Pediatric and Adolescent Mental Health

Response to Intervention (School-based) Approach
Tier 1 interventions
include assisting in school wide prevention efforts, collaborating with school personnel to create positive environments, and observing all children’s behaviors
Response to Intervention (School-based) Approach
Tier 2 interventions
include developing and running programs for at-risk students and consulting with teachers to modify learning demands for at-risk students
Response to Intervention (School-based) Approach
Tier 3 interventions
include providing individual or group intervention for students with mental health concerns and collaborating with school-based mental health providers
Psychoeducation
Educate child and family about the disorder
Affective education
Teach skills to identify and recognize emotions and influences on emotions
Cognitive restructuring
Teach skills to recognize faulty or anxious thinking
Relaxation training
Teach progressive muscle relaxation techniques, deep b breathing, and guided imagery
Exposure to fears and contingency management
Provide exposure involving gradual introduction of feared events and rewards for brave behaviors
Autism Pharmalogical options
clomipramine
pimozide
fluoxetine for anxiety and hyperactivity
Professorial Speech
Speech with little regard for the interest of the listener is typical for people with Asperger’s syndrome
An OTR® is planning an occupational therapy intervention focused on leisure exploration for a client with oppositional defiant disorder who likes graffiti, body piercings, and tattoos. Which activity would be MOST appropriate?
A. Making posters with colored markers on poster paper
B. Leather tooling a wallet with premade designs
C. Knitting a blanket following an assigned pattern
D. Freestyle painting a design on the wall in a public area
A. Making posters with colored markers on poster paper

People with oppositional defiant disorder respond best to moderate, but not too much, structure. The choice of activities should be client centered and should capture the interests of the individual. Making posters allows the client to capture the style of art found in graffiti and tattoos while providing clear boundaries in the form of the poster paper and safe tools.

During an initial evaluation, the OTR® brings a 7-year-old child with autism to the sensory gym to observe the child’s play skills. The OTR® demonstrates a variety of play equipment and tells the child, “I want to see you play in the gym. What would you like to do?” The child is unable to figure out which equipment to use and how to use it. The OTR® suspects that the client may have difficulties in what aspect of play?
A. Ideational praxis
B. Motor organizational praxis
C. Symbolic play
D. Exploratory play
A. Ideational praxis

Ideational praxis is the ability to conceptualize and identify a motor goal and ways to achieve this goal. Problems in this area may lead to difficulties in generating independent play.

Which statement accurately describes the eligibility determination for occupational therapy services under IDEA Part C in an early intervention program?
A. Infants and toddlers with established risk because of a diagnosis automatically qualify for Part C services.
B. Infants with marked developmental delays but without a specific diagnosis automatically qualify for Part C services.
C. An OTR® is automatically a member of an evaluation team in early intervention programs.
D. Early intervention is always provided by a multidisciplinary team.
A. Infants and toddlers with established risk because of a diagnosis automatically qualify for Part C services.

As part of IDEA Part C, all children with established risk are eligible for services.

An OTR® in an inpatient facility is conducting a cooking activity to teach effective coping skills to a small group of adolescents. A group member becomes frustrated with a teammate and is angry and verbally threatening. What is the BEST response in this situation?

A. “I see that you’re becoming upset by your teammate. Let’s calm down and breathe for 10 seconds.”
B. “You seem to be getting upset by your teammate. Verbally threatening is not a good behavior to show others.”
C. “I need you to stop, pause for a while, and calm down.”
D. “You seem really upset right now. Would you want to take a minute to calm down or just go back to your room for now?”

D. “You seem really upset right now. Would you want to take a minute to calm down or just go back to your room for now?”

When a potentially dangerous situation commences, such as a threat of assault, the OTR® should offer the adolescent choices for effective coping strategies to deal with emotional outbursts.

An OTR® has developed a prevocational program for clients who have an enduring mental illness. Program modules include assessing the advantages and disadvantages of employment, evaluating work and leisure skills, practicing completion of job applications, and learning to write resumes and cover letters. Which frame of reference reflects the design of this program?
A. Cognitive-behavioral
B. Psychodynamic
C. Model of Human Occupation
D. Dynamic Interactional Model
A cognitive-behavioral frame of reference is commonly applied in social and life skills groups where clients can focus on self-regulation through observational learning and modeling of skills. Clients in the group described in this scenario would be able to engage in observational learning and modeling of completing applications, writing letters, and expanding on work and leisure skills through group activities.
An OTR® is seeing an adolescent client with major depression for the first time in an individual treatment session. The client has been withdrawn and has stayed in bed except for meals. What is the MOST important consideration in choosing an activity for this client?
A. The activity should involve some degree of challenge.
B. The activity should be completed easily.
C. The activity should require multiple sessions to finish.
D. The activity should require primarily observational learning.
B. The activity should be completed easily.

Activities for clients with major depression should be able to be completed easily to provide a sense of success and competence.

A 6-year-old child with moderate autism has poor interoceptive sensory skills. Which occupation may be MOST significantly affected?
A. Handwriting
B. Toileting
C. Reading a book
D. Playing a video game
B. Toiling

Interoception is the ability to perceive information from inside the body. Children with autism spectrum disorders typically have difficulties with toileting because of insufficient ability to perceive the need to urinate and eliminate.

An OTR® is evaluating a child with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome). At 1:05 p.m., the child pulls out a smartphone and says, “It’s 1:05. I have to check the weather.” What response to this behavior would be MOST effective?
A. Redirect the behavior to a more appropriate one
B. Insist that the child put the cell phone away during the evaluation
C. Find out more about the child’s insistence on checking the weather
D. Introduce the child to a new weather app for the smart phone
C. Find out more about the child’s insistence on checking the weather

An evaluation includes identification of factors that affect participation in occupation, and this ritual is one such factor. It is good client-centered practice to obtain the client’s perspective on what the weather at 1:05 means to this person and to gather enough information about it to determine whether this factor is a strength or a weakness.

An OTR® is attending an individualized education program (IEP) team planning for a 10-year-old child with autism. Which principle BEST contributes to a good IEP?

A. Set academic, functional, and measurable goals achievable within a 6-month time frame
B. To the maximum extent possible, the student must be educated with nondisabled peers
C. Transition planning must begin with an emphasis on future vocational goals and independent life skills
D. To be succinct, the IEP reports only the needs and challenges of the student

B. To the maximum extent possible, the student must be educated with nondisabled peers

A general education environment is considered first because the IEP process includes placement in the least restrictive environment possible.

An OTR® and speech-language pathologist are co-leading a group for people with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome). One of the group’s outcome measures is to increase participants’ social and pragmatic language skills. Which element of group design illustrates best practice for this type of group?

A. The group must be heterogeneous.
B. Participants should be encouraged to practice their new language skills in settings outside of the group context.
C. The OTR® should lead this group as an occupational therapy group rather than engage in the group as a co-leader.
D. Parallel group activities or tasks should be included to maximize social interaction.

B. Participants should be encouraged to practice their new language skills in settings outside of the group context.

People with autism spectrum disorder typically do not generalize skills well. A challenge in practice is to facilitate carryover of rehearsed skills from therapy sessions to other settings to ensure that participants can apply the skills in cross-contextual situations.

An OTR® in an inpatient setting is inviting an adolescent with major depression to participate in an individual treatment session. The adolescent has refused to participate for 3 days, claiming not to feel well. How should the OTR® BEST respond?
A. “I think that participating in occupational therapy will make you feel a lot better.”
B. “I noticed you’ve been feeling like this for 3 days straight now, and it might be helpful for you to participate in occupational therapy.”
C. “I can see that you aren’t feeling well. Let’s try doing something you like that will not take too long and see what happens.”
D. “I can see that you aren’t feeling well, and I’m sorry for this. Can we try again tomorrow?”
C. “I can see that you aren’t feeling well. Let’s try doing something you like that will not take too long and see what happens.”

When working with a client who is depressed, it is essential to relate with understanding and empathy. Encouraging participation in any way can be helpful.

An OTR® plans to use a top-down approach to assess a 15-year-old child with attention deficit hyperactivity disorder and oppositional defiant disorder. Which top-down frame of reference emphasizes the three “dimensions of doing” at the participation, performance, and skills level?
A. Person-Environment-Occupation Model
B. Occupational Adaptation Model
C. Model of Human Occupation
D. Ecology of Human Performance Model
C. Model of Human Occupation

The Model of Human Occupation articulates the three dimensions of doing.

A child with a sensory processing disorder and Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome) is attending a regular classroom. Which reasonable accommodation would be BEST for this child under the Individuals With Disabilities Education Improvement Act?
A. Place the student’s desk at the back of the classroom
B. Reduce the number of math problems to one per page
C. Increase the number and variety of spontaneous activities in the school day
D. Increase the number of other students at the student’s lunch table
B. Reduce the number of math problems to one per page

Presenting math problems one to a page reduces sensory overload by removing clutter on the page, allowing the student to attend to one math problem at a time and supporting the student in an inclusive setting by altering the task.

An OTR® working in a school system has been asked to help the education team planning for Tier 1 of a Response to Intervention (RtI) model. Which role is appropriate for an OTR at Tier 1 of RtI?
A. Develop a social skills program for children with behavioral concerns
B. Provide direct services to children in special education
C. Provide a presentation to teachers on multisensory handwriting strategies
D. Integrate technology for children with autism
C. Provide a presentation to teachers on multisensory handwriting strategies

Tier 1 includes general education schoolwide services geared toward prevention of educational difficulties.

An OTR® working in a school setting receives a referral from a teacher to evaluate a 7-year-old child diagnosed with autism spectrum disorder and receiving special education services. What is the FIRST thing the OTR® should do as part of the evaluation process?
A. Identify which standardized assessments to use to provide a holistic picture of the child’s abilities
B. Gather information to create the student’s occupational profile
C. Send home a Sensory Profile questionnaire for the parent to fill out
D. Observe the child in the classroom to determine whether an occupational therapy assessment is warranted
B. Gather information to create the student’s occupational profile

The occupational profile is the first step in determining needs, skills, and abilities and identifying whether further assessments are needed.

An OTR® is working in a school with a high incidence of violence in a district with increasing numbers of students diagnosed with oppositional defiant disorder. The superintendent announces the formation of a task force to study the problem. Which response to this announcement would be BEST?
A. Document the progress the OTR® has made with students with oppositional defiant disorder to justify continuing work with these students
B. Increase the frequency of visits to the students on the OTR®’s caseload with this diagnosis because the task force will scrutinize intervention with these students
C. Research intervention strategies to make sure that the intervention the OTR® has been providing to these students is considered best practice
D. Contact the superintendent and request to be appointed to a seat on the task force to study violence and the incidence of oppositional defiant disorder
D. Contact the superintendent and request to be appointed to a seat on the task force to study violence and the incidence of oppositional defiant disorder

AOTA’s societal statement on youth violence has clearly articulated the role occupational therapy should play in this area. Prevention is within the scope of occupational therapy practice, and practitioners should welcome any opportunity to participate.

Which high school extracurricular activity would a youth with oppositional defiant disorder be MOST likely to succeed at?
A. An art program with well-established boundaries in which students are encouraged to pursue their own interests
B. A chess club in the library in which students participate in tournaments and, when not playing, participate as observers
C. A school basketball team that has the rule that students cannot play in a game if they miss a practice or are tardy or absent from school
D. A science club in which students work together in small groups to prepare science projects for the state science fair
The art program has the fewest rules, the greatest degree of individual choice, and the potential for the least amount of authority or adult direction.
A 4-year-old child with autism always flushes the toilet before using it and leaves the toilet unflushed after using it. What should the OTR® do to ensure correct toileting habits?
A. Give a reward every time the child flushes the toilet after using it
B. Suggest a sensor-activated toilet to ensure it is flushed after each use
C. Use a visual schedule depicting the correct flow of actions during toileting
D. Facilitate memory by prompting the child to flush the toilet after each use
C. Use a visual schedule depicting the correct flow of actions during toileting

A visual schedule tends to work better than auditory and operant conditioning for children with autism when teaching them the correct steps in using the toilet.

An OTR® is facilitating an activity for a group that includes an adolescent with major depression. Partway into the session, the adolescent complains of an inability to concentrate on the activity because the bright lights in the room have caused sore eyes. How should the OTR® respond?

A. Offer the client a choice to discontinue the session and ask the nurse about medication changes and effects
B. Immediately report the situation to the nurse and ask the client to rest for the day
C. Ignore the client’s response because it might be an effort to avoid work
D. Speak to the client privately and inquire whether the client is telling the truth

A. Offer the client a choice to discontinue the session and ask the nurse about medication changes and effects

OTR®s should be cognizant of the possible functional performance effects of medication. Offering a choice is an effective way of handling an adolescent.

An OTR® is working with a child diagnosed with oppositional defiant disorder in a public middle school. The child has been breaking rules in the physical education class by not wearing sneakers in the gym, chewing gum during class, and repeatedly forgetting to bring a swimsuit for the swimming class. Which solution would be BEST for this student?
A. Referral to an alternative school located nearby
B. Assignment of in-school suspension during gym class
C. Implementation of a behavioral plan
D. Replacement of gym class with another class
A behavioral plan would provide the student with expectations and explicit consequences and would provide educational personnel and the family with consistent strategies to effectively manage the student’s difficult behaviors. In addition, a behavioral plan would allow the student to stay in the least restrictive environment, consistent with the Education for All Handicapped Children Act of 1975 (Pub. L. 94-142).
An OTR® reviews recommended guidelines on the use of weighted vests to help provide sustained touch pressure and promote organization in a child with autism. Which statement describes a correct use of a weighted vest?
A. The child must be between 4 and 7 years old.
B. The vest is worn for 45 minutes to 1 hour at a time.
C. The vest’s weight should be no more than 10% of the child’s body weight.
D. Weight should be distributed over the trunk and upper extremities.
C. The vest’s weight should be no more than 10% of the child’s body weight.

The evidence-based recommendation is that the vest weigh no more than 10% of the child’s body weight.

An OTR® in a school system is evaluating a 7-year-old child with behavioral and depressive symptoms. Which tool can the OTR® BEST use to establish an occupational profile for this client?
A. Social Skills Rating Scale
B. Occupational Therapy Psychosocial Assessment of Learning
C. Canadian Occupational Performance Measure
D. Test of Playfulness
C. Canadian Occupational Performance Measure

The Canadian Occupational Performance Measure is a structured interview used to develop a client’s occupational profile.

An OTR® is working with a 3-year-old child with autism and oral defensiveness to improve feeding skills. Which activity is BEST to begin desensitization of this child’s oral defensiveness?
A. Make the child hold a vibrating toy and put it close to the face
B. Provide deep pressure on distal parts of the body and slow linear rocking
C. Ask the child to touch the lips with a piece of cracker
D. Provide only preferred foods during feeding sessions
A. Make the child hold a vibrating toy and put it close to the face

Tools can be used to provide oral stimulation to desensitize oral hypersensitivity.

An OTR® receives a referral for a 7th grader diagnosed with oppositional defiant disorder. Which condition that often occurs concurrently with oppositional defiant disorder should the OTR® look for?
A. Depression
B. Conduct disorder
C. Attention deficit hyperactivity disorder
D. Schizophrenia
Attention deficit hyperactivity disorder (ADHD) often occurs with oppositional defiant disorder (ODD), so practitioners conducting an assessment with a client with ODD should always look for signs of ADHD.
An OTR® is leading an initial group craft activity for patients on a behavioral health unit. After introductions of the leader and members, what is the NEXT step for promoting cooperation and understanding of the activity?
A. Demonstrate the steps involved in completion of the craft activity.
B. Explain the purpose of the group and verbalize expectations.
C. Orient members on the safe use of equipment needed to complete the project.
D. Provide samples of the craft project at various stages of completion.
B. Explain the purpose of the group and verbalize expectations.

Once introductions are made in a group setting, the purpose of the group should be clearly explained so clients know what the expectations of the group include.

An OTR® receives a referral for evaluation of a 6-year-old client with autism and sensory processing disorders who has extreme difficulties with sports activities in physical education class. The mother reports that the child has fair to good comprehension of verbal instructions but cannot seem to follow movement patterns related to sports activities. Medical reports indicate that the child is able to follow simple verbal directions and is generally able to perform during standardized testing. Which assessment is the BEST choice for assessing this child?
A. Sensory Integration and Praxis Test
B. DeGangi-Berk Test of Sensory Integration
C. Sensory Profile
D. Sensory Processing Measure
The Sensory Integration and Praxis Test offers the most comprehensive measure of sensory integrative functions appropriate for a child’s age.
An OTR® is working with a 9-year-old child with autism who has been on a new extended-release stimulant medication for 3 days. When the child comes to the clinic after school, the child is manic, zoned out, and crying for no apparent reason. What is the MOST immediate course of action for the OTR®?
A. Provide sensory activities to help the child become calmer and more organized
B. Change the therapy time so the medication is still in effect during occupational therapy sessions
C. Ask the parents about possible side effects of the medication affecting behaviors and performance
D. Recommend taking a break from medication and observe whether behaviors improve
C. Ask the parents about possible side effects of the medication affecting behaviors and performance

OTR®s need to monitor and report possible effects of medications on performance and behaviors.

The mother of a 5-year-old child with attention deficit hyperactivity disorder is nervous about her child’s ability to perform in kindergarten. What is the BEST recommendation the OTR® can give using the Person-Environment-Occupation (PEO) Model?
A. Allow the child to adjust to the classroom setup for a few weeks and observe whether there are difficulties
B. Further develop the child’s attention and sitting span to prepare for the structure of kindergarten
C. Ask the teacher to position the child closest to the front of the class for immediate monitoring
D. Defer kindergarten until the child is able to sit for at least 30 minutes at a time
A. Allow the child to adjust to the classroom setup for a few weeks and observe whether there are difficulties

The PEO Model focuses on the transaction between the child (person), the classroom (environment), and school-related tasks (occupation). By allowing time to adjust, the parent will be able to assess the fit between kindergarten and the child’s strengths.

An OTR® in an inpatient facility is working with an adolescent with major depression who repeatedly expresses feelings of worthlessness and poor self-concept. What therapeutic activities will BEST address this client’s self-concept issues?
A. Activities that establish normal daily routines
B. Activities that engage the client socially
C. Activities that do not require too many choices
D. Activities that allow for self-expression
D. Activities that allow for self-expression

For clients who have self-concept symptoms, activities that allow for self-expression and self-exploration help combat feelings of worthlessness and guilt.

An OTR® at a private clinic is working with a 10-year-old client with attention deficit hyperactivity disorder and depression. At the start of the session, the child shows signs of being depressed and reports feelings of worthlessness because of academic difficulties. The client refuses to participate in the planned handwriting activity for the day. What is the MOST appropriate course of action for the OTR®?
A. Ask the child to cheer up because many activities have been planned for the day
B. Ask whether the child wants to discontinue the session
C. Discontinue the session and report the signs of depression to the parent
D. Offer the child a change in activities from planned handwriting to artwork
D. Offer the child a change in activities from planned handwriting to artwork

When a client is depressed and shows signs of self-concept issues, engaging in occupations that involve self-expression can help the client deal with his or her emotions.

Which game is MOST difficult for a 7-year-old child with autism?
A. Following simple designs using plastic interlocking blocks
B. Fishing for letter puzzles while on a swing
C. Playing Simon Says with a peer
D. Making a sandwich using play dough
Playing Simon Says requires social skills, auditory processing, and praxis skills, which are typical areas of challenge for children with autism.
Praxis
Praxis is the neurological process by which cognition directs motor action (Ayres, 1985). Put simply, it involves planning what to do and how to do it.
Which statement BEST describes the role of occupational therapy in an early intervention program under the Individuals With Disabilities Education Act Part C?
A. Occupational therapy is one of 16 primary services provided for children in need of early intervention services.
B. Occupational therapy is a related service provided only as a support to special education services.
C. Occupational therapy is provided as a fee-for-service intervention for children in need of early intervention services.
D. Occupational therapy is primarily a school-based service provided for children in need of early intervention.
A. Occupational therapy is one of 16 primary services provided for children in need of early intervention services.

As part of IDEA Part C, occupational therapy is listed as a primary service, as are speech and physical therapy and special instruction.

An OTR® is conducting the first session of an occupational therapy group for adolescents with oppositional defiant disorder in an inpatient behavioral treatment center. Which activity is a priority?
A. Assess individual members’ likes and dislikes
B. Set ground rules with clear expectations
C. Do an ice breaker using a large parachute
D. Identify the time-out chair for participants who misbehave
B. Set ground rules with clear expectations

Clients with oppositional defiant disorder need clear rules about what behaviors are acceptable and not acceptable. Expectations for participation in the group need to be made explicit.

An OTR® working in a public school receives a referral for a middle school student with oppositional defiant disorder. Which method to gather reliable information about this student would be MOST effective?
A. Interview the student
B. Interview the teacher or caregiver
C. Read the student’s school file
D. Observe the child at home
B. Interview the teacher or caregiver

People with oppositional defiant disorder are not always truthful and generally do not have insight into their oppositional behavior. They are unlikely to be able to articulate an accurate picture of their behavior.

An OTR® is working with a 6-year-old child with attention deficit hyperactivity disorder on self-monitoring energy and arousal levels inside the classroom. Which intervention is BEST to use for this goal?
A. Train the parent to use a sensory diet to help the child remain calm throughout the day.
B. Use the ALERT Program to train the child to self-regulate.
C. Train the child to use breathing and relaxation techniques when feeling hyperactive.
D. Provide a therapy ball for seating in the classroom.
B. Use the ALERT Program to train the child to self-regulate.

The ALERT Program teaches children self-regulation skills to self-monitor their arousal and energy levels.

Which statement BEST describes settings for intervention under IDEA Part C in early intervention services?
A. All interventions must be provided in the school context.
B. All interventions must be provided in the home context.
C. All interventions must be provided in all natural contexts of performance.
D. All interventions must be provided in the private clinic.
C. All interventions must be provided in all natural contexts of performance.

As part of IDEA Part C, all interventions must be provided in all of the client’s natural environments

An OTR® is using the Ayres Sensory Integration Intervention program for a 6-year-old child with attention deficit hyperactivity disorder and sensory-seeking behaviors. Which principle should the OTR® keep in mind when selecting activities for this intervention program?
A. The sensory environment is completely structured to allow for optimum integration of sensory information.
B. Sensory experiences are limited to one sensory factor at a time to ensure mastery.
C. Passive participation on the part of the child is encouraged.
D. Appropriate activities are done individually and not in a small group.
D. Appropriate activities are done individually and not in a small group.

The Ayres Sensory Integration Intervention program is applied individually rather than in groups.

An adolescent referred for occupational therapy has oppositional defiant disorder. During the initial interview, the parent reports that the youth never listens to requests, become angry several times a day, blames mistakes on an older sibling, and deliberately annoys a younger sibling. The youth also fails to respect others’ space and complete assigned chores and is often disruptive and argumentative at the dinner table. Which area of occupation is MOST affected?
A. Activities of daily living
B. Rest and sleep
C. Leisure
D. Social participation
D. Social participation

Social participation is an area of occupation that pertains to behavior in the context of a social system, in this case a family. This youth’s interaction with others and fulfillment of roles in the family system are impaired by defiant behavior.

The parent of a 7-year-old child with attention deficit hyperactivity disorder informs the OTR® that the child recently started taking dexmethylfenidate (Focalin). Which side effect of this drug must the OTR® watch for?
A. Moodiness and agitation
B. Euphoria
C. Blurred vision
D. Mydriasis and hyperthermia
A. Moodiness and agitation

Of the options, only A is a possible side effect of central nervous system stimulants.

An OTR® is conducting a classroom observation as part of an evaluation for a 6-year-old child with attention deficit hyperactivity disorder. The therapist decides to approach this case using the Occupational Adaptation Model. Which target of observation is MOST consistent with the use of this model?
A. The way the child modulates various stimuli in the classroom environment
B. The teacher’s teaching styles and whether they match the student’s learning styles
C. The demand that the classroom rules place on the child’s ability to follow them
D. The child’s ability to navigate the physical classroom
C. The demand that the classroom rules place on the child’s ability to follow them

The occupational environment includes classroom rules, which create a demand for mastery. The interaction between the child’s ability to follow the rules (desire for mastery) and the occupational environment creates a press for mastery.

An OTR® is helping a 3-year-old child with autism develop functional play skills. Which of play activity is BEST for achieving this goal?
A. Feeding dolls
B. Stacking colored rings
C. Dipping hands in rice grains
D. Pretending to be a fairy tale character.
A. Feeding dolls

Functional play uses real objects to re-create real-life situations.

An OTR® plans to use ecological assessments to evaluate the strengths and weaknesses of a 4-year-old child with autism. Which assessment is a good example of an occupational therapy ecological assessment?
A. Knox Preschool Play Scale
B. Bruininks-Oseretsky Test of Motor Proficiency
C. School Function Assessment
D. Beery-Buktenica Development Test of Visual-Motor Integration
The Knox Preschool Play Scale is an assessment of play skills that can be used in various performance contexts.
An OTR® is evaluating a 16-year-old adolescent with major depression and suicide precautions in an inpatient facility. Which source of information will BEST enable the OTR® to document the intensity, severity, and duration of this client’s symptoms?
A. Observation during occupational performance
B. A life events inventory of the client
C. Interviews with caregivers
D. Interviews with roommates in the facility
B. A life events inventory of the client

A life events history can provide an accurate history of the client.

An adolescent hospitalized for suicidal ideation and depression is meeting with an OTR® for discharge planning. What aspect of the discharge plan is MOST urgent?
A. Provide client education on the effects of prescription medication
B. Review the contract for safety procedures the client will follow when thoughts of suicide commence
C. Contact the client’s school system to see if a suicide prevention program is in place
D. Reinforce the need for follow-up occupational therapy treatments to monitor progress
B. Review the contract for safety procedures the client will follow when thoughts of suicide commence

A contract for safety is the client’s written agreement that he or she will tell an appropriate person if he or she is having thoughts of suicide. Preventive measures are the MOST urgent and important part of the discharge plan for clients with suicidal tendencies.

An OTR® is using an Ecology of Human Performance Model to help a child with attention deficit hyperactivity disorder improve handwriting efficiency. Which intervention strategy is MOST consistent with this approach?
A. Use movement-based activities to help the child improve focus and attention during structured tasks
B. Use highlighted ruled paper to enable the child to stay within boundaries when writing
C. Facilitate the child’s development of strategies to develop mastery of handwriting tasks
D. Strengthen the child’s hand muscles to improve pencil grasp
B. Use highlighted ruled paper to enable the child to stay within boundaries when writing

Modifying or adapting task tools is an intervention strategy of the Ecology of Human Performance Model.

An OTR® is preparing to assess a student who is 17 years old and has moderate symptoms associated with Asperger’s syndrome. The purpose of the assessment is to determine the student’s strengths and needs for a work-study experience as part of a transition services program. What type of assessment would be MOST BENEFICIAL to administer when gathering information to achieve this goal?
A. Self-administered occupational performance checklists
B. Self-perception questionnaire related to occupational performance
C. Social interactions and social adjustment inventory
D. Functional capacities and work readiness evaluation
C. Social interactions and social adjustment inventory

Social skills such as getting along with others and functioning socially in a group situation have been found to be significant predictors of employment for individuals with mental illness. This would be the most beneficial information to gather in this assessment.

A 4-year-old child with attention deficit hyperactivity disorder is using a tire swing for vestibular input to feel more organized. After a few minutes, the child appears to have some autonomic reactions to the fast swinging. Which course of action for the OTR® is BEST?
A. Immediately ask the child to stop and sit in a corner to relax
B. Ask the child to slow down the swinging by pulling a trapeze bar for proprioceptive input
C. Ask the child to slow down while doing slow, deep breathing
D. Let the child continue because the vestibular stimulation ceases with autonomic activation
B. Ask the child to slow down the swinging by pulling a trapeze bar for proprioceptive input

Research indicates that proprioceptive input inhibits vestibular stimulation.

An OTR® is collaborating with a team of early intervention specialists to develop an individualized family service plan (IFSP). Which of the following components is required?
A. Steps to support the child’s transition to preschool
B. Projected dates of each individual service to be provided
C. A detailed report and documentation of all sources of income for the family
D. A statement of all expenses to be incurred from occupational therapy services
A description of the steps to support the child’s transition to preschool is one of the required components of an IFSP under the Individuals With Disabilities Education Act.
An OTR® is working with children with autism in an early childhood intervention program. Which practice BEST reflects an integrated developmental model of assessment for these children?
A. Use of the most appropriate standardized assessments
B. Observation of the children’s function in various contexts
C. Observation of the children without their parents to see their natural behaviors
D. Use of an unfamiliar examiner to provide more objective results
B. Observation of the children’s function in various contexts

Integrated developmental assessment incorporates multicontextual sources of information.

An OTR® is reading a previous initial evaluation report for a child with autism that concluded, on the basis of a sensory processing assessment, that the child shows signs of low registration of sensory information. Which of the child’s behavior observed by the OTR® is consistent with low sensory registration?
A. Easily gets dizzy with linear swinging
B. Shows increased hyperactivity and movement
C. Dislikes being touched and hugged
D. Shows guarded and cautious movement
B. Shows increased hyperactivity and movement

According to Dunn’s model, low registration of stimuli is demonstrated by sensory seeking.

An OTR® is evaluating a client who is functioning at Level 1 of autism spectrum disorder without intellectual impairment (Asperger syndrome). What factor would be MOST likely to limit the client’s occupational performance?
A. Memory limitations
B. Poor speech intelligibility
C. Low intellectual ability
D. Habitual behaviors
D. Habitual behaviors

Autism spectrum disorder is characterized primarily by social interaction problems and habitual behaviors.

An OTR® is asked to help a 4-year-old child with autism with feeding skills. A main concern for the parents is their inability to eat at a restaurant because the child can only tolerate food served at home. They also would like the child to tolerate sitting at a restaurant for at least 10 minutes to eat. Which treatment goal should the OTR® prioritize?
A. Tolerate holding a French fry for 5 minutes while seated at a restaurant
B. Tolerate sitting at a restaurant for 5 minutes while eating preferred home food
C. Tolerate sitting at a restaurant for 1 minute while eating a French fry
D. Tolerate putting a French fry near the mouth for 5 minutes while seated at a restaurant
B. Tolerate sitting at a restaurant for 5 minutes while eating preferred home food

Increasing food intake is difficult if the child is unable to tolerate sitting for a long time. Increasing the amount of time seated at a restaurant with preferred food must be the priority.

An OTR® has been working on increasing the concentration and attention span of an 8-year-old child with autism who is distractible during handwriting activities in the classroom. Using a sensory integration approach, which environment is the BEST to address concentration and attention skills?
A. An isolated room free from any kind of distraction
B. A small classroom with two other children and soothing music
C. A small corner of a sensory gym where two other children are swinging
D. A quiet corner in the child’s classroom with a chalkboard divider
B. A small classroom with two other children and soothing music

Sensory integration techniques emphasize the use of naturalistic environments for intervention. Using a small classroom where two other children are doing handwriting tasks is the most naturalistic environment similar to an actual classroom without unnecessary sensory stimulation.

Which occupation-based intervention activity is MOST appropriate to develop the bilateral hand skills of a 3-year-old child with autism?
A. Holding a cup while pouring water from a large pitcher
B. Donning a dress and buttoning the five 2-inch buttons on the dress
C. Writing the child’s own name while stabilizing the paper
D. Holding the handle of a small bucket while filling it with water from a faucet
D. Holding the handle of a small bucket while filling it with water from a faucet

Of the options, holding the handle of a small bucket while filling it with water from a faucet is the most appropriate play-based activity for the child’s age.

Which accommodation under the Americans With Disabilities Act would be MOST likely to foster a successful transition to work at a fast-paced office for a high school student with Level 1 autism spectrum disorder without intellectual impairment (Asperger syndrome)?
A. Install space enclosures or cubicle walls
B. Widen doorways throughout the office
C. Enlarge signs and elevator controls
D. Prohibit other workers from speaking loudly
Simple alterations to the physical space such as installing cubicle walls are considered reasonable accommodation under ADA and would allow a person who is easily distracted to concentrate on work more successfully by screening out extraneous stimuli from the environment.
An OTR® working with families of children with autism wants to ensure a family-centered intervention program. Which strategy BEST reflects use of this approach?
A. Ensuring that all of the children’s skill deficits are addressed
B. Helping develop a weekend plan of activities with the families
C. Educating families about their child’s deficits and needs indicated in the evaluation
D. Modifying families’ lifestyle to ensure carryover of intervention at home
B. Helping develop a weekend plan of activities with the families

Of the options, only involving families in selecting activities reflects a family-centered approach to intervention.

The mother of a 7-year-old boy with autism asks the OTR® to teach her child to urinate inside the toilet bowl. Which method is BEST to teach this skill?
A. Use a water gun to squirt water inside the toilet bowl to teach the concept of in and out
B. Ask the child to sit, keep deflecting the urine stream inside the bowl, and slowly stand
C. Place a piece of cereal inside the bowl to serve as a target
D. Use a piece of cardboard to elevate the rim of the bowl for a visual cue
Using a target such as a piece of cereal can help increase a child’s attention to accuracy when learning to urinate while standing.
]]>