Sharon Cermak EdD, OTR/L, FAOTA
Professor, joint appointment with the Keck School of Medicine of USC, Department of Pediatrics
Room: CHP 222V
Phone: (323) 442-2879
Sharon Cermak received her Bachelor of Science degree in Occupational Therapy from The Ohio State University, her Master of Science degree in Occupational Therapy from Boston University, Graduate Program, and her doctoral degree in Special Education at Boston University. Dr. Cermak is renowned for her expertise in Dyspraxia/Developmental Coordination Disorder, a long-standing interest of hers. She co-edited a leading text, "Developmental Coordination Disorders," and more recently served as a member of an NIH Task Force on Childhood Motor Disorders.
Dr. Cermak’s current research focuses on health promotion in children with disabilities, which is a critical area of national health concern for children. She is involved in two NIH-funded projects as part of an interdisciplinary team of researchers at the Eunice Kennedy Shriver Center in Massachusetts. Dr. Cermak is Principal Investigator of an NIH-funded R21 grant, Physical Activity, Fitness and Obesity in Children with Coordination Disorders, which is designed to examine the effect of children’s motor coordination on their participation in physical activity and the effects on fitness, risk for obesity, and self-efficacy. Another area of research is with children with autism. Dr. Cermak is Co-Investigator on an NIH-funded R21 grant, Diet, Activity and Obesity in Children with Autism. Another related area of Dr. Cermak’s research expertise is the sensory processing and developmental effects of deprivation in institutionalized and post-institutionalized children. Dr. Cermak has been involved intensively in orphanages in Romania, conducting both research and service programs. She collaborates with Dr. Laurie Miller, M.D., Director of the International Adoption Clinic at Tufts New England Medical Center. Dr. Cermak was consultant and contributing author on a grant that Dr. Miller (PI) received from the Fogarty International Center for research on brain disorders in developing countries. The investigators on this study examined neurodevelopmental outcomes in children in Russian orphanages, and explored the contributions of the environment in promoting optimal brain development in young children.
Doctor of Education (EdD) in Special Education
Master of Science (MS) in Occupational Therapy
Bachelor of Science (BS) in Occupational Therapy
The Ohio State University
Goldstand, S., Gevir, D., Cermak, S., & Bissell, J. (2013). Here's How I Write: A Child's Self-assessment of Handwriting and Goal Setting Tool. Framingham, MA: Therapro. Link to full text
Mauro, T., & Cermak, S. A. (2006). The everything parent's guide to sensory integration disorder. Avon, MA: Adams Media.
A sweeping multidisciplinary, multicultural view of developmental coordination disorder (DCD), this work presents current advances from such fields as medicine, occupational therapy, physical therapy, pediatric neurology, human movement, and psychology. Description and assessment are fully covered, along with underlying mechanisms, functional implications, and intervention strategies. Special attention is given to hand skills and handwriting, physical fitness, social skills, and family issues.
Cermak, S. A. (2011). Twenty five years of research in developmental dyspraxia. In A. J. Ayers (Ed.), Ayres dyspraxia monograph (25th anniversary edition). Torrance, CA: Pediatric Therapy Network. Link to full text
Cermak, S. A. (2010). Position statement on terminology related to sensory integration dysfunction. In K. Morris (Ed.), Insights into sensory issues for professionals. (pp. 117-122). Arlington, TX: Sensory World. Link to full text
Daunhauer, L. A., & Cermak, S. A. (2008). Play occupations and the experience of deprivation. In L. D. Parham & L. S. Fazio (Eds.), Play in occupational therapy for children (2nd ed.). (pp. 251-262). St. Louis, MO: Mosby Elsevier. Link to full text
Cermak, S. A. (2006). Perceptual functions of the hand. In A. Henderson & C. Pehoski (Eds.), Hand function in the child: Foundations for remediation (2nd ed.). (pp. 63-88). Rockville, MD: Mosby Elsevier. Link to full text
Osborne, P. S., & Cermak, S. A. (2006). Developmental therapies and functional assistance: Physical therapy. In I. L. Rubin & A. C. Crocker (Eds.), Medical care for children & adults with developmental disabilities (2nd ed.). Baltimore, MD: Brookes Publishing Co. Link to full text
Cermak, S. A., & Osborne, P. S. (2006). Developmental therapies and functional assistance: Occupational therapy. In I. L. Rubin & A. C. Crocker (Eds.), Medical care for children & adults with developmental disabilities (2nd ed.). (pp. 521-534). Baltimore, MD: Brookes Publishing. Link to full text
Cermak, S. A., & Mitchell, T. W. (2006). Sensory integration. In R. J. McCauley & M. E. Fey (Eds.), Treatment of language disorders in children. (pp. 435-470). Baltimore, MD: Brookes Publishing Co. Link to full text
Raz-Silbiger, S., Lifshitz, N., Katz, N., Steinhart, S., Cermak, S. A., & Weintraub, N. (2015). Relationship between motor skills, participation in leisure activities and quality of life of children with Developmental Coordination Disorder: Temporal aspects. Research in Developmental Disabilities, 38C, 171-180. doi:10.1016/j.ridd.2014.12.012. Link to full text Abstract →
The study examined the relationship between motor skills, participation in leisure activities and quality of life (QOL), within a temporal context (school year vs. summer vacation and school days vs. weekends). Parents of 22 children with Developmental Coordination Disorder (DCD) and of 55 typically developing children, aged 6-11, filled out two questionnaires relating to their children's participation in leisure activities (vigorous, moderate and sedentary) and QOL. The Movement Assessment Battery for Children-2 (MABC-2) was administered to their children. Results showed that among the children with DCD, balance scores positively correlated with participation in sedentary activities, and in both groups both balance and aiming and catching were related to the physical and school aspects of QOL. Furthermore, participation in vigorous activities in the summer was positively correlated with social and school QOL. In contrast, among typically developing children, participation in vigorous activities during the school year was negatively correlated with school QOL. Finally, in both groups, participation in sedentary activities during school days was negatively correlated with school QOL. These results suggest that the parents' perceptions of their children's QOL may be related to the level of activeness of the leisure activities but also to temporal aspects. Therefore, it is important that therapists and educators consider the temporal aspects, when consulting with parents and their children regarding participation in leisure activities.
Cermak, S. A., Stein Duker, L. I., Williams, M. E., Dawson, M. E., Lane, C. J., & Polido, J. C. (2015). Sensory adapted dental environments to enhance oral care for children with autism spectrum disorders: A randomized controlled pilot study. Journal of Autism and Developmental Disorders, Advance online publication. doi:10.1007/s10803-015-2450-5. Link to full text Abstract →
This pilot and feasibility study examined the impact of a sensory adapted dental environment (SADE) to reduce distress, sensory discomfort, and perception of pain during oral prophylaxis for children with autism spectrum disorder (ASD). Participants were 44 children ages 6-12 (n = 22 typical, n = 22 ASD). In an experimental crossover design, each participant underwent two professional dental cleanings, one in a regular dental environment (RDE) and one in a SADE, administered in a randomized and counterbalanced order 3-4 months apart. Outcomes included measures of physiological anxiety, behavioral distress, pain intensity, and sensory discomfort. Both groups exhibited decreased physiological anxiety and reported lower pain and sensory discomfort in the SADE condition compared to RDE, indicating a beneficial effect of the SADE.
Roley, S. S., Mailloux, Z., Parham, L. D., Schaaf, R. C., Lane, C. J., & Cermak, S. (2015). Sensory integration and praxis patterns in children with autism. American Journal of Occupational Therapy, 69, 6901220010p1-6901220010p8. doi:10.5014/ajot.2015.012476. Link to full text Abstract →
OBJECTIVE: We sought to characterize sensory integration (SI) and praxis patterns of children with autism spectrum disorder (ASD) and discern whether these patterns relate to social participation.
METHOD: We extracted Sensory Integration and Praxis Tests (SIPT) and Sensory Processing Measure (SPM) scores from clinical records of children with ASD ages 4-11 yr (N = 89) and used SIPT and SPM standard scores to describe SI and praxis patterns. Correlation coefficients were generated to discern relationships among SI and praxis scores and these scores' associations with SPM Social Participation scores.
RESULTS: Children with ASD showed relative strengths in visual praxis. Marked difficulties were evident in imitation praxis, vestibular bilateral integration, somatosensory perception, and sensory reactivity. SPM Social Participation scores were inversely associated with areas of deficit on SIPT measures.
CONCLUSION: Children with ASD characteristically display strengths in visuopraxis and difficulties with somatopraxis and vestibular functions, which appear to greatly affect participation.
Cermak, S. A., Stein Duker, L. I., Williams, M. E., Lane, C. J., Dawson, M. E., Borreson, A. E., & Polido, J. C. (2015). Feasibility of a sensory-adapted dental environment for children with autism. American Journal of Occupational Therapy, 69, 6903220020p1-6903220020p10. doi:10.5014/ajot.2015.013714. Link to full text Abstract →
OBJECTIVE: To provide an example of an occupational therapy feasibility study and evaluate the implementation of a randomized controlled pilot and feasibility trial examining the impact of a sensory-adapted dental environment (SADE) to enhance oral care for children with autism spectrum disorder (ASD).
METHOD: Twenty-two children with ASD and 22 typically developing children, ages 6-12 yr, attended a dental clinic in an urban hospital. Participants completed two dental cleanings, 3-4 mo apart, one in a regular environment and one in a SADE. Feasibility outcome measures were recruitment, retention, accrual, dropout, and protocol adherence. Intervention outcome measures were physiological stress, behavioral distress, pain, and cost.
RESULTS: We successfully recruited and retained participants. Parents expressed satisfaction with research study participation. Dentists stated that the intervention could be incorporated in normal practice. Intervention outcome measures favored the SADE condition.
CONCLUSION: Preliminary positive benefit of SADE in children with ASD warrants moving forward with a large-scale clinical trial.
Stein, L. I., Lane, C. J., Williams, M. E., Dawson, M. E., Polido, J. C., & Cermak, S. A. (2014). Physiological and behavioral stress and anxiety in children with autism spectrum disorders during routine oral care. BioMed Research International, 2014(Article ID 694876), 10 pages. http://dx.doi.org/10.1155/2014/694876. Link to full text Abstract →
BACKGROUND: Children with autism spectrum disorders (ASD) commonly exhibit uncooperative behaviors which impede oral care. Previous studies have utilized dentist-report measures of uncooperative behaviors in children with ASD but none have utilized an objective measure of children's behavior or a physiological measure of distress. This study investigated behavioral and physiological distress in children with ASD during routine oral care and examined factors associated with this distress.
METHODS: Participants were 44 children (typical, ASD) aged 6-12 receiving routine dental cleanings. Behavioral and physiological measures of stress and anxiety were collected during dental cleaning.
RESULTS: Children with ASD exhibited greater distress, compared to the typical group, on dentist-report and researcher-coded measures of overt distress behaviors and on physiological measures. Correlations between physiological and behavioral measures of distress were found in the ASD but not in the typical group. Behavioral distress was correlated with age in the typical group and with expressive communication ability and sensory processing difficulties in the ASD group; physiological distress was correlated with parent-report of anxiety in the typical group and sensory processing difficulties in the ASD group.
CONCLUSIONS: Novel strategies may be required to decrease behavioral and physiological distress in children with ASD in the dental clinic.
Lifshitz, N., Raz-Silbiger, S., Weintraub, N., Steinhart, S., Cermak, S. A., & Katz, N. (2014). Physical fitness and overweight in Israeli children with and without developmental coordination disorder: Gender differences. Research in Developmental Disabilities, 35, 2773-2780. doi:10.1016/j.ridd.2014.07.020. Link to full text Abstract →
Physical fitness and overweight among children has become paramount in the general population and more so in children with developmental coordination disorder (DCD). The purpose of the current study was to examine the association between physical fitness and overweight in a sample of Israeli children in comparison to typical children, and to examine gender differences. DCD was identified through total scores on the movement assessment battery for children 2 (MABC-2) equal to or less than the 16th percentile as well as parents' report that the child's deficits in motor skills interfered with at least two daily life activities. The sample included a group of children with DCD (n=22, M age=8.70 [SD=1.36], 16 boys [73%]) and a control group of typical children (n=47, M age=8.90 [SD=1.52], 34 boys [72%]). Measures included the strength subtest of the Bruininks-Oseretsky test of motor proficiency (BOT-2), the six minutes' walk test (6MWT) with heart rate measure, BMI and the percentage of body fat. Significant differences between DCD and typical children were found on all variables of physical fitness and weight. A two-way analysis of variance (ANOVA) analysis (group/gender) also revealed significant interactions for the percentage of body fat (F=8.51, p<.005) and BMI (F=4.50, p<.038) meaning that less fit children are more obese. The current study supports previous findings that children with DCD are less physically fit and more overweight compared to typically developing children. Moreover, in comparing between the genders, the girls in the study sample weighed more and had a significantly higher percentage of body fat than boys, it is essential to further our understanding of the relationships between obesity, physical fitness and gender among children with and without DCD.
Koester, A. C., Mailloux, Z., Coleman, G. G., Mori, A. B., Paul, S. M., Blanche, E., Muhs, J. A., Lim, D., & Cermak, S. A. (2014). Sensory integration functions of children with cochlear implants. American Journal of Occupational Therapy, 68, 562-569. doi:10.5014/ajot.2014.012187. Link to full text Abstract →
OBJECTIVE: We investigated sensory integration (SI) function in children with cochlear implants (CIs).
METHOD: We analyzed deidentified records from 49 children ages 7 mo to 83 mo with CIs. Records included Sensory Integration and Praxis Tests (SIPT), Sensory Processing Measure (SPM), Sensory Profile (SP), Developmental Profile 3 (DP-3), and Peabody Developmental Motor Scales (PDMS), with scores depending on participants' ages. We compared scores with normative population mean scores and with previously identified patterns of SI dysfunction.
RESULTS: One-sample t tests revealed significant differences between children with CIs and the normative population on the majority of the SIPT items associated with the vestibular and proprioceptive bilateral integration and sequencing (VPBIS) pattern. Available scores for children with CIs on the SPM, SP, DP-3, and PDMS indicated generally typical ratings.
CONCLUSION: SIPT scores in a sample of children with CIs reflected the VPBIS pattern of SI dysfunction, demonstrating the need for further examination of SI functions in children with CIs during occupational therapy assessment and intervention planning.
Chaspari, T., Tsiartas, A., Stein, L. I., Cermak, S. A., & Narayanan, S. S. (2014). Sparse representation of electrodermal activity with knowledge-driven dictionaries. IEEE Transactions on Bio-Medical Engineering, Advance online publication. Link to full text Abstract →
Biometric sensors and portable devices are being increasingly embedded into our everyday life, creating the need for robust physiological models that efficiently represent, analyze, and interpret the acquired signals. We propose a knowledgedriven method to represent electrodermal activity (EDA), a psychophysiological signal linked to stress, affect, and cognitive processing. We build EDA-specific dictionaries that accurately model both the slow varying tonic part and the signal fluctuations, called skin conductance responses (SCR), and use greedy sparse representation techniques to decompose the signal into a small number of atoms from the dictionary. Quantitative evaluation of our method considers signal reconstruction, compression rate, and information retrieval measures, that capture the ability of the model to incorporate the main signal characteristics, such as SCR occurrences. Compared to previous studies fitting a predetermined structure to the signal, results indicate that our approach provides benefits across all aforementioned criteria. This paper demonstrates the ability of appropriate dictionaries along with sparse decomposition methods to reliably represent EDA signals and provides a foundation for automatic measurement of SCR characteristics and the extraction of meaningful EDA features.
Mailloux, Z., Leão, M., Becerra, T. A., Mori, A. B., Soechting, E., Roley, S. S., Buss, N., & Cermak, S. A. (2014). Modification of the postrotary nystagmus test for evaluating young children. American Journal of Occupational Therapy, 68, 514-521. doi:10.5014/ajot.2014.011031. Link to full text Abstract →
This article explores the use of the postrotary nystagmus (PRN) test for children younger than current norms (children 4.0 yr-8.11 yr). In the first study, 37 children ages 4-9 yr were examined in the standard testing position and in an adult-held adapted position to determine whether holding a child affected the reflex. Because the position did not affect the reflex, in the second study, PRN in 44 children ages 2 mo-47 mo was compared with published normative mean raw scores for 44 children age 5 yr to determine whether norms for older children were applicable to younger children. No statistically significant differences were found between <4-yr-old and 5-yr-old children, suggesting that the PRN test can be used in infants and toddlers with valid comparison to current norms for 4-yr-olds on the Sensory Integration and Praxis Tests (4.0 yr-8.11 yr). Future research exploring the predictive value of this measure is warranted.
Cermak, S. A., & Bissell, J. (2014). Content and construct validity of Here’s How I Write (HHIW): A Child’s Self-Assessment and Goal Setting Tool. American Journal of Occupational Therapy, 68, 296-306. doi:10.5014/ajot.2014.010637. Link to full text Abstract →
OBJECTIVE: We examined content and construct validity of Here’s How I Write: A Child’s Self-Assessment and Goal Setting Tool, to assess children’s perception of their handwriting and set child-directed goals.
METHOD: In Study 1, a content validity study, 6 occupational therapists and 2 educators assessed the need for this type of measure and examined the proposed items. Thirty-four occupational therapists and educators then completed an online survey examining the items. Study 2, a construct validity study, compared the self-ratings of 20 children with poor handwriting and 20 children with good handwriting in Grades 2–5 with their teachers’ ratings.
RESULTS: Results supported test content and indicated freedom from culture and gender bias. The assessment discriminated between good and poor writers. The relationship between teacher and student ratings was significant, although teachers of poor writers rated the children lower than the children rated themselves.
CONCLUSION:These studies provide support for the tool’s validity.
PURPOSE: The purpose of this study was to investigate the relationship between sensory sensitivities and oral care difficulties in children with autism spectrum disorders (ASDs) or typical development (TD).
METHODS: Participants included 396 parents of 2- to 18-year-old children with ASDs or TD who completed a questionnaire about oral care in the home and dental office. Descriptive and bivariate analyses were conducted to examine the association between sensory sensitivities and oral care variables.
RESULTS: Both hypotheses were supported: (1) ASDs children vs. TD children were reported to have a significantly greater prevalence of sensory over-responsivity across all sensory domains; and (2) ASDs children characterized as "sensory over-responders" exhibited a significantly greater prevalence of oral care difficulty in the home and dental office vs. ASDs children who responded more typically to sensory stimuli ("sensory not over-responders").
CONCLUSIONS: This study provides further evidence for the impact of sensory processing problems on oral care, both in the home and dental office. Methods to best serve children with autism spectrum disorders may include strategies that alter the sensory characteristics of the dental environment as well as interventions to reduce children's sensory sensitivities.
Bandini, L. G., Gleason, J., Curtin, C., Lividini, K., Anderson, S. E., Cermak, S. A., Maslin, M., & Must, A. (2013). Comparison of physical activity between children with autism spectrum disorders and typically developing children. Autism: The International Journal of Research and Practice, 17, 44-54. doi:10.1177/1362361312437416. Link to full text Abstract →
Regular physical activity is important for promoting health and well-being; however, physical activity behaviors in children with autism spectrum disorders (ASD) have received little attention. We compared physical activity levels among 53 children with ASD and 58 typically developing children aged 3-11 years who participated in the Children's Activity and Meal Patterns Study (CHAMPS). After adjustment for age and sex the amount of time spent daily in moderate and vigorous activity was similar in children with ASD (50.0 minutes/day and typically developing children 57.1 minutes/day). However, parents reported that children with ASD participated in significantly fewer types of physical activities than did typically developing children (6.9 vs. 9.6, p <.0001) and spent less time annually participating in these activities than typically developing children (158 vs. 225 hours per year, p < 0.0001) after adjusting for age and sex. Although both groups of children engaged in similar levels of moderate and vigorous activity as measured by accelerometry, children with ASD engaged in fewer physical activities and for less time according to parental report, suggesting that some of the activity in children with ASD is not captured by standard questionnaire-based measures.
Peterson, E., Stein, L., & Cermak, S. A. (2013). Helping children with autism spectrum disorders participate in oral care. Sensory Integration Special Interest Section Quarterly, 36(3), 1-4. Link to full text
Katz, E. R., Cermak, S., Kertesz, H. A., Meeske, K., Ruccione, K., Mellon, L., & Engelman, L. (2013). Activity preferences, engagement and quality of life in children and adolescents with acute lymphoblastic leukemia. International Journal of Child Health and Human Development, 6, 475.
Foran, A. C., & Cermak, S. A. (2013). Active and traditional videogame ownership and play patterns among youths with autism spectrum disorders & relationships to physical activity. Palaestra, 27(1), 42-48. Link to full text
Foran, A., Cermak, S. A., & Spruijt-Metz, D. (2013). Psychosocial determinants of participation in moderate-to-vigorous physical activity among Hispanic and Latina middle school-aged girls. Hispanic Health Care International, 11, 142-148. doi:10.1891/1540-4188.8.131.52. Link to full text Abstract →
Abstract: We examined physical activity (PA)–related psychosocial factors, weight status, and self-reported participation in moderate-to-vigorous physical activity (MVPA) in Latina middle school-aged girls. Baseline data from a middle school–based health behavior study ( = 326) was used. Contrasting activity-level groups were identified (81 most active, 144 least active) and compared. More active girls had significantly greater social support for PA, motivation to exercise, and positive meanings of PA than their less active peers. There was no significant difference in body mass index (BMI) percentile, barriers to PA, or negative meanings of PA between groups. Less active girls reported more screen time activities than the highly active girls. Positive psychosocial factors may be predictive of participation in MVPA for middle school-aged Latina youth. However, BMI may not be directly related to PA participation in this population.
Spanish: Se examinaron los factores psicosociales relacionados con: actividad física, peso y auto reporte de actividad física moderada a vigorosa en niñas latinas en enseñanza secundaria. Los datos basales se obtuvieron de un estudio sobre la relación entre el comportamiento y la salud en niñas de la misma edad (N = 326). Los grupos se identificaron de acuerdo al nivel de actividad física (81 más activos y 144 menos activos) y comparados.
Las niñas latinas más activas tenían niveles significativamente más altos de apoyo social para realizar actividad física, mayor motivación para realizar ejercicio, y tenían un pensamiento positivo sobre la realización de actividad física en comparación con sus compañeras menos activas. No hubo diferencias significativas entre los grupos en cuanto al Indice de Masa Corporal (IMC), barreras para realizar actividad física o pensamiento negativo sobre la realización de actividad física. Las niñas en el grupo menos activo reportaron: pasar más tiempo mirando televisión, jugando juegos de video o computadora en comparación con las niñas muy activas.
Los factores psicosociales positivos pueden ser predictores de la actividad física moderada a vigorosa en niñas Latinas en enseñanza secundaria. Sin embargo, el IMC no está directamente relacionado con la realización de actividad física en esta población.
Stein, L. I., Polido, J. C., & Cermak, S. A. (2012). Oral care and sensory concerns in autism [Brief report]. American Journal of Occupational Therapy, 66, e73-e76. doi:10.5014/ajot.2012.004085. Link to full text Abstract →
We examined sensory-related aspects of oral care at home and the dentist’s office in children with autism spectrum disorders (ASD) and their typically developing (TD) peers. Results from parent questionnaires (n = 196 ASD, n = 202 TD) and one focus group were analyzed to determine whether sensory experiences were different between groups. Significantly more parents of children with ASD reported difficulties with sensory-related oral care variables in the home and dental office; this finding was supported by qualitative data. Using sensory strategies to modify the environment may enhance the dental experience and improve quality of life for children with ASD and their families.
Stein, L. I., Polido, J. C., Najera, S. O., & Cermak, S. A. (2012). Oral care experiences and challenges in children with autism spectrum disorders. Pediatric Dentistry, 34, 387-391. Link to full text Abstract →
PURPOSE: The purpose of this study was to investigate the differences between children with autism spectrum disorders (ASD) and their typically developing peers in relation to aspects of oral care.
METHODS: Participants included 396 parents of ASD children or typically developing 2- to 18-year-olds. Parents completed a 37-item questionnaire designed by authors to elicit information about oral care in the home and dental office. Descriptive, bivariate, and multivariate regression analyses were conducted to examine the association between diagnostic group and oral care variables.
RESULTS: Significantly more parents of ASD children than parents of typically developing children reported difficulty across almost all oral care variables explored, including oral care in the home, oral care at the dentist, and access to oral care. Following multivariate regression to control for possible confounders—including age, gender, Hispanic status, and paternal education level—all previously significant variables remained significant.
CONCLUSION: This study indicates that children with autism spectrum disorders experience greater difficulties and barriers to care in both the home and dental office settings than their typically developing peers.
Stein, L. I., Foran, A. C., & Cermak, S. A. (2011). Occupational patterns of parents of children with autism spectrum disorders: Revisiting Matuska and Christiansen’s Model of Lifestyle Balance. Journal of Occupational Science, 18, 115-130. doi:10.1080/14427591.2011.575762. Link to full text Abstract →
We synthesized selected literature from psychology, neuroscience, occupational therapy, nursing, and other fields regarding parents of children with ASD and utilized Matuska and Christiansen's Model of Lifestyle Balance to organize the literature to present a theoretically grounded and occupation-based picture of the life experiences of parents of children with ASD. In doing so, we discerned a complex relationship among the five dimensions suggested by Matuska and Christiansen, prompting a refinement of their model to address this complexity. Overall, a variety of factors associated with caring for children with ASD have the potential to cause or contribute to negative psychological consequences such as stress, anxiety, and depression, as well as functional limitations and other health problems such as hypertension or diabetes. In order to promote health and general well-being, lifestyle changes to enhance balance may be necessary for many parents of children with ASD.
Tseng, M. H., Fu, C. P., Cermak, S. A., Lu, L., & Shieh, J. Y. (2011). Emotional and behavioral problems in preschool children with autism: Relationship with sensory processing dysfunction. Research in Autism Spectrum Disorders, 5, 1441-1450. doi:10.1016/j.rasd.2011.02.004. Link to full text Abstract →
This study aimed to investigate the sensory processing (SP) dysfunction and emotional and behavioral problems in preschool children with autism and then examine the relationship between the SP dysfunction and emotional and behavioral problems. The parents of 112 children aged 48–84 months (67 with autism; 45 age-matched typically developing) completed a demographic questionnaire, the Child Behavior Checklist-Chinese version (CBCL-C), and the Sensory Profile-Chinese version (SP-C). We found that 95.8% of children with autism who showed significant internalizing problems had at least one SP quadrant in the definite difference range, while 81.8% with significant externalizing problems had at least one SP quadrant in the definite difference range. Typically developing children showed lower percentages of 66.7% and 40.0%. Stepwise linear regression analysis revealed that in children with autism, avoiding and male gender were significant predictors of internalizing problems and sensitivity was a significant predictor of externalizing problems. In contrast, in typically developing children, avoiding was a significant predictor of internalizing problems and seeking was a significant predictor of externalizing problems. This study provided further understanding of the factors influencing emotional and behavioral problems in autism.
Mailloux, Z., Mulligan, S., Smith Roley, S., Blanche, E. J., Cermak, S. A., Coleman, G. G., Bodison, S., & Lane, C. J. (2011). Verification and clarification of patterns of sensory integrative dysfunction. American Journal of Occupational Therapy, 65, 143-151. doi:10.5014/ajot.2011.000752. Link to full text Abstract →
Building on established relationships between the constructs of sensory integration in typical and special needs populations, in this retrospective study we examined patterns of sensory integrative dysfunction in 273 children ages 4–9 who had received occupational therapy evaluations in two private practice settings. Test results on the Sensory Integration and Praxis Tests, portions of the Sensory Processing Measure representing tactile overresponsiveness, and parent report of attention and activity level were included in the analyses. Exploratory factor analysis identified patterns similar to those found in early studies by Ayres (1965, 1966a, 1966b, 1969, 1972b, 1977, & 1989), namely Visuodyspraxia and Somatodyspraxia, Vestibular and Proprioceptive Bilateral Integration and Sequencing, Tactile and Visual Discrimination, and Tactile Defensiveness and Attention. Findings reinforce associations between constructs of sensory integration and assist with understanding sensory integration disorders that may affect childhood occupation. Limitations include the potential for subjective interpretation in factor analysis and inability to adjust measures available in charts in a retrospective research.
Stein, L. I., Polido, J. C., Mailloux, Z., Coleman, G. G., & Cermak, S. A. (2011). Oral care and sensory sensitivities in children with autism spectrum disorders. Special Care in Dentistry, 31, 102-110. doi:10.1111/j.1754-4505.2011.00187.x. Link to full text Abstract →
Children with autism spectrum disorders (ASD) are at high risk for oral disease. The aim of this study was to examine the contribution of sensory processing problems to challenges in receiving oral care for children with ASD. A questionnaire was sent to the parents of 206 children with disabilities to test the hypotheses that children with ASD, relative to children with other disabilities, experience greater difficulty with home-based and professional oral care, and that these difficulties may relate in part to sensory processing problems. The results partially supported these hypotheses. Compared to children with other disabilities, those with ASD had greater behavioral difficulties and sensory sensitivities that parents believed interfered with their child's oral care. Among children with ASD, sensory sensitivities were associated with oral care difficulties in the home and dental office, and with behavioral difficulties in the dental office. Utilizing strategies to modify the sensory environment may help facilitate oral care in children with ASD.
Daunhauer, L. A., Coster, W. J., Tickle-Degnen, L., & Cermak, S. A. (2010). Play and cognition among young children reared in an institution. Physical and Occupational Therapy in Pediatrics, 30(2), 83-97. doi:10.3109/01942630903543682. Link to full text Abstract →
The relationship between cognitive functioning and play behaviors of children residing in an orphanage was examined. Twenty-six young children (15 boys) between 10 and 38 months of age participated. More developmentally competent play behaviors were highly related to better performance on cognitive functioning as measured by the Bayley Scales of Infant Development (r = .78, p < or = .01). The participants' play behaviors were less competent compared to previous data for children of the same chronological age living at home on four out of five levels of symbolic play (p < or = .05). However, when compared to data for children living at home with similar cognitive development, the participants demonstrated no significant differences in symbolic play (p > or =.05). The findings suggest that the relationship between thinking and playing is robust, even in an institutional environment. Additionally, practitioners assessing children from institutions who cannot engage in standardized testing may consider observing play behaviors to make an initial estimate of developmental status.
Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238-246. doi:10.1016/j.jada.2009.10.032. Link to full text Abstract →
Autism spectrum disorders comprise a complex set of related developmental disorders that are characterized by impairments in communication, social interaction, and repetitive behaviors. Impairments in sensory processing are also extremely common. The prevalence of autism spectrum disorders is increasing and is currently estimated to affect 1 in 150 children. Autism spectrum disorders are considered to be a major health and educational problem, affecting many areas of daily living, including eating. Children with autism spectrum disorders are often described as picky or selective eaters. This article provides a comprehensive narrative review of the empirical literature over the last 25 years on food selectivity and nutritional adequacy in children with autism spectrum disorders. The possible contributions of sensory factors, such as sensory sensitivity, to food selectivity are discussed. The need for an interdisciplinary approach to managing atypical eating patterns in children with autism spectrum disorders is highlighted.
Bandini, L. G., Anderson, S. E., Curtin, C., Cermak, S. A., Evans, E. W., Scampini, R., Maslin, M., & Must, A. (2010). Food selectivity in children with autism spectrum disorders and typically developing children. The Journal of Pediatrics, 157, 259-264. doi:10.1016/j.jpeds.2010.02.013. Link to full text Abstract →
OBJECTIVES: To define food selectivity and compare indices of food selectivity among children with autism spectrum disorders (ASDs) and typically developing children, and to assess the impact of food selectivity on nutrient adequacy.
STUDY DESIGN: Food selectivity was operationalized to include food refusal, limited food repertoire, and high-frequency single food intake using a modified food frequency questionnaire and a 3-day food record. Food selectivity was compared between 53 children with ASDs and 58 typically developing children age 3-11 years. Nutrient adequacy was assessed relative to the dietary reference intakes.
RESULTS: The children with ASDs exhibited more food refusal than typically developing children (41.7% of foods offered vs 18.9% of foods offered; p <.0001). They also had a more limited food repertoire (19.0 foods vs 22.5 foods; p <.001). Only 4 children with ASDs and 1 typically developing child demonstrated high-frequency single food intake. Children with a more limited food repertoire had inadequate intake of a greater number of nutrients.
CONCLUSIONS: Our findings suggest that food selectivity is more common in children with ASDs than in typically developing children, and that a limited food repertoire may be associated with nutrient inadequacies.
Ben-Sasson, A., Simmell, K. E., & Cermak, S. A. (2009). Sequence of gestural representations in children with high functioning autism. Israeli Journal of Occupational Therapy, 8(4), E57-E73. Abstract →
There is controversy as to whether gestural representation deficits in autism spectrum disorders reflect a language or/and a motor-based deficit. In this study children with high functioning autism (HFA, n=26), children with language impairment (LI, n=24), and typically developing children (n=30) demonstrated and described tooth brushing. Children with HFA showed a significantly lower level of gestural representation compared to the typical group but did not differ from LI group, and demonstrated significantly fewer recognizable actions within tooth brushing than both comparison groups but did not differ in the number of steps they described. The lower gestural representation level in both clinical groups may reflect a symbolic representation impairment, while the specific difficulties of children with HFA in presenting an elaborate and accurate sequence of motor actions may more closely reflect dyspraxia. The planning and initiation of motor actions allow us to communicate our needs, feelings, and thoughts through gestures. Specifically, gestural representation enables us to remember skill steps for future use and enact them. Gestural representation refers to the ability to demonstrate a familiar action of tool use in absence of the object of the action, otherwise called pantomime (Green et al., 2002; Hill, Bishop, & Nimmo-Smith, 1998). Children with autism spectrum disorders (ASDs) often show difficulties in producing meaningful gestures compared to typically developing children (Green et al.; Smith & Bryson, 2007), particularly in demonstrating gestures of object-use.
Toglia, J., & Cermak, S. A. (2009). Dynamic assessment and prediction of learning potential in clients with unilateral neglect. American Journal of Occupational Therapy, 63, 569-579. doi:10.5014/ajot.63.5.569. Link to full text Abstract →
OBJECTIVE: We investigated the application of dynamic assessment in examining learning potential for adults with right hemisphere stroke and unilateral neglect.
METHODS: Forty adults with right cerebrovascular accident were randomly assigned to a control or dynamic group. Both groups were administered standard pretests and posttests of unilateral neglect. The dynamic group received cues, strategy training, and feedback during an object search task.
RESULTS: Multivariate analysis of covariance indicated significant differences between groups on the object search task, with reduced unilateral neglect in the dynamic group. Greater initiation of left-sided search, strategy use, and near and intermediate transfer of learning were observed in the dynamic group.
CONCLUSIONS: The brief dynamic assessment, developed for this study, provided an opportunity to observe the client's ability to incorporate strategy training and feedback across visual search tasks. This assessment approach has the potential to characterize learning profiles and to guide intervention decisions.
Chen, Y. W., Tseng, M. H., Hu, F. C., & Cermak, S. A. (2009). Psychological adjustment and attention in children with developmental coordination disorder using different motor tests. Research in Developmental Disabilities, 30, 1367-1377. doi:10.1016/j.ridd.2009.06.004. Link to full text Abstract →
This study examined the consistency between the findings of developmental coordination disorder (DCD) as identified by the Bruininks–Oseretsky Test of Motor Proficiency (BOTMP) and the Movement Assessment Battery for Children (MABC), and explored the psychosocial and attention characteristics of children with DCD identified by the two motor tests, respectively. Participants were 270 children (male: 161, female: 109; age 7.74 ± 0.81 years). The association between DCD status identified by each of the motor tests and psychosocial problems measured by the Child Behavioral Checklist-Chinese version (CBCL-C) was examined using multiple logistic regressions. The results showed that DCD identified by the BOTMP was associated with high scores on the Withdrawn and Social Problems, with a higher proportion of females identified. DCD identified by the MABC was associated with high scores on the Withdrawn and Attention Problems and low score on the Aggressive Behavior. The results reaffirmed the lack of consistency between the motor tests and indicated that children identified by the two motor tests showed different profiles of attention and psychosocial adjustment.
Cermak, S. A. (2009). Deprivation and sensory processing in institutionalized and postinstitutionalized children: Part II. Sensory Integration Special Interest Section Quarterly, 32(3), 1-4. Link to full text Abstract →
Part I of this article (Cermak, 2009) reviewed research on the effects of institutionalization and deprivation on sensory processing. Part II examines possible contributing mechanisms to institutional deprivation and discusses implications for intervention.
Chen, Y. W., Tseng, M. H., Hu, F. C., & Cermak, S. A. (2009). Psychosocial adjustment and attention in children with developmental coordination disorder using different motor tests. Research in Developmental Disabilities, 30, 1367-1377. doi: 10.1016/j.ridd.2009.06.004. Link to full text Abstract →
This study examined the consistency between the findings of developmental coordination disorder (DCD) as identified by the Bruininks–Oseretsky Test of Motor Proficiency (BOTMP) and the Movement Assessment Battery for Children (MABC), and explored the psychosocial and attention characteristics of children with DCD identified by the two motor tests, respectively. Participants were 270 children (male: 161, female: 109; age 7.74 ± 0.81 years). The association between DCD status identified by each of the motor tests and psychosocial problems measured by the Child Behavioral Checklist-Chinese version (CBCL-C) was examined using multiple logistic regressions. The results showed that DCD identified by the BOTMP was associated with high scores on the Withdrawn and Social Problems, with a higher proportion of females identified. DCD identified by the MABC was associated with high scores on the Withdrawn and Attention Problems and low score on the Aggressive Behavior. The results reaffirmed the lack of consistency between the motor tests and indicated that children identified by the two motor tests showed different profiles of attention and psychosocial adjustment.
Cermak, S. A. (2009). Deprivation and sensory processing in institutionalized and postinstitutionalized children: Part I. Sensory Integration Special Interest Section Quarterly, 32(2), 1-3. Link to full text Abstract →
The damaging effects of institutionalization in young children have been known for many years (Bowlby, 1951; Casler, 1961; Goldfarb, 1945; Provence & Lipton, 1962). Literature has described cognitive and developmental concerns as well as emotional and behavioral issues in children who have experienced institutionalization (Beckett et al., 2007; Colvert et al., 2008; Gunnar, van Dulmen, & the International Adoption Project Team, 2007; Johnson, Browne, & Hamilton-Giachritsis, 2006). Most studies report that children who have experienced greater lengths of institutionalization have a higher prevalence and degree of developmental delays and emotional and behavioral concerns than children who spend little to no time in institutions (Ames, 1997; Gunnar et al., 2007; Kadlec & Cermak, 2002; Lin, 2003; Marcovitch et al., 1995). Part I of this article reviews research on the effects of institutionalization and deprivation on sensory processing. Part II (Cermak, in press) will examine possible contributing mechanisms and discuss implications for intervention.
Ben-Sasson, A., Hen, L., Fluss, R., Cermak, S. A., Engel-Yeger, B., & Gal, E. (2009). A meta-analysis of sensory modulation symptoms in individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders, 39(1), 1-11. doi:10.1007/s10803-008-0593-3. Link to full text Abstract →
Sensory modulation symptoms are common in persons with autism spectrum disorders (ASD); however have a heterogeneous presentation. Results from 14 studies indicated a significant high difference between ASD and typical groups in the presence/frequency of sensory symptoms, with the greatest difference in under-responsivity, followed by over-responsivity and sensation seeking. Three moderators that reduced the variability in findings among studies were: chronological age, severity of autism, and type of control group. Sensory differences were highest for studies of children ages 6-9 years, samples with more than 80% with an autism diagnosis, and compared to a CA matched versus a MA or DD matched group. It is important to consider these moderators in the design of studies and interventions addressing sensory symptoms.
Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Tager-Flusberg, H., Kadlec, M. B., & Carter, A. S. (2008). Sensory clusters of toddlers with autism spectrum disorders: Differences in affective symptoms. Journal of Child Psychology and Psychiatry, 49, 817-825. doi:10.1111/j.1469-7610.2008.01899.x. Link to full text Abstract →
BACKGROUND: Individuals with autism spectrum disorders (ASDs) show variability in their sensory behaviors. In this study we identified clusters of toddlers with ASDs who shared sensory profiles and examined differences in affective symptoms across these clusters.
METHOD: Using cluster analysis 170 toddlers with ASDs were grouped based on parent rating of the Infant Toddler Sensory Profile (Dunn, 2002) under-responsivity, over-responsivity, and seeking scales. Affective symptoms were evaluated with the Infant Toddler Social Emotional Assessment (Carter & Briggs-Gowan, 2005).
RESULTS: Three clusters were identified: (1) low frequency of sensory symptoms (n = 44); (2) high frequency of symptoms (n = 49); and (3) mixed (n = 77); high frequency of under-and over-responsivity and low frequency of seeking). Relative to the low frequency cluster, parents rated toddlers in the high frequency and mixed clusters (both characterized by high frequencies of sensory under- and over-responsivity) as higher on negative emotionality, depression, and anxiety symptoms. Sensory and affective differences among clusters remained after co-varying severity of ASD symptoms.
CONCLUSIONS: Interdisciplinary assessments are recommended for toddlers with ASDs in order to identify the interplay of sensory and affective symptoms.
Tirella, L. G., Chan, W., Cermak, S. A., Litvinova, A., Salas, K. C., & Miller, L. C. (2008). Time use in Russian Baby Homes. Child: Care, Health and Development, 34(1), 77-86. doi:10.1111/j.1365-2214.2007.00766.x. Link to full text Abstract →
BACKGROUND: We investigated time use of Russian children residing in Baby Homes to document their opportunities and experiences during institutional care.
METHODS: Time use of 138 non-special needs, randomly selected children (65 female vs. 73 male, age 1 month to 4 years) in Baby Homes in Murmansk, Russia, was analysed. Baby Home specialists were trained in time-use spot observation methodology. Each child was observed every 10 min for 5 h (31 observations/child; >4000 data points). At each observation, we coded: who the child was with, adult role, what the child was doing, location and vocalizations.
RESULTS: Children spent 50% of their time alone, 27% with a caregiver, 15% with another adult, and 7% with another child. Infants spent significantly more time alone (65%) than toddlers (43%) or pre-schoolers (46%) [F(2,133) = 13.05, P < 0.0001]. Caregivers supervised children (58%), led group activities (16%), cared for individuals (14%), or were absent from the room (12%). Children spent the most time (32%) in activities of daily living; remaining time was spent in meaningful play (27%), non-purposeful activity (16%) or sleep (18%). The percentage of time spent in meaningful play significantly increased across age groups [infants 10%, toddlers 25%, pre-schoolers 36%, F(2,133) = 26.9, P < 0.001]. Infants (23%) and toddlers (20%) spent significantly more time than the older group (10%) in non-purposeful activity [F(2,133) = 26.9, P < 0.001]. In 12% of observations, an adult was speaking to the child, in 10% to the group, and <1% to another adult. Child vocalizations varied by age: infants 42% of observations, toddlers 56%, and pre-schoolers 59%. Older children directed more vocalizations to adults than younger children [F(2,133) = 24.47, P < 0.001].
CONCLUSION: Time use of children residing in Baby Homes is limited by routinized schedules and care, at the expense of child-directed or interactive play with adults. Despite close proximity and living in group care, children's vocalizations and interactions with others are limited.
Daunhauer, L., Coster, W. J., Tickle-Degnen, L., & Cermak, S. A. (2007). Effects of caregiver-child interactions on play occupations among young children institutionalized in Eastern Europe. American Journal of Occupational Therapy, 61, 429-440. doi:10.5014/ajot.61.4.429. Link to full text Abstract →
OBJECTIVE: We investigated whether children institutionalized in an orphanage would engage in more developmentally competent play with their caregivers as opposed to playing alone and whether specific qualities of caregiver-child interactions were associated with more developmentally competent play.
METHOD: Twenty-six children, ages 10 to 38 months, participated in independent play sessions and in a play session with a caregiver. Interrater reliability for coding play performance was established using the weighted kappa statistic (M = .82). Twelve pediatric experts rated both child and caregiver behaviors for the interactive sessions (mean effective reliability with intraclass correlations = .89).
RESULTS: The children demonstrated more developmentally competent play when interacting with a caregiver than when playing alone, t (25) = -1.88, p < .04, one-tailed. The effect size was moderate (d = .53). Longer periods of institutionalization were associated with less improvement in play performance from independent to interactive play sessions (r = -.51, p < .01). Successful engagement for the child was associated with having a caregiver who provided more structure and assistance and who was directive and encouraging (r = .82, .75, .75, and .64, respectively).
CONCLUSION: Caregivers facilitated more developmentally competent participation in play with children residing in an orphanage, despite the fact that these interactions occurred in an environment vulnerable to many challenges not typical of an exclusive caregiver-child relationship. Findings are discussed in the context of environmental challenges and occupational therapy practice.
May-Benson, T. A., & Cermak, S. A. (2007). Development of an assessment of ideational praxis. American Journal of Occupational Therapy, 61, 148-153. doi:10.5014/ajot.61.2.148. Link to full text Abstract →
OBJECTIVE: This study developed an assessment of ideational praxis, examined its psychometric properties, and analyzed age and gender trends in children who were typically developing.
METHOD: Part 1 developed items and scoring criteria of the Test of Ideational Praxis (TIP) and examined interrater reliability and internal consistency. Part 2 studied performance of 80 typically developing children between ages 5 and 8 years.
RESULTS: The TIP demonstrated acceptable interrater reliability (ICC = .85) and internal consistency (coefficient alpha = .74). Children who were typically developing demonstrated age and gender trends. Girls scored higher than boys, and older children scored higher than younger children.
CONCLUSION: The TIP is the first objective assessment for identification of ideational abilities and is a reliable assessment tool. Further research is needed to validate the construct of ideation and examine the TIP's ability to discriminate between children with and without ideational difficulties.
Miller, L. C., Chan, W., Litvinova, A., Rubin, A., Tirella, L., & Cermak, S. A. (2007). Medical diagnoses and growth of children residing in Russian orphanages. Acta Paediatrica, 96, 1765-1769. doi:10.1111/j.1651-2227.2007.00537.x. Link to full text Abstract →
AIMS: Survey the health of young children residing in Russian orphanages.
METHODS: Retrospective chart review of all 193 'healthy' young children (105M:88F, age range 2-72 months) residing in orphanages in Murmansk, Russia.
RESULTS: Mothers of these institutionalized children had complex histories including chronic health problems (38%), use of tobacco (41%), alcohol (39%) and illicit drugs (7%). Frequent diagnoses of the children included rickets (21%), foetal alcohol syndrome (10%), anemia (6%), developmental delay (11% mild, 25% moderate, 28% severe), behavioural problems (60%) and 'perinatal encephalopathy' (46%<1 year of age). At orphanage entry, growth delays were common (underweight 34%, short stature 25%, microcephaly 34%). During orphanage residence, height z scores further decreased (p=0.01), but head circumference improved (p<0.0001, paired t-tests). Head circumferences increased significantly in 62% of microcephalic children. Smaller children (z score<-2) at entry exhibited more rapid growth (z score/month) for weight (+0.24 vs. -0.12, p=0.04), height (+0.81 vs. -0.65, p=0.0001), and head circumference (+1.02 vs. -0.10, p=0.0004). Growth correlated with child developmental status.
CONCLUSIONS: Young institutionalized children in Murmansk have complex medical status, social histories and frequent growth and developmental delays. Anthropometric measurements-particularly head circumference-improved during orphanage residence in children who entered with more severe growth delays.
Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Carter, A. S., & Fogg, L. (2007). Can we differentiate sensory over-responsivity from anxiety in toddlers? Perspectives of occupational therapists and psychologists. Infant Mental Health Journal, 28, 536-558. doi:10.1002/imhj.20152. Link to full text Abstract →
Suppose a toddler becomes distressed after hearing a loud noise or when getting messy; are these indicators of sensory over-responsiveness or indicators of anxiety? There is little evidence regarding the distinction between sensory over-responsivity and anxiety disorders in toddlers. This construct validity study examined differences between occupational therapists' and psychologists' judgments of behaviors as representing sensory processing disorders (SPD) versus anxiety disorders. Twenty-four occupational therapists and 25 psychologists completed a mailed survey, rating items from sensory and anxiety scales as representing sensory and/or anxiety disorders in toddlers, and analyzing cases of toddlers with these disorders. Occupational therapists were more likely to rate items as representing SPD than psychologists, and occupational therapists were more certain of the distinction of the sensory scales from anxiety. For the case designed to present a general anxiety disorder and the one designed to present sensory over-responsivity, more occupational therapists diagnosed as sensory over-responsive, while more psychologists diagnosed with a general anxiety disorder. The overlap in judgments of sensory over-responsivity and anxiety supports the notion that these constructs in part reflect different professionals' perspectives upon behaviors as well as the difficulty in distinguishing these constructs in toddlers.
Miller, L. J., Anzalone, M. E., Lane, S. J., Cermak, S. A., & Osten, E. T. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis [From the guest editor]. American Journal of Occupational Therapy, 61, 135-140. doi:10.5014/ajot.61.2.135. Link to full text Abstract →
Sensory integration is a long-standing and growing area of practice in occupational therapy. Debate and discussion with colleagues have led us to develop a proposed taxonomy reflecting a new classification scheme to enhance diagnostic specificity. The nosology proposed here is rooted in empirical data first published by Ayres that has evolved based on empirical and theoretical information. This new nosology provides a viewpoint for discussion and research.
Ben-Sasson, A., Cermak, S. A., Orsmond, G. I., Tager-Flusberg, H., Carter, A. S., Kadlec, M. B., & Dunn, W. (2007). Extreme sensory processing behaviors in toddlers with autism spectrum disorders. American Journal of Occupational Therapy, 61, 584-592. doi:10.5014/ajot.61.5.584. Link to full text Abstract →
This study examined the incidence of extreme sensory modulation behaviors in toddlers with autism spectrum disorders (ASD) and investigated the consistency of sensory information across measures. Parent report of sensory behaviors in 101 toddlers with ASD was compared with 100 toddlers who were typically developing matched on chronological age and 99 additional infants or toddlers matched on mental age. Measures included the Infant/Toddler Sensory Profile, Infant-Toddler Social Emotional Assessment, Autism Diagnostic Interview-Revised, and Autism Diagnostic Observation Schedule-Generic. Toddlers with ASD were most distinct from typically developing groups in their high frequency of underresponsiveness and avoiding behaviors and their low frequency of seeking. Within the toddlers with ASD, there were significant associations across sensory parent report measures, but parent report was not correlated with clinical observation. Findings point to the early onset of an extreme sensory profile in ASD. Occupational therapists need to assess multiple domains of sensory behaviors to accurately identify the needs of toddlers with ASD.
Miller, L. C., Chan, W., Litvinova, A., Rubin, A., Comfort, K., Tirella, L., Cermak, S. A., Morse, B., Kovalev, I., & oston-Murmansk Orphanage Research Team, B. (2006). Fetal alcohol spectrum disorders in children residing in Russian orphanages: A phenotypic study. Alcoholism: Clinical and Experimental Research, 30, 531-538. doi:10.1111/j.1530-0277.2006.00059.x. Link to full text Abstract →
BACKGROUND: Alcohol use in Russia is among the highest in the world. Over 600,000 children reside in institutional care in Russia, most of them in baby homes and orphanages. The actual prevalence of fetal alcohol spectrum disorders (FASD) among these children is unknown. Therefore, we performed a systematic survey of phenotypic features associated with prenatal alcohol exposure among institutionalized Russian children and related these findings to their growth, development, medical, and social histories.
METHODS: Phenotypic screening was conducted of all 234 baby home residents in the Murmansk region of Russia (mean age 21+12.6 months). Phenotypic expression scores were devised based on facial dysmorphology and other readily observable physical findings. Growth measurements from birth, time of placement in the baby home, and at present were analyzed. In addition, the charts of 64% of the children were randomly selected for retrospective review. Information collected included maternal, medical, developmental, and social histories.
RESULTS: Thirteen percent of children had facial phenotype scores highly compatible with prenatal alcohol exposure and 45% had intermediate facial phenotype scores. These scores correlated with maternal gravidity and age. At least 40% of mothers in whom history was available ingested alcohol during pregnancy; some also used illicit drugs and tobacco. Z scores for growth measurements corresponded to phenotypic score, as did the degree of developmental delay. Children with no or mild delay had significantly lower phenotypic scores than those with moderate or severe delay (p = 0.04); more than 70% of children with high phenotypic scores were moderately or severely delayed.
CONCLUSIONS: More than half of residents of the baby homes in Murmansk, Russia, have intermediate (45%) or high (13%) phenotypic expression scores suggesting prenatal exposure to alcohol. Despite good physical care, stable daily routine, availability of well-trained specialists, and access to medical care, these vulnerable children show significant growth and developmental delays compared with their institutionalized peers.
Lin, S. H., Cermak, S. A., Coster, W. J., & Miller, L. (2005). The relation between length of institutionalization and sensory integration in children adopted from Eastern Europe. American Journal of Occupational Therapy, 59, 139-147. doi:10.5014/ajot.59.2.139. Link to full text Abstract →
OBJECTIVE: To examine the relation between length of institutionalization and sensory integration in children adopted from Eastern Europe.
METHOD: The Sensory Integration and Praxis Tests (SIPT) and the Developmental and Sensory Processing Questionnaire were administered to 60 adopted children, 4 years to 8 years, 11 months of age. Thirty had longer institutionalization histories (mean: 34 months; LIH group) and the other 30 had shorter institutionalization histories (mean: 3 months; SIH group).
RESULTS: The LIH group demonstrated significantly lower scores than the SIH group on the SIPT in vestibular-proprioceptive, visual, and praxis areas, and effect sizes ranged from .09 to 1.13. The LIH group also had significantly more frequent behaviors suggestive of sensory modulation dysfunction compared to the SIH group, particularly in touch and movement seeking, vision, and audition. Effect sizes ranged from 0 to 1.39.
CONCLUSION: Longer lengths of institutionalization are associated with more atypical sensory discrimination, praxis, and sensory modulation scores in children adopted from Eastern European orphanages. The areas of sensory integration that appear to be more vulnerable to deprived conditions in early childhood are vestibular-proprioceptive, tactile, visual, auditory, and praxis. Adopted children with lengthy periods of institutionalization may benefit from occupational therapy for early sensory integrative and developmental screenings.
Marr, D., Cermak, S. A., Cohn, E. S., & Henderson, A. (2003). Fine motor activities in Head Start and kindergarten classrooms. American Journal of Occupational Therapy, 57, 550-557. doi:10.5014/ajot.57.5.550. Link to full text Abstract →
OBJECTIVE: The purpose of this study was to describe and compare the fine motor activities in Head Start and kindergarten classrooms in order to open a dialogue between the two contexts about the fine motor activities children in preschool will face in kindergarten.
METHODS: Children in 10 Head Start and 10 kindergarten classrooms were observed for 1 day each. Time spent in activities was categorized into four groups: fine motor activities with no academic purpose, fine motor activities with academic purpose, academic activities with no fine motor component, and nonacademic activities with no fine motor component. Percentages of time were calculated and t tests were used for comparison between contexts.
RESULTS: Children in Head Start spent 27%-46% (mean of 37%) of the in-class day in all fine motor activities whereas children in kindergarten spent 36%-66% (mean of 46%). For children in kindergarten, 42% of total fine motor activity time involved paper and pencil activities. In contrast, children in Head Start spent 10% of total fine motor activity time in paper and pencil activities.
CONCLUSION: The higher mean percent of time spent in fine motor activities in kindergarten classrooms suggests a developmentally appropriate increase in fine motor demands. The percent of paper and pencil activity time the children engaged in substantially increased from Head Start to kindergarten. The findings describe a difference between the two environments, informing Head Start of the fine motor demands their graduates face in kindergarten.
Marr, D., & Cermak, S. A. (2003). Consistency of handwriting in early elementary students. American Journal of Occupational Therapy, 57, 161-167. doi:10.5014/ajot.57.2.161. Link to full text Abstract →
OBJECTIVE: The purpose of this longitudinal study was to examine the consistency of handwriting in children from the beginning of kindergarten to the middle of the first-grade year. Consistency was defined as retaining the same qualitative performance and relative ranking over time.
METHOD: Ninety-three children were tested at the beginning of the kindergarten year and again in the middle of the first-grade year on the Scale of Children's Readiness In PrinTing (SCRIPT). Data were analyzed with a repeated measures analysis of variance (ANOVA) (3 performance groups [lower, middle, upper] x 2 grades) followed by a Tukey's HSD post hoc analysis. An analysis of the change in performance of individual children also was conducted.
RESULTS: The main effects and the interaction in the ANOVA were significant. Post hoc analysis for grade demonstrated that both the middle and the lower performing groups showed a significant improvement from kindergarten to first grade, whereas the upper performing group remained unchanged. Post hoc analysis found significant differences among all three performance groups in kindergarten. In first grade, the lower performing group continued to score significantly lower than the middle and upper performing groups, whereas the middle and upper performing groups were not significantly different. Analysis of individual data revealed that 60% of the students were consistent in their performance from kindergarten to first grade.
CONCLUSION: The correlation between kindergarten SCRIPT scores and first-grade SCRIPT scores provides initial evidence that a moderately consistent pattern of handwriting performance exists. Students with low- and middle-ranked handwriting skills show relatively similar improvement over time, whereas change for students ranked high is limited.
Marr, D., & Cermak, S. A. (2002). Predicting handwriting performance of early elementary students with the Developmental Test of Visual-Motor Integration. Perceptual & Motor Skills, 95, 661-669. doi:10.2466/pms.2002.95.2.661. Link to full text Abstract →
The purpose of this study was to examine use of the Developmental Test of Visual-Motor Integration in predicting handwriting performance of early elementary students and the contribution of sex. An additional purpose was to examine whether successful completion of the first nine figures or the oblique cross from the test predicted handwriting. 101 children were tested at the beginning of their kindergarten year and again in the middle of the first-grade year on the Scale of Children's Readiness In PrinTing (SCRIPT). The VMI kindergarten scores did not significantly predict first-grade SCRIPT scores for the sample as a whole. When boys and girls were considered separately. VMI scores predicted handwriting SCRIPT scores for girls, but accounted for only 10% of the variance. Successful performance on the first nine VMI figures was significantly associated with handwriting for girls but not boys, while the oblique cross did not significantly predict handwriting performance. These results do not provide clear support for administration of the Developmental Test of Visual-Motor Integration during kindergarten as a tool to identify children at risk for handwriting difficulties.
Cohn, E. S., & Cermak, S. A. (1998). Including the family perspective in sensory integration outcomes research. American Journal of Occupational Therapy, 52, 540-546. doi:10.5014/ajot.52.7.540. Link to full text Abstract →
Occupational therapy, along with other health and rehabilitation professions, is experiencing an increased emphasis on measurement of intervention outcomes. The results of outcomes research are being used to develop practice guidelines, set standards for reimbursement, and justify health care policy. The outcome assessments used by therapists reflect our belief systems and the assumptions about behaviors we expect to influence. Using a sensory integration perspective to illustrate key points, we present a conceptual framework that is based on the disablement framework and Coster's occupational functioning for children model. We highlight the need to examine each of the multiple levels at which intervention may influence child and family function and the links among levels. Sensory integration theory and efficacy studies are reviewed to identify assumptions relative to how sensory integration affects the everyday occupations of children in the context of their families. Potential research methods and assessments are suggested to include the family perspective in outcome studies.
Katz, N., Cermak, S. A., & Shamir, Y. (1998). Unilateral neglect in children with hemiplegic cerebral palsy. Perceptual & Motor Skills, 86, 539-550. doi:10.2466/pms.19184.108.40.2069. Link to full text Abstract →
The purpose of this study was to examine the pattern of attentional deficits in children with right and left hemiplegic cerebral palsy. Unilateral neglect and visuospatial deficits are common findings following right brain injury in adults. It has been suggested by some that children may show a similar pattern. Children were tested on several paper-and-pencil measures of neglect. It was hypothesized that (a) on the left side of the page, children with left hemiplegia (right hemispheric damage) will score significantly lower than both the control group and the right hemiplegia group and (b) on the right side of the page, there will be no significant difference between the control group and the right and left hemiplegic groups. Participants included 32 children with cerebral palsy, 15 with left hemiplegia, 17 with right hemiplegia, and 32 matched controls. The ages ranged from 5 years 10 months to 12 years 6 months; all had normal intelligence. Inventories included 3 subtests of the Conventional part of the Behavioral Inattention Test, the Mesulam Symbol Cancellations tests, and the Rey Osterrieth Complex Figure, copy and recall. Analysis indicated that children with left hemiplegia scored significantly more poorly than controls on seven of the eight measures on the left side of the page, but they did not consistently score more poorly than children with right hemiplegia. Moreover, the poorer performance of the children with left hemiplegia was not specific only to the left side of the page; they also scored significantly lower than the controls on five of the eight measures on the right side. These findings suggest that children with left hemiplegia may have relatively greater attentional and perceptual problems than children with right hemiplegia, but they do not clearly indicate a left unilateral neglect. Results also indicate that children with right hemiplegia have attentional and perceptual problems relative to controls, particularly on the more complex tasks of high demand.
Cermak, S. A., & Daunhauer, L. (1997). Sensory processing in the postinstitutionalized child. American Journal of Occupational Therapy, 51, 500-507. doi:10.5014/ajot.51.7.500. Link to full text Abstract →
OBJECTIVE: The purpose of this study was to examine whether children adopted from Romanian orphanages have difficulty with sensory processing and related behaviors.
METHOD: Seventy-three children adopted from Romanian orphanages were compared with 72 peers who were typically developing. The subjects' ages ranged from 3 to 6 years. The parent-report Developmental and Sensory Processing Questionnaire was used to assess sensory processing and related behaviors. The tool consists of questions in six sensory processing domains and five related behavioral domains.
RESULTS: Multiple t tests indicated that the subjects adopted from Romanian orphanages demonstrated significantly greater problems than those in the control group on five of the six sensory processing domains: touch, movement-avoids, movement-seeks, vision, and audition. Additionally, the Romanian subjects exhibited significantly greater problems than the control subjects on four of the five behavioral domains: activity level, feeding, organization, and social-emotional.
CONCLUSIONS: These findings substantiate clinical observations and parent reports of sensory processing deficits in children adopted from Romanian orphanages and highlight the critical importance of the environment for sensory integration. The findings also enhance our understanding of how children who were previously institutionalized respond to the human and physical environment.
Katz, N., Champagne, D., & Cermak, S. A. (1997). Comparison of the performance of younger and older adults on three versions of a puzzle reproduction task. American Journal of Occupational Therapy, 51, 562-568. doi:10.5014/ajot.51.7.562. Link to full text Abstract →
OBJECTIVES: Because constructional ability is a crucial perceptual-motor skill that relates to daily functioning, it should be accurately assessed in clients with neurological dysfunction. This study examined three versions ofthe Puzzle Reproduction task (a constructional ability task) of the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) in order to determine whether a reduced detail version of the task would be easier (i.e., require less time to complete) than the original version and whether a subplacement version would be more difficult to perform (i.e., require more time to complete) than the original version. In addition, the study examined whether older adult subjects would perform more slowly than younger adult subjects.
METHOD: Seventy-two right-handed adults with no disabilities were divided into two age groups: 18 to 30 years old (n = 36) and 58 to 70 years old (n = 36). Each subject was tested on one of three versions of the LOTCA Puzzle Reproduction task (i.e., original, subplacement, simplified). For the older subjects, the simplified version ofthe task required significantly less time than the original version, although there was not a significant time difference between the original and subplacement versions.
RESULTS: For the younger subjects, the subplacement version required significantly more time than the original version, but there was no significant time difference between the original and simplified versions. Results also indicated that older subjects took significantly longer to perform all thr'ee versions of the task than did the younger subjects.
CONCLUSION: The findings support the use of the simplified version of the LOTCA Puzzle Reproduction task with older adults or with persons with major cognitive-perceptual difficulties. Further studies of the level of difficulty of the subplacement version are needed to examine whether this version is more sensitive to constructional deficits in a sample of persons with neurological impairments because even mild constructional deficits have been shown to relate to disabilities in daily functioning.
Lin, K. C., Cermak, S. A., Kinsbourne, M., & Trombly, C. A. (1996). Effects of left-sided movements on line bisection in unilateral neglect. Journal of the International Neuropsychological Society, 2, 404-411. doi:10.1017/S135561770000148X. Link to full text Abstract →
Thirteen patients with left neglect performed line bisection under four conditions: no cue, visual cueing involving the report of a digit placed at the left end of the line, circling the left-end digit, and digit circling plus tracing of the line with the right index finger from its left end to its midpoint before bisection. Digit circling plus finger tracing was unequivocally more effective in reducing left neglect than digit circling alone, which was in turn more effective than visual cueing; indeed, digit circling with tracing completely abolished the rightward bisection bias. Thus continuously directing visuomotor control to the left side of the line (even with the right hand) until bisection is performed reduces neglect more than only requiring patients to attend to left-sided visual cues. The facilitatory effects of the cueing procedures may reflect their differential efficacy in constraining as well as attracting attention and action to the left part of the target line. These findings have implications for neglect rehabilitation.
Rainville, E. B., Cermak, S. A., & Murray, E. A. (1996). Supervision and consultation services for pediatric occupational therapists. American Journal of Occupational Therapy, 50, 725-731. doi:10.5014/ajot.50.9.725. Link to full text Abstract →
OBJECTIVE: Occupational therapists with advanced experience or expertise provide supervision and consultation services in a variety of settings. This pilot study examined the use of such supervision and consultation services by pediatric occupational therapists.
METHOD: Special education administrators and pediatric occupational therapists from Massachusetts, a state often regarded as a leader in special education, responded to surveys designed especially for this study. These surveys asked about current supervision and consultation use, satisfaction with present services, and the need for additional resources in this area. Opinions regarding practice areas that would best be addressed by supervision and consultation were also obtained.
RESULTS: Both administrator and therapist respondents agreed that expert occupational therapy supervision and consultation are needed. Identified areas of interest were classroom supervision and consultation strategies, service delivery decisions, and evaluation methods.
CONCLUSION: Pediatric occupational therapists need expert supervision and consultation from occupational therapists with advanced experience or expertise in addition to traditional management, education, and training methods.
York, C. D., & Cermak, S. A. (1995). Visual perception and praxis in adults after stroke. American Journal of Occupational Therapy, 49, 543-550. doi:10.5014/ajot.49.6.543. Link to full text Abstract →
OBJECTIVES: The purpose of this study was to examine the performance of persons with right cerebrovascular accident (RCVA) and persons with left cerebrovascular accident (LCVA) on a variety of measures of praxis and visual perception in order to examine the relative contributions of the left and right cerebral hemispheres to praxis and perception.
METHODS: Forty-five subjects, 15 with RCVA, 15 with LCVA, and 15 without CVA (control subjects), were tested on three tests of praxis-praxic production, gesture comprehension, and gesture discrimination-and selected tests of visual perception, including the Judgement of Line Orientation Test, the Motor Free Visual Perception Test, the Hooper Visual Organization Test, and the Line Bisection Test.
RESULTS: Subjects in both groups with CVA performed more poorly on all of the tests than did control subjects. The group with LCVA performed most poorly on tests of gesture comprehension and praxis production, whereas the group with RCVA performed most poorly on tests of gesture discrimination and visual perception.
CONCLUSION: These findings suggest that both the right and left cerebral hemispheres contribute to different aspects of praxis. Elements of visual perception may be related to gesture comprehension, gesture discrimination, and praxis production in adults who have had stroke. These findings have clinical implications regarding instructional style and perceptual and praxic training.
Cermak, S. A., Katz, N., McGuire, E., Greenbaum, S., Peralta, C., & Maser-Flanagan, V. (1995). Performance of Americans and Israelis with cerebrovascular accident on the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA). American Journal of Occupational Therapy, 49, 500-506. doi:10.5014/ajot.49.6.500. Link to full text Abstract →
OBJECTIVE: The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) measures the cognitive performance of persons with cerebrovascular accident (CVA). Although this assessment was developed and standardized in Israel, it is frequently used in the United States. The purpose of this study was to identify whether differences in performance on the LOTCA existed between Americans and Israelis who have had strokes. Additionally, this study was designed to compare the performance of persons with right CVA with the performance of persons with left CVA because the normative data for the LOTCA does not include separate information for these two groups.
METHOD: The LOTCA was administered to 25 Americans with CVA (19 right CVA and 6 left CVA) and 56 Israelis with CVA (26 right CVA and 30 left CVA).
RESULTS: On the majority of LOTCA subtests, there were no significant differences between American and Israeli subjects. Only one subtest, Orientation to Time, revealed significant differences between Americans and Israeli subjects both for subjects with right CVA and subjects with left CVA. Examination of subjects with right CVA versus subjects with left CVA also indicated few differences. Only one subtest, Pegboard Construction, revealed significant differences between subjects with right CVA and subjects with left CVA for both American and Israeli subjects.
CONCLUSION: The LOTCA is an appropriate tool for occupational therapists to use in assessing Americans who have had strokes. In addition, for the most part, the subtests of the LOTCA assess cognitive-perceptual abilities that are not specific to the right or left cerebral hemisphere
Tseng, M. H., & Cermak, S. A. (1993). The influence of ergonomic factors and perceptual-motor abilities on handwriting performance. American Journal of Occupational Therapy, 47, 919-926. doi:10.5014/ajot.47.10.919. Link to full text Abstract →
Difficulty with handwriting is one of the most frequent reasons that children in the public schools are referred to occupational therapy. Current research on the influence of ergonomic factors, such as pencil grip and pressure, and perceptual-motor factors traditionally believed to affect handwriting, is reviewed. Factors such as visual perception show little relationship to handwriting, whereas tactile-kinesthetic, visual-motor, and motor planning appear to be more closely related to handwriting. By better understanding the ergonomic and perceptual-motor factors that contribute to and influence handwriting, therapists will be better able to design rationally based intervention programs.
Chen Sea, M. J., Henderson, A., & Cermak, S. A. (1993). Patterns of visual spatial inattention and their functional significance in stroke patients. Archives of Physical Medicine and Rehabilitation, 74, 355-360. Link to full text Abstract →
The relationship between patterns of visual spatial inattention and activities of daily living (ADL) performance was investigated in 64 Chinese patients with right brain lesions, using the Klein-Bell ADL Scale and the Random Chinese Word Cancellation Test. The result showed that patients demonstrating hemi-inattention were significantly worse in ADL performance than patients with nonlateralized inattention or patients with normal attention, but that the latter two groups did not differ from each other. Although ADL performance was also found to be significantly related to somatosensation, motor status, and visual factors, after controlling the effects of these variables by partial correlation, hemi-inattention still was highly related to ADL performance. Independence in dressing, mobility, and elimination appeared to be more adversely affected by hemi-inattention than were bathing/hygiene, eating, and telephone use.
McHale, K., & Cermak, S. A. (1992). Fine motor activities in elementary school: Preliminary findings and provisional implications for children with fine motor problems. American Journal of Occupational Therapy, 46, 898-903. doi:10.5014/ajot.46.10.898. Link to full text Abstract →
This study was designed to obtain a detailed picture of the fine motor requirements in regular elementary school classrooms. This knowledge is critical for occupational therapists in working with children with fine motor and handwriting problems who are mainstreamed into regular classes. The allocation of time to fine motor activities and the types of fine motor tasks children are expected to perform in elementary school were investigated through the observation of six elementary school classrooms. A written minute-by-minute record of one whole day's activities in each classroom showed that 30% to 60% of the day was allocated to fine motor activities, with writing tasks predominating over other manipulative tasks. Implications for children with fine motor difficulties include the need for modifications to volume of work, types of tasks, and materials.
Cermak, S. A., & Murray, E. A. (1991). The validity of the Constructional subtests of the Sensory Integration and Praxis Tests. American Journal of Occupational Therapy, 45, 539-543. doi:10.5014/ajot.45.6.539. Link to full text Abstract →
This study was designed to examine the validity of the Design Copying and Constructional Praxis subtests of the Sensory Integration and Praxis Tests (SIPT) (Ayres, 1989) through an examination of convergent validity and the use of contrast groups. The subjects were 39 children aged 5 to 8 years. Of these children, 21 had learning disabilities and 18, who served as the control group, had no learning disabilities. The subjects were administered the SIPT as well as four other standardized measures of constructional abilities: the Developmental Test of Visual-Motor Integration (Beery, 1980), the Block Design subtest of the Wechsler Intelligence Scale for Children-Revised (Wechsler, 1974), the Primary Visual Motor Test (Haworth, 1970), and the Rey-Osterrieth Complex Figure Test (Waber & Holmes, 1985). The results indicated that the children with learning disabilities performed significantly more poorly than did the control subjects on both the Design Copying and Constructional Praxis subtests. These two subtests showed moderately high correlations (.46 to .71) with the other tests of constructional abilities when both groups were combined. Correlations were mostly in the moderate range for the children with learning disabilities but were generally not significant for the control sample. The results are discussed in terms of task demands and subject variability.
Henderson, A., Cermak, S. A., Coster, W., Murray, E., Trombly, C., & Tickle-Degnen, L. (1991). Occupational science is multidimensional [The issue is]. American Journal of Occupational Therapy, 45, 370-372. doi:10.5014/ajot.45.4.370. Link to full text Abstract →
The development of a science of occupation is one of the goals of the profession of occupational therapy. Disagreement exists, however, as to the definition of occupational science and therefore as to what is considered legitimate occupational therapy research. An overly restrictive interpretation of the term occupational science will affect the funding and publication of research studies, resulting in potentially valuable knowledge being lost to the profession.
Goodgold-Edwards, S. A., & Cermak, S. A. (1990). Integrating motor control and motor learning concepts with neuropsychological perspectives on apraxia and developmental dyspraxia. American Journal of Occupational Therapy, 44, 431-439. doi:10.5014/ajot.44.5.431. Link to full text Abstract →
This paper reviews selected pertinent literature on the learning and performance of skilled motor acts. Information on normal motor performance is integrated with that on adult apraxia and related to common problems observed in children with developmental dyspraxia. The process of motor skill acquisition is outlined, and aspects of styles of motor organization, modes of control, premovement organization, sensory organization, and analysis of the types of errors are presented. Recommendations for clinicians working with children with developmental dyspraxia are offered.
Cermak, S. A., Morris, M. L., & Koomar, J. (1990). Praxis on verbal command and imitation. American Journal of Occupational Therapy, 44, 641-645. doi:10.5014/ajot.44.7.641. Link to full text Abstract →
Nondysfunctional 4-year-old and 6-year-old children were administered the Praxis on Verbal Command subtest of the Sensory Integration and Praxis Tests (SIPT) (Ayres, 1989) under two conditions. One condition was administered in the standardized manner on verbal command; the other involved administration of the same items on imitation. An analysis of variance indicated that the variables of age and condition were significant, whereas sex was not significant. The Age x Condition interaction was also significant. Scheffe multiple comparisons revealed a significant difference between 4-year-olds and 6-year-olds on verbal command but not on imitation. Verbal-command scores were significantly lower than imitation scores for the 4-year-olds but not for the 6-year-olds.
Murray, E. A., Cermak, S. A., & O'Brien, V. (1990). The relationship between form and space perception, constructional abilities, and clumsiness in children. American Journal of Occupational Therapy, 44, 623-628. doi:10.5014/ajot.44.7.623. Link to full text Abstract →
The Sensory Integration and Praxis Tests (SIPT) (Ayres, 1989) were administered to 21 children with learning disabilities and 18 children without learning disabilities, aged 5 to 8 years. The children with learning disabilities were divided into two groups, clumsy and nonclumsy, on the basis oftheir scores on the Test of Motor Impairment (Stott, Moyes, & Henderson, 1984). It was hypothesized that the learning-disabled children in the clumsy group would score significantly lower than the learning-disabled children in the nonclumsy group on the six SIPT subtests that measure form and space perception and visual construction and that the nonclumsy learning-disabled children, in turn, would score significantly lower than the non-learning-disabled children. It was further hypothesized that there would be a significant correlation between the degree of clumsiness and the degree of visual perceptual and constructional deficits. An analysis of the data indicated that both groups of learning disabled children scored lower than the non-learning-disabled children on four of the six SIPT subtests. The clumsy and nonclumsy children with learning disabilities, however, differed from each other on only two subtests. The degree of clumsiness correlated significantly with three of the six subtests. The results are discussed in terms ofvaiations in perceptual and motor skills related to subtypes of learning disabilities.
Witt, A., Cermak, S. A., & Coster, W. (1990). Body part identification in 1- to 2-year-old children. American Journal of Occupational Therapy, 44, 147-153. doi:10.5014/ajot.44.2.147. Link to full text Abstract →
The purpose of this study was to examine the developmental sequence of body part identification in very young children, 11 to 25 months of age. In the first part of the study, 113 children, divided into five age groups (12-month-olds, 15-month-olds, 18-month-olds, 21-month-olds, and 24-month-olds), were asked to point to 20 body parts on a doll. The results indicated a positive correlation between number of parts correctly identified and increasing age. No sex differences or Sex × Age interactions were found.
In the second part of the study, the difference between pointing to body parts on the self and pointing to body parts on a doll was examined in two groups of 2-year-olds. The results indicated no significant difference between the ability to point to body parts on a doll and the ability to point to body parts on the self.
Factors that may contribute to the development of body part identification in 1- to 2-year-olds and the sequence in which body parts are learned are discussed. The results help provide diagnostic criteria for children with suspected delays in cognitive language, or body scheme development.
Magalhaes, L. C., Koomar, J. A., & Cermak, S. A. (1989). Bilateral motor coordination in 5- to 9-year-old children: A pilot study. American Journal of Occupational Therapy, 43, 437-443. doi:10.5014/ajot.43.7.437. Link to full text Abstract →
The purpose of this study was to collect normative data on and to assess the clinical usefulness of scales designed to measure the quality of children's ability to perform three bilateral motor coordination tasks: jumping jacks, symmetrical stride jumps, and reciprocal stride jumps. One hundred children, aged 5 to 9 years, were tested according to the scales developed for this study. Results indicated that scores tended to increase with age and that sex differences were not significant. Jumping jacks were found to be the most reliable and the easiest of the three tasks. Reciprocal stride jumps were the most difficult. Quality of performance was assessed, and the number of jumps in a 10-sec trial was recorded for each age. The data from this study may be useful in comparing the performance of children with motor deficits to the performance of normal children of the same age.
Lennox, L., Cermak, S. A., & Koomar, J. (1988). Praxis and gesture comprehension in 4-, 5-, and 6-year-olds. American Journal of Occupational Therapy, 42, 99-104. doi:10.5014/ajot.42.2.99. Link to full text Abstract →
This investigation examined (a) whether the ability to comprehend pantomimed gestures improves with age in young children and whether the ability to point to the actual object precedes the ability to point to a functional associate and (b) whether there is a difference in the ability to comprehend pantomimed gestures between learning-disabled and normal subjects. The Gesture Comprehension Test, the Imitation of Postures test, and the Test for Auditory Comprehension of Language were administered to 68 normal children and 24 learning-disabled children 4 to 6 years of age. Results indicated that gesture comprehension improved with age and that the ability to point to the actual object preceded the ability to point to its functional associate. Boys performed significantly better than girls. There was no significant difference between normal and learning-disabled subjects' ability to comprehend gestures. A moderate correlation was found between the Gesture Comprehension Test and the Test for Auditory Comprehension of Language; a low correlation was found between the Gesture Comprehension Test and the Imitation of Postures test. These results suggest the possibility that in preschool children and young school-age children, gesture comprehension may be more closely related to language than to nonsymbolic aspects of praxis.
O'Brien, V., Cermak, S. A., & Murray, E. (1988). The relationship between visual-perceptual motor abilities and clumsiness in children with and without learning disabilities. American Journal of Occupational Therapy, 42, 359-363. doi:10.5014/ajot.42.6.359. Link to full text Abstract →
One visual-perceptual test, four visual-motor tests, and a test of motor impairment were administered to 22 children with learning disabilities and 22 children without learning disabilities, aged 5 to 8 years. The children with learning disabilities were divided into two groups--"clumsy" and "nonclumsy"--based on their scores on the motor impairment test. It was hypothesized that the clumsy children with learning disabilities would score significantly lower on visual-perceptual and visual-motor tests than the nonclumsy children with learning disabilities who, in turn, would score significantly lower than the children without learning disabilities. It was further hypothesized that there would be a significant correlation between the degree of clumsiness and the degree of visual-perceptual and visual-motor deficit. Analysis of the data indicated that, as expected, the clumsy children with learning disabilities scored significantly lower than the children without learning disabilities (the control group). There was no significant difference between the clumsy and nonclumsy children with learning disabilities or between the nonclumsy children with learning disabilities and the control group. Degree of clumsiness significantly correlated with scores on four of five tests. Results are discussed in terms of subtypes of learning disabilities and sample size.
Menken, C., Cermak, S. A., & Fisher, A. (1987). Evaluating the visual-perceptual skills of children with cerebral palsy. American Journal of Occupational Therapy, 41, 646-651. doi:10.5014/ajot.41.10.646. Link to full text Abstract →
The Test of Visual-Perceptual Skills (TVPS) was used to determine if children with cerebral palsy demonstrated problems in visual perception on a motor-free visual perception test. Twenty-four children with cerebral palsy and 24 normal children, all of normal intelligence, were given the TVPS. Results showed that children with cerebral palsy attained significantly lower mean perceptual quotients than did the normal children. The TVPS appears to be a useful tool for the occupational therapist in evaluating visual perception in children with cerebral palsy.
Hung, S. S., Fisher, A. G., & Cermak, S. A. (1987). The performance of learning-disabled and normal young men on the test of visual-perceptual skills. American Journal of Occupational Therapy, 41, 790-797. doi:10.5014/ajot.41.12.790. Link to full text Abstract →
The present study explored the discriminative validity of the motor-free Test of Visual-Perceptual Skills (TVPS) as an assessment for adults. The subjects were 26 learning-disabled and 26 normal young men. Overall, the subjects with learning disabilities made significantly more errors and took significantly more time on the total TVPS than did the normal subjects. The group with learning disabilities demonstrated significantly lower accuracy scores on four of the seven subtests and longer time scores on five subtests. Discriminant analysis revealed that the time score for Visual Sequential Memory and the accuracy score for Visual Closure were the two subtest scores that best discriminated between groups and, together, were able to correctly classify 84.6% of the subjects. The TVPS total accuracy score for the subjects with learning disabilities significantly correlated with their overall performance IQ but not with their verbal IQ. Their TVPS total accuracy scores also correlated with scores on Block Design, but not with scores on the Object Assembly or Picture Completion subtests of the WAIS-R. The results seem to indicate that the TVPS is valid as an assessment of visual-perceptual functions for young adult subjects. Recommendations for further study were made.
MacWhinney, K., Cermak, S. A., & Fisher, A. (1987). Body part identification in 1- to 4-year-old children. American Journal of Occupational Therapy, 41, 454-459. doi:10.5014/ajot.41.7.454. Link to full text Abstract →
The purpose of this study was to examine the sequence in which body parts are learned and can be identified by very young children. The 101 children tested were divided into four age groups: 1-year-olds, 2-year-olds, 3-year-olds, and 4-year-olds. The children were requested to point to 20 body parts on a doll. Analysis of the results indicated significant differences in the ability to identify body parts by age and sex. The greatest increase in scores occurred between the ages of 1 and 2 years, with girls achieving a slightly higher score in each age group. The percentage of subjects at each age who identified different body parts is presented, indicating the sequence in which body parts are learned.
Cermak, S. A., Ward, E. A., & Ward, L. M. (1986). The relationship between articulation disorders and motor coordination in children. American Journal of Occupational Therapy, 40, 546-550. doi:10.5014/ajot.40.8.546. Link to full text Abstract →
This study was designed to examine the relationship between articulation disorders, soft neurological signs, and motor abilities. Fifteen children with articulation problems, as measured by the Templin-Darley Articulation Screening Test and a connected speech sample, were compared with a normal control group (matched for sex and age) on the Quick Neurological Screening Test, the Imitation of Postures test (from the Southern California Sensory Integration Tests), and the 1984 version of the Stott Test of Motor Impairment that has been revised by Henderson. A significant difference was found between the groups on the Motor Impairment Test and the Quick Neurological Screening Test, supporting the hypothesis that the articulation disorder children would have more motor coordination problems and soft neurological signs than the normal children in the control group. There was no between-group difference on the Imitation of Postures test, suggesting that as a group, children with articulation deficits are not dyspraxic. This study supports other research findings stating a relationship between articulation problems and motor impairment, but it also indicates that this motor impairment is not necessarily dyspraxia.
Atwood, R. M., & Cermak, S. A. (1986). Crossing the midline as a function of distance from midline. American Journal of Occupational Therapy, 40, 685-690. doi:10.5014/ajot.40.10.685. Link to full text Abstract →
This study examined the effect of differential block placement on the frequency of midline crossing during the Space Visualization test (SV) of the Southern California Sensory Integration Tests. The SV test was administered at distances of 0.75, 3.00, and 6.00 inches to a group of 71 normal right-handed boys (ages 5 and 7 years) to obtain the Space Visualization Contralateral Use score (SVCU) and the Space Visualization Contralateral Use Percentage score (SVCU percent). Space Visualization (SV) adjusted scores were also obtained to examine the effect of differential block placement on visual perception scores. The analyses for the SVCU and SVCU percent scores showed that age and distance were significant. Analysis of variance of the SV adjusted standard score indicated that trial, but not distance or age, was significant. There was a significant age-by-trial interaction. The need for a standard protocol for block placement during the administration of the SV test was shown. Future research needs were identified.
Smith, C. M., Cermak, S. A., & Nelson, D. L. (1984). Sequential versus simultaneous graphesthesia tasks in 6- and 10-year-old children. American Journal of Occupational Therapy, 38, 377-381. doi:10.5014/ajot.38.6.377. Link to full text Abstract →
Reported in the statistics of the Southern California Graphesthesia Test are significant sex differences for certain young age groups, with females scoring higher than males. In contrast, another study has reported that adult males scored higher than females on the same test. The purpose of this study was to examine the interaction between sex and age and to investigate a possible explanation for this interaction. Sixty-four normal children between the ages of 6.0 and 7.0 years, and 10.0 and 11.0 years were administered two graphesthesia tasks. One task was an adaptation of the Graphesthesia Test of the Southern California Sensory Integration Test (SCSIT). In this task, shapes were drawn sequentially on the palmar surface of the child's hand. A second task was devised whereby each of the same shapes was presented in a simultaneous manner, that is, the entire outline of each shape was pressed onto the palmar surface of the child's hand. Results indicated that for both tasks, younger boys performed relatively less ably than girls, but older boys equalled or surpassed the girls. At a level approaching significance, females scored relatively higher than males on the sequential task, and males scored relatively higher than females on the simultaneous task. However, this tendency toward an interaction between sex and the type of task does not fully explain the interaction between sex and age on graphesthesia tasks.
Mandell, R. J., Nelson, D. L., & Cermak, S. A. (1984). Differential laterality of hand function in right-handed and left-handed boys. American Journal of Occupational Therapy, 38, 114-120. doi:10.5014/ajot.38.2.114. Link to full text Abstract →
This study was designed to investigate differences in the degree of manual lateralization between right-handed and left-handed normal boys. Sixty-three 5, 7, and 9 year olds were tested on the Minnesota Rate of Manipulation Test (displacing subtest and turning subtest), the Finger Tapping Test, the Purdue Pegboard (placing subtest and assembly subtest), and the Southern California Motor Accuracy Test--Revised. Significant differences between right- and left-handed subjects were obtained on two of the six measures, and a third measure approached significance, with less lateralization among the left handers than among the right handers. Subsequent analyses indicated that differences in lateralization were significant or near-significant in the 5 and 7 year olds. By 9 years of age, right- and left-handed subjects no longer differed in the degree of laterality. Differences in degree of laterality, or the lack of such differences, between young right- and left-handed boys might be a function of the nature of the fine motor task or a function of the child's previous experience with the task.
Cermak, S. A., & Ayres, A. J. (1984). Crossing the body midline in learning-disabled and normal children. American Journal of Occupational Therapy, 38, 35-39. doi:10.5014/ajot.38.1.35. Link to full text Abstract →
The SVCU scores of 179 learning-disabled children, ages 5 to 8, were compared with the scores of 120 normal children, using both the actual Space Visualization Contralateral Use (SVCU) score, and the SVCU category of "normal, suspect, or possible deficit," in order to evaluate whether using guidelines to interpret the SVCU as a function of age enabled differentiation between normal children and children with learning disabilities. The SVCU measure clearly differentiated between groups at the younger ages, although the difference was not as clear for the older age groups. It was suggested that the SVCU score be used in conjunction with other observations of midline crossing. Alternative interpretations of the SVCU score are discussed.
Eimon, M. C., Eimon, P. L., & Cermak, S. A. (1983). Performance of schizophrenic patients on a motor-free visual perception test. American Journal of Occupational Therapy, 37, 327-332. doi:10.5014/ajot.37.5.327. Link to full text Abstract →
The Motor-Free Visual Perception Test (MVPT) was administered to 15 chronic schizophrenic patients and 15 normal controls, ages 40 to 60, to see whether, perceptual deficits would be found on non-motor tasks. Groups significantly affected performance on the MVPT, as did occupational status. In the schizophrenic group only, efficiency of intellectual functioning was positively related to how well they performed on the MVPT. Age, educational level, and IQ had no significant impact on functioning on this test in either group. The schizophrenic patients made more errors on the more complex operations of the MVPT, and the only significant group differences in percentage of subjects' own errors was in figure-ground. The MVPT may be useful in screening for visual-perceptual deficits in adult schizophrenic patients.
Conrad, K. E., Cermak, S. A., & Drake, C. (1983). Differentiation of praxis among children. American Journal of Occupational Therapy, 37, 466-473. doi:10.5014/ajot.37.7.466. Link to full text Abstract →
This study was designed to evaluate the conceptual model proposed by Luria to identify different types of dyspraxia in learning-disabled (LD) children. The types of apraxia investigated were kinesthetic, optic-spatial, symbolic, and dynamic. In addition, the study explored differential performance on tasks of praxis in learning-disabled children as a function of their Wechsler Intelligence Scale for Children-Revised (WISC-R) IQ patterns. The subjects included 41 LD and 17 normal children ages 108 months to 153 months. They were administered The Praxis Test for Children, a compilation based on Luria's division of types of praxis with brain-damaged adults. Results indicated that the test differentiated between the LD and normal groups on the dynamic and optic-spatial tests. Data analyzed for the LD children with a significant WISC-R discrepancy between their Verbal IQ and Performance IQ profile yielded no difference between these two IQ groups. Results were discussed in terms of the need to investigate individual patterns of performance in the differentiation of dyspraxia.
This study was designed to determine if Parkinsonian patients exhibited a deficit in motor planning. Thirty adult males, 15 with Parkinson's disease and 15 normal controls, were given a gestural test which had two components. The first component required the symbolic representation of implement usage on verbal command and on imitation (representational items) and the second component required the imitation of non-symbolic hand positions (non-representational items). The results indicated that Parkinsonian patients performed at a significantly lower gestural level on the representational tasks and made significantly more spatial errors on non-representational tasks than the normal controls.
Cermak, L. S., Goldberg-Warter, J., DeLuca, D., Cermak, S. A., & Drake, C. (1981). The role of interference in the verbal retention ability of learning disabled children. Journal of Learning Disabilities, 14, 291-295. doi:10.1177/002221948101400514. Link to full text Abstract →
Three groups of learning disabled children defined on the basis of their Wechsler Intelligence Scale for Children test profiles, and one control group of normal readers, were asked to retain verbal material across distractor intervals ranging from 0 to 24 s. The to-be-retained material consisted of word triads presented either visually (in one half of the conditions) or auditorily (in the other half). Six distractor tasks were designed to vary the level of similarity between the memoranda and distraction. Three of these distractor tasks were auditory, three visual. In each modality, one task required nonverbal analysis, one phonemic analysis, and one semantic analysis. In addition, two unfilled distractor intervals were also introduced; one following auditory, and one after visual presentation of the to-be-retained materials. Each child participated in each of the eight conditions. All three LD groups retained less information than the normals following phonemic or semantic distractors in either modality. However, their performance following nonverbal distraction or no distraction was nearly normal. It was concluded that LD children's retention of verbal material is more susceptible to interference from similar material than is the case for normals.
Koomar, J. A., & Cermak, S. A. (1981). Reliability of dichotic listening using two stimulus formats with normal and learning-disabled children. American Journal of Occupational Therapy, 35, 456-463. doi:10.5014/ajot.35.7.456. Link to full text Abstract →
This study was designed to establish test-retest reliability of the consonant vowel and digit formats of the dichotic listening test with normal and learning-disabled children between the ages of 7 and 10 years. Between-group differences on ear advantage and total accuracy scores were also examined. The results indicated that both groups showed a right ear advantage and that there were no significant differences in ear advantage between the two groups on either format. However, on the digit format, the learning-disabled group performed significantly lower than the normal group on both the percentage of total accuracy and the left ear raw score. There were no significant differences between the two groups on percentage of total accuracy or raw ear scores on the consonant vowel format. The normal group tended to obtain higher reliability coefficients than he learning-disabled group. Both groups tended to obtain higher reliability on the consonant vowel format than on the digit format. Wide variability in reliability results was found when using different laterality formulas to determine ear advantage.
Cermak, L. S., Goldberg, J., Cermak, S. A., & Drake, C. (1980). The short-term memory ability of children with learning disabilities. Journal of Learning Disabilities, 13, 25-29. doi:10.1177/002221948001300106. Link to full text Abstract →
Three groups of learning disabled children, defined on the basis of their Wechsler Intelligence Scale for Children profiles, and one control group of normal readers were asked to retain verbal material across distractor intervals ranging from zero to 18 seconds. None of the learning disabled groups (low verbal, high performance; high verbal, low performance; verbal equals performance) performed worse on this task than the normal controls. Furthermore, the older learning disabled children in the high-verbal, low-performance group actually retained somewhat more material than the normal control group. It was concluded that at least on this standard version of a short-term retention assessment task, learning disabled children are not at a significant disadvantage.
Cermak, S. A., Quintero, E. J., & Cohen, P. M. (1980). Developmental age trends in crossing the body midline in normal children. American Journal of Occupational Therapy, 34, 313-319. doi:10.5014/ajot.34.5.313. Link to full text Abstract →
The ability to cross the body midline was assessed in 150 normal children, ages 4 through 8, by observing hand usage during the Space Visualizaion Test of the Southern California Sensory Integration Tests. A Space Visualization Contralateral Use score (SVCU) was computed for each subject and was regarded as a measure of the tendency to spontaneously cross the body midline. This score is based on a ratio of ipsilateral (uncrossed) to contralateral (crossed) responses. The percentage of time a child use the preferred hand to pick up a block was also recorded. Results indicated that spontaneous midline crossing increased with age. Although the percent of preferred hand responses increased with age, there was enough variability at each age that there were no significant differences among age groups. Perceptual, motor, and psychosocial factors that could influence midline behavior were discussed. Based on the data from this study, a preliminary reinterpretaton of the SVCU score is offered.
Cermak, S. A., Coster, W., & Drake, C. (1980). Representational and nonrepresentational gestures in boys with learning disabilities. American Journal of Occupational Therapy, 34, 19-26. doi:10.5014/ajot.34.1.19. Link to full text Abstract →
This study was designed to investigate the gestural abilities of boys with learning disabilities. Eighteen boys with learning disabilities (who had a low verbal-high performance WISC profile) and 24 normal boys between the ages of 9 and 13 were given a gestural test that consisted of two sets of tasks, one requiring the symbolic representation of implement usage–on command and on imitation (representational items) and the other requiring the imitation of hand positions (nonrepresentational items). The items were classified according to place of action as either on-self or away-from-self. The results indicated that the learning-disabled subjects performed at a significantly lower level than the normal control group on the gestural representation tasks. There was a significant difference between instruction (command vs. imitation) and between place of action (self vs. away). Further, the learning-disabled subjects made significantly more spatial errors than the control subjects on imitation of gestural representation and nonrepresentation tasks. Results are discussed in terms of the need to investigate the various parameters of praxis.
Cermak, S. A., Cermak, L. S., Drake, C., & Kenney, R. (1978). The effect of concurrent manual activity on the dichotic listening performance of boys with learning disabilities. American Journal of Occupational Therapy, 32, 493-499. Link to full text Abstract →
Three groups of learning-disabled children, defined according to their Wechsler Intelligence Scale for Children (WISC) profiles, and one normal control group, were given both a standard dichotic listening task and a dichotic listening task performed concurrently with a manual tapping task. Learning-disabled children who showed no disparity in their verbal and performance subscale scores on the WISC demonstrated a right ear preference under standard testing and when tapping with the left hand, but not the right, which was nearly the same pattern as that obtained by the control group. Learning-disabled children whose verbal WISC score was at least 15 point lower than their performance demonstrated a right-ear preference only when tapping with their left hand. Finally, learning-disabled children who had high verbal, low performance WISC profiles showed no ear preference under any conditions. These results were interpreted as indicating that these three types of learning-disabled children are differentially lateralized and differentially affected by the facilitory-inhibitory effects of concurrent hemispheric activities.
A community-based field work experience for senior occupational therapy students is described. The program was designed to meet five objectives: to provide students with an effective integration of theory and practice; to allow an application of theoretical concepts to early intervention and prevention programs; to enable students to confront complexities of community service delivery; to allow students to learn new roles in community programs; and to demonstrate the role of occupational therapy within a public health model of service delivery. In addition to these project objectives, placement sites, student roles, and organization of supervision are discussed. Examples are given to illustrate the diversity of student experience. Student and consumer feedback indicated that positive gains had been made toward fulfillment of the project objectives.
Based on clinical observations, the author discusses the role of occupational therapy in treating hyperactive children, including self-regulation of the child through activity groups where other children serve as monitoring agents.