Karrie Kingsley OTD, OTR/L

Importance. This Practice Guideline provides stakeholders with a condensed summary of a large number of effectiveness studies. It is a valuable tool for facilitating decision making related to occupational therapy interventions for children ages birth–5 yr.

Objective. Early childhood (birth–5 yr) is a critical period in which the foundation of key life occupations is developed (e.g., eating, dressing, play, learning, social participation, rest and sleep, and chores). The development of cognitive, motor, social–emotional, and self-care skills is important to support these occupations. This Practice Guideline synthesizes recent systematic reviews (SRs) on these areas of development to promote decision making for and high-quality interventions with this population.

Method. Four SRs related to cognition, mental health, motor function, and ADLs analyzed studies published from 2010 to 2017 retrieved from six electronic databases (MEDLINE, PsycINFO, CINAHL, ERIC, OTseeker, and Cochrane).

Results. A total of 196 articles were included in the SRs, which served as a guide to final clinical recommendations. Case studies describe translation and application to practice.

Conclusions and Recommendations. A variety of interventions within the domain of occupational therapy were found to support the development of cognitive, social–emotional, motor, and self-care skills. Although some of these interventions are typically implemented by occupational therapy practitioners, others can be implemented by parents after training or by teams working in preschool settings. These findings should be used to inform evidence-based practice provided by occupational therapy practitioners working in various early childhood settings.

What This Article Adds. This Practice Guideline gives occupational therapy practitioners clear information about which interventions will be effective for specific outcomes. Better intervention choices mean better outcomes for young children and their families.

Importance. It is critical for providers to use evidence-based interventions to address mental health and behavioral barriers to occupational performance during early childhood.

Objective. To identify evidence-based interventions within the scope of occupational therapy practice to improve mental health and positive behavior for children ages 0–5 yr and their families.

Data Sources. PsycINFO, Cochrane, ERIC, MEDLINE, and OTseeker databases were searched for publications from 2010 through March 2017.

Study Selection and Data Collection. This review was completed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines. Risk of bias was assessed for each article using either A Measurement Tool to Assess Systematic Reviews (AMSTAR) or the Cochrane method. Articles meeting inclusion criteria were critically appraised.

Findings. Forty-six articles met inclusion criteria and were organized into three themes: touch-based interventions (n = 9), parent–child interaction therapy (PCIT; n = 4), and instruction-based interventions (n = 33). Statistically significant findings and overall risk of bias supported the use of touch-based interventions, PCIT, and parent training.

Conclusions and Relevance. The evidence indicates that touch-based interventions can improve infant self-regulation (strong), social behavior, and attachment (moderate) and reduce maternal stress, anxiety, and depression (low). Moderate-strength evidence supports PCIT to improve child behavior. The evidence indicates that parent training can improve parent behavior, maternal–infant attachment (strong), and parent mental health (moderate). Teacher training can improve mental health and behavior (moderate). Group-based parent training and sleep training have insufficient support (low).

What This Article Adds. Occupational therapy professionals working with children younger than age 5 yr can use the results of this systematic review to guide clinical decision making related to mental health and behavioral outcomes.

This special issue of the American Journal of Occupational Therapy on interventions for children and youth highlights the current developments in and evidence for the effectiveness of occupational therapy interventions and psychometric properties of assessments for children and youth. In this guest editorial, we identify various factors that challenge the implementation of evidence-based strategies in daily clinical practice. We assert that scholars, educators, and practitioners need to address several strategic steps. To facilitate critical consumption of evidence in practice, efforts need to be made to build capacity for evidence production and evidence use through implementation science and to ensure that evidence-based practice is not only taught but also reflectively applied across the educational curriculum and that clinicians are given more access to resources that are easy to translate to daily clinical practice.

During early childhood, most children in the United States achieve their developmental milestones; however, about 1 of every 6 children will have a developmental disability or disabling behavioral problem before age 18. Less than half are identified during early childhood. Occupational therapists and occupational therapy assistants work with families and caregivers to support and enhance young children's ability to engage in occupations appropriate to their age. This is a critical time not only to educate children but to also provide them with support to participate fully throughout their lives.

This publication addresses occupational therapy practice for children birth to age 5 years, including early intervention and preschool practice. It defines the occupational therapy domain, process, and intervention that occur within the boundaries of acceptable practice. Topics include prematurity, ASDs, feeding disorders, obesity, the NICU, and cerebral palsy, as well as motor and praxis skills, sensory-perceptual skills, emotional regulation, cognitive skills, and communication and social skills. Interventions discussed include those promoting social-emotional development; for feeding, eating, and swallowing; for improving cognitive development; for promoting motor performance; and for service delivery in early childhood. Appendices contain additional information relating to early childhood practice, coding for intervention and evaluations, funding sources affecting early childhood settings, and methodologies used in the evidence-based literature review.

Consideration of the evidence for all aspects of service delivery is a growing relevant concern of occupational therapists, including those providing early intervention to children and families. We conducted a review of the literature to uncover what evidence existed for determining the effectiveness of different service delivery models and methods used to improve occupational performance for children and families who receive early intervention services. Through a comprehensive search, we reviewed and synthesized studies, finding common themes of family-centered and routine-based approaches, service setting, and the inclusion of parent participation and training. Families consistently reported positive perceptions of family-centered and routine-based approaches. Parent participation and training resulted in positive outcomes. No specific setting or method of service delivery was identified as clearly most effective, with most studies reporting combined approaches and environments for interventions.