or handouts used during the corresponding TYB sessions in an effort to augment teacher insight into strategies taught. At the end of the semester, the research team used an original survey to investigate teachers’ use and perception of the feedback forms. The survey link was sent to an administrator at the partner school who distributed it to teachers. Survey results were analyzed using frequency analyses.
RESULTS: Teacher feedback forms were edited after session 1 and included 5 open-ended sections: Session topic, session activity, strengths, areas for growth, and strategies. They were edited again after session 2 to adjust formatting. Both (n=2) teachers whose students participated in the TYB program responded to the survey. Both reported reading the feedback forms but differed in other perspectives of the form. Strategies recommended, teacher barriers, and teacher preferences are discussed.
CONCLUSION: Based off these data, we conclude that the type of feedback reported was useful since teachers are integrating the suggestions into their classrooms but method of delivery could be changed. One teacher indicated wanting more guidance about EF suggestions, but both teachers do not want this additional guidance from printed PowerPoint slides of the lesson. Overall, teachers did not indicate strong feelings relative to the inclusion, or lack thereof, of the feedback forms as a part of the TYB program. Therefore, we might be suggesting the right type of feedback, just not presenting it in a delivery format the teachers prefer or with sufficient detail. Further work could be done to determine which method(s) of delivery may prove to be more useful to teachers for receiving this feedback.
Select References:
Botting N., Morgan G., Jones A., Marshall C., Denmark T., Atkinson J. (2017). Nonverbal executive function is mediated by language: A study of deaf and hearing children. Child Dev. 88 1689–1700. 10.1111/cdev.12659
Cite:
Cheatham Oberle, S.; Michel, A. (2022, April 29). Evolution and utility of a teacher feedback system for an after-school executive functioning support program. [PowerPoint Slides]. https://sites.wustl.edu/trainyourbrain/files/2024/09/Michel-Ariana-scholarship-day.pdf
Kelsey Stevens, OTR/L MSOT
Sarah Cheatham Oberle, OTD, OTR/L
Abstract:
Title: The Development of an After-School Program and Curriculum Manual for Executive Function Support
PURPOSE: The purpose of this project was to implement an executive function (EF) after-school program in a local school district and to develop a comprehensive curriculum manual for this program. EFs are “the group of complex mental processes and cognitive abilities that control the skills required for goal-directed behavior” (Merriam-Webster, 2021) and are vital for the development of social, academic, and life skills (Diamond & Lee, 2011). There is currently no academic programming which specifically teaches EF skills even though research shows that overt teaching of these skills during the early-childhood years is especially beneficial (Blair, 2017). Some populations are notably at risk for EF deficits, including those with neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) (Zelazo,2020), and children who are d/Deaf and hard of hearing (D/HH) (Hauser, 2008).
DESIGN: Both formative and process evaluations were performed during the implementation of this community-based EF support program and subsequent development of the curriculum manual. This program was conducted with a WUOT community partner, a local public school district with D/HH elementary-aged students.
METHOD: This program consisted of 8 one-hour sessions immediately following the conclusion of a school day during the fall semester. Session frequency was determined by schedule compatibility between the community partner and researchers; the longest span between two sessions was 2 weeks. This program was implemented in a classroom-setting in a K-5 elementary school with eight total D/HH elementary students signed up to participate, though session attendance varied from 3-8 per session. Immediately following each session, facilitators met to determine (1) what went well, (2) what could have been improved upon, and (3) discussed edits to the upcoming session based on that session’s performance.
RESULTS: Formative evaluation: A summer program for EF support was modified to be used in an after-school format with students who are D/HH. The format was changed from 3 hours per day for one week to one hour per week for 8 weeks. To better support the D/HH students and their communication styles, facilitators used listening and spoken language throughout the program in coordination with American Sign Language interpreters provided by the partner program.
Process evaluation: Programmatic changes were made from the initial lesson plans as opportunities and program limitations were identified throughout the sessions. These included the elimination of one of two planned introductory activities for each session, the revision of the project timeline to use two program sessions to complete one project, and a change in the curriculum manual of the order of the projects following the conclusion of the program to better support skill development.
CONCLUSION: A new, after-school EF support program was implemented in a site-based program for students who are D/HH, and the subsequent curriculum manual for that program was developed. The successful implementation of the program with this population and the development of the curriculum manual supports its continued use and creates the possibility of its dissemination and implementation with other students who have EF deficits. The next phase of this project is to use the established curriculum to implement the program again with an outcome evaluation to measure the impact this curriculum has on the EF skills of this population.
Cite:
Cheatham Oberle, S.; Stevens, K. (2022, April 29). The development of an after-school executive functioning support program and curriculum manual. [Poster Session]. Saint Louis, Missouri, United States. https://sites.wustl.edu/trainyourbrain/files/2024/09/Stevens_Scholarship-Day-Poster.pdf
Paige McDermot, OTD, OTR/L
Sarah Cheatham Oberle, OTD, OTR/L
Abstract:
Title: A Parent’s Perspective on Executive Functioning Skills for Their Child with Hearing Loss
PURPOSE: The complex cognitive skills encompassed by executive functioning are vital for the development of social, academic, and life skills (Diamond & Lee, 2011). Because these skills are so vital, children, adolescents, and adults who struggle with executive functioning skills are more likely to experience difficulty with adult roles, like parenting and productive employment (Center on the Developing Child at Harvard University, 2016). Research shows that school-age children who are Deaf or Hard of Hearing (D/HH) perform less well on executive functioning (EF) tasks than children without hearing loss (Botting, 2017). Further research suggests that language mediates EF performance and that there is no statistically significant difference in EF between children who use American Sign Language vs children with typical hearing who use listening and spoken language (Botting et al., 2017; Hall et al., 2018). This research shows that EF issues are caused by delays in access to and utilization of language in children who are D/HH, not the deafness itself (Hall et al., 2018). This project seeks to support the development of an EF support program for children who are D/HH by gathering parent input on their children’s EF skills and their impressions of how an EF support program could impact their child.
DESIGN: A qualitative, interview-based study.
METHODS: Parents of children enrolled in a school for children who are D/HH which utilizes listening and spoken language in the greater St. Louis region were recruited to participate via paper flyer sent home from their child’s school. Parents were invited to participate in a one-on-one interview with the research team via phone call.
RESULTS: Paper flyers were sent home from school to 14 families on two occasions. One parent contacted the research team and was interviewed one-on-one via phone call. The parent reported that her 9-year-old child has bilateral cochlear implants and has been at a school for listening and spoken language for six years. She identified memory and attention as executive functioning deficits in her child. The child currently participates in a weekly executive functioning program at his school, although the parent was unaware of this program. Other observations from the parent included that her child does not “pick up” on concepts without explicit instruction and teaching. The parent expressed desire for her child to continue to participate in the school program and possibly participate in other formats of the program (e.g., summer day camp) because he “misses out” on many skills due to his continued language and EF deficits.
CONCLUSIONS: This student who is D/HH struggles with the EF skills of memory and attention and has continued challenges with language manipulation and output. As a child with severe/profound hearing loss who has been learning listening and spoken language for six years, there is a strong likelihood that his delayed access to language is affecting his EF development, as displayed by previous research (Botting et al., 2017; Hall et al., 2018). Additionally, the student’s need for explicit instruction on EF skills validates the purpose and structure of the EF support program and supports its continued use in his school. The feedback and information provided by this parent can be utilized to craft programming to support EF skills of kids who are D/HH.
Select References:
Botting N., Morgan G., Jones A., Marshall C., Denmark T., Atkinson J. (2017). Nonverbal Executive Function is Mediated by Language: A Study of Deaf and Hearing Children. Child Dev. 88 1689–1700. 10.1111/cdev.12659
Center on the Developing Child (2012). Executive Function (InBrief). Retrieved from www.developingchild.harvard.edu.
Diamond, A., & Lee, K. (2011). Interventions shown to aid executive function development in children 4 to 12 years old. Science,333(6045), 959-964.
Hall, M. L., Eigsti, I., Bortfeld, H., & Lillo-Martin, D. (2018). Executive Function in Deaf Children: Auditory Access and Language Access. Journal of Speech, Language and Hearing Research (Online), 61(8), 1-19. http://dx.doi.org.beckerproxy.wustl.edu/10.1044/2018_JSLHR-L-17-0281
Cite:
Cheatham Oberle, S.; McDermot, P. (2022, April 29). Parent’s perspective on executive functioning skills for their child with hearing loss. [Poster Session]. Saint Louis, Missouri, United States. https://sites.wustl.edu/trainyourbrain/files/2024/09/McDermott_Scholarship-Day-Poster.pdf
2021
Lauren Morgan, OTD, OTR/L
Sarah Cheatham Oberle, OTD, OTR/L
Abstract
Title: Understanding teachers’ of the d/Deaf experiences with executive function and occupational therapy in a site-based, school program
PURPOSE: Two to three of every one thousand children born in the United States are found to have some level of detectable hearing loss (Centers for Disease Control and Prevention, 2010). Because of the connection between hearing loss, language development, and cognitive development (Kronenberger et al., 2014; Pisoni et al., 2012), children with hearing loss are at risk of executive dysfunction and the impact that can have on their daily lives (Hintermair, 2011). While facilitating cognitive and executive function (EF) development falls within the occupational therapy (OT) scope of practice, most students who are d/Deaf or hard-of-hearing (DHH) do not receive OT services. This study sought to (1) create a district-wide profile of a DHH site-based education program, (2) assess teachers’ of the d/Deaf (TOD’s) knowledge of and experiences with OT, (3) assess TOD’s knowledge of and experiences with EF, and (4) determine TOD’s interest in an after-school EF support program.
DESIGN: This was a descriptive research design study. This study was the first of several in a larger exploratory project designed to assess and address the needs of students who are DHH in order to create a relevant and effective after-school EF support program.
METHOD: The research team partnered with a site-based school program that provides services to students with hearing loss from eight public school districts. The research team used an online software program to create original surveys to investigate the study’s research questions. One administrator and all TODs in the partner program were asked to complete the online surveys.
RESULTS: A total of 63 students are enrolled in kindergarten – 12th grade in the partner program. The majority of students use listening and spoken language (LSL) or total communication (TC) as communication styles (84%, n=53). The response rate from TOD was 88% (n=14). Over a quarter, (29%, (n=4), of the TOD reported no previous experience with OT in their time as an educators. Of those that had experience with OT, 64% (n=9), had experienced OT pulling a student out of class, and 43% (n=6) had consulted with OT about a student. When asked about the frequency of difficulty with ten distinct EF skills, over 50% (n=7) respondents of the TOD reported that their students “Always” or “Often” experience difficulty with each EF skill. Working memory, inhibition, self-monitoring, and planning/organizing were the EF skills TOD most often reported their students have difficulty with while at school. On average, TOD would recommend 82% of their students for enrollment in an after-school EF support program if it were available.
CONCLUSION: The results of the surveys indicate that a majority of TOD within the partner program are witnessing EF difficulties among their students. While the majority of TOD have experience with OT, the experiences are limited. Despite this limited experience, a majority of the TOD reported that they would recommend most of their students attend an EF support program if one were available.
IMPACT STATEMENT: OT services are not typically provided to students with hearing loss, however TOD who interact with these students on a daily basis have provided evidence to indicate that these students’ needs are within OT’s scope of practice, and OT support could be beneficial to their students’ development and success.
Select References:
Centers for Disease Control and Prevention. (2010). Identifying infants with hearing loss—United States, 1999-2007. Morbidity and Mortality Weekly Report, 59(8), 220 – 223. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5908a2.
htm
Hintermair (2011). Health-related quality of life and classroom participation of deaf and hard-of-hearing students in general schools. Journal of Deaf Studies and Deaf Education, 16(2), 254–271. https://doi.org/10.1093/deafed/enq045
Kronenberger, W. G., Colson, B. G., Henning, S. C., & Pisoni, D. B. (2014). Executive functioning and speech-language skills following long-term use of cochlear implants. Journal of Deaf Studies and Deaf Education, 19(4), 456–470. https://doi.org/10.1093/deafed/enu011
Pisoni, D. B., Conway, C. M., Kronenberger, W. G., Henning, S. C., & Anaya, E. M. (2012). Executive function, cognitive control, and sequence learning in deaf children with cochlear implants. In The Oxford Handbook of Deaf Studies, Language, and Education (Vol. 2). Oxfod University Press. https://doi.org/10.1093/oxfordhb/9780195390032.013.0029
Cite:
Cheatham Oberle, S.; Morgan, L. (2021, April 30). Understanding teachers’ of the d/Deaf experiences with executive function and occupational therapy in a site-based school program [PowerPoint Slides]. https://sites.wustl.edu/trainyourbrain/files/2024/09/Morgan-Presentation-Teacher-Surveys-2021.pdf
Brittany Grimes, OTD, OTR/L
Sarah Cheatham Oberle, OTD, OTR/L
Abstract:
Title: Perspectives of Teachers of the Deaf on Students’ Cognitive, Self-Advocacy, and Social Skills as Related to Development of an After-School Program
PURPOSE: Pediatric hearing loss puts children at risk for a number of developmental delays that can affect school participation and academic performance. In particular, children who are d/Deaf or hard-of-hearing (D/HH) are at risk for executive functioning (EF) delays, which affects many school-related tasks, such as attention, emotional regulation, problem solving, working memory, inhibitory control, and planning (Beer et al., 2014). Additionally, children who are D/HH may have lower-level social skills (Chang et. al, 2014) and underdeveloped self-advocacy skills (Schoffstall et al., 2015). Traditional interventions for children with hearing loss focus on speech and audiology services but do not directly address additional developmental delays. While these services are crucial, occupational therapy can serve as a complement by providing uniquely comprehensive developmental support.
This project is part of a larger investigation aimed at designing and implementing an after-school EF support program for students with hearing loss at a site-based program in the Hazelwood School District (HSD). The purpose of this project is to guide program development by exploring (1) common EF problems seen in the classroom, (2) students’ self-advocacy and social skills, and (3) the feasibility of implementing an after-school occupational therapy program.
DESIGN: A qualitative, focus group-based study. All teachers of the d/Deaf (TOD) who work in HSD and teach grades K-12 were invited via email to participate (16 total).
METHOD: Focus groups were held and recorded on Zoom Teleconferencing Software. The recordings were transcribed using Otter transcription software and edited by the researcher to ensure verbal accuracy. Data was analyzed using thematic analysis (Braun & Clark, 2006).
RESULTS: A total of 3 focus groups were conducted via Zoom with 8 TODs (2-3 teachers per group). Each session lasted about 60 minutes. Thematic analysis of the focus groups indicated that EF delays can inhibit learning, lead to classroom distractions, and require extra support from TODs. Self-advocacy and social skills are impacted by students’ ages (ex: younger students are more willing to task risks when making friends), personalities (ex: shy vs confident), language skills (ex: difficulty expressing needs), and school and social environments (ex: supportive faculty, noisy classrooms, and peer support vs pressure). Lastly, TODs predicted students and parents would be interested in an after-school EF program, but transportation could be a barrier to participation.
CONCLUSION: Students who are D/HH experience EF-related delays that affect school participation, self-advocacy skills, and social skills, all of which fall within OT’s scope of practice. Therefore, an OT-driven, after-school EF program would provide support that compliments school-based educational and therapeutic services through skilled instruction on EF strategies, while simultaneously addressing self-advocacy and social skills (ex: completing a group project). Additionally, there is interest to create an EF after-school program from TODs, which further supports the continued development of the proposed program.
IMPACT STATEMENT: Supportive services for students who are D/HH will be expanded to meet their full school participation needs.
Select References:
Beer, J., Kronenberger, W. G., Castellanos, I., Colson, B. G., Henning, S. C., & Pisoni, D. B. (2014). Executive functioning skills in preschool-age children with cochlear implants. Journal of Speech Language and Hearing Research, 57(4), 1521–1534. doi: 10.1044/2014_JSLHR-H-13-0054
Braun, V. & Clarke, V (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. doi: 10.1191/1478088706qp063oa
Chang, Y. S., Moon, I. J., Kim, E. Y., Ahn, J., Chung, W. H., & Hong, S. H. (2014). Social skills and developmental delay: Importance in predicting the auditory and speech outcomes after cochlear implantation in children. Acta Oto-Laryngologica, 135(2), 154-161. doi: 10.3109/00016489.2014.97351
Schoffstall, S., Cawthon, S. W., Trantolo-Leppo, R. H., & Wendel, E. (2015). Developing consumer and system-level readiness for effective self-advocacy: Perspectives from vocational rehabilitation counselors working with deaf and hard of hearing individuals in post-secondary settings. Journal of Developmental and Physical Disabilities, 27, 533-555, doi: 10.1007/s10882-015-9435-3
Cite:
Cheatham Oberle, S.; Grimes, B. (2021, April 30). Perspectives of teachers of the d/Deaf on students’ cognitive, self-advocacy, and social skills as related to development of an after-school program. [PowerPoint Slides]. https://sites.wustl.edu/trainyourbrain/files/2024/09/Grimes-Presentation-Teacher-Focus-Groups-2021.pdf
Allie Snell, OTD, OTR/L
Sarah Cheatham Oberle, OTD, OTR/L
Abstract:
Title: A Qualitative Analysis of the Perspectives of St. Louis Teachers of the Deaf on Student Executive Functioning
PURPOSE: Children with language and learning needs, such as children with hearing loss (2-3 out of 1000 [CDC, 2018]), are at risk for significant executive functioning (EF) deficits. Executive functions are self-regulatory processes such as attention, inhibition, working memory, emotional regulation, planning, and problem solving (Beer et al., 2008). Additionally, research shows that children who are d/Deaf or hard-of-hearing (D/HH) tend to fall behind their hearing peers in academic performance (Marschark & Knoors, 2012). Many aspects of academic participation and performance can be affected by EF deficits. Occupational therapy (OT) practitioners are important members of the school team who enhance participation and performance in meaningful and necessary academic activities and are knowledgeable about clinical manifestations of EF deficits, making them well suited to address and support EF needs in this population (Obermeyer, 2018). The purpose of this project was to explore the perspectives of Teachers of the Deaf (ToDs) regarding their experiences with school-based OT and their students’ EF strengths and challenges. This project is part of a larger investigation that aims to implement an OT-based, after-school EF support program for students who are D/HH. Information gained from this study will guide modification of the program to meet the specific needs of these students.
DESIGN: A qualitative, interview-based study. All ToDs teaching any grade(s) (K-12), employed by Special School District, and working through the site-based program in the Hazelwood School District were invited via e-mail to participate (16 total).
METHOD: One-on-one interviews took place and were recorded via Zoom Teleconferencing Software, and were transcribed using Otter transcription software. Interview data were analyzed using thematic analysis.
RESULTS: Four ToDs participated in virtual interviews (M = 52 minutes; range = 30-72 minutes). Analysis revealed that 1) school district characteristics impact student EF and can serve as supports (e.g., services, accommodations, technology, and routines) or barriers (e.g., social pressure and limited training/knowledge among non-D/HH-dedicated faculty and staff), 2) all participants teach students with EF deficits related directly to their hearing loss and/or other person factors (e.g., poor sleep or nutrition), which manifest in a variety of behaviors, 3) while all participants expressed that OTs are valuable members of the school team, few of their students receive OT services and collaboration with OT is minimal, and 4) all participants were supportive of the proposed OT support program.
CONCLUSION: Based on teacher report, EF skills are supported, exacerbated, and/or related to a variety of internal and external factors for students who are D/HH. OT practitioners are equipped to address and support EF skill deficits and internal barriers to EF. Although many of the identified external barriers are outside the proposed program’s focus, it is essential to understand the context in which these students learn. Finally, OTs are considered by ToDs to be valuable members of the school team, and the proposed program was deemed by all participants to be relevant and potentially beneficial to their students.
Impact Statement: According to teachers, an OT-based, after-school, EF support program for students who are D/HH is a welcome opportunity to expand supportive services for school participation and performance needs.
Select References:
Centers for Disease Control and Prevention. (2018). 2018 summary of national CDC EDHI data. U.S. Department of Health and Human Services. https://www.cdc.gov/ncbddd/hearingloss/2018-data/01-data-summary.html
Beer, J., Kronenberger, W. G., Castellanos, I., Colson, B. G., Henning, S. C., & Pisoni, D. B. (2014). Executive functioning skills in preschool-age children with cochlear implants. Journal of speech, language, and hearing research: JSLHR, 57(4), 1521–1534. https://doi.org/10.1044/2014_JSLHR-H-13-0054
Marschark, M. & Knoors, H. (2012). Educating deaf children: Language, cognition, and learning. Deafness & Education International, 14(3), 136-160. https://doi.org/10.1179/1557069X12Y.0000000010
Obermeyer, I. (2018). Executive function for school-age students. SIS Quarterly Practice Connections, 3(4), 2-5. https://www.aota.org/Publications-News/SISQuarterly/children-youth-practice-connections/CYSIS-11-18.aspx
Cite:
Cheatham Oberle, S.; Snell, A. (2021, April 30). A qualitative analysis of the perspectives of St. Louis teachers of the d/Deaf on student executive functioning. [PowerPoint Slides]. https://sites.wustl.edu/trainyourbrain/files/2024/09/Snell-Presentation-Teacher-Interviews-2021.pdf