Cognitive Orientation for Daily Occupational Performance (CO-OP) with Children with Asperger Syndrome: Enabling Achievement of Social and Organisational Goals

Background:  

Children and young people with Asperger Syndrome (AS) are frequently challenged by motor, social and organisational difficulties that impact on their performance in life roles (such as player, school student, self carer) and hence their participation in important life contexts and situations. Cognitive Orientation for daily Occupational Performance (CO-OP), an intervention developed and researched by occupational therapists will be described. CO-OP is effective in assisting children with motor issues achieve their occupational goals including children with Asperger Syndrome (Rodger & Brandenburg, 2009; Rodger, Pham & Mitchell, 2008).

Objectives:  

The key features of CO-OP will be outlined (global problem solving framework, domain specific strategies [DSSs], and guided discovery) using case examples of this intervention with children with AS who have social and organisational goals.

Methods:  

Detailed case study methodology was utilised to investigate the use of CO-OP with children with AS. This paper specifically focuses on goals associated with self management, organisation and managing school and playground social situations (Rodger et al., 2007, 2008a, Rodger & Vishram, 2010). Two children with pseudonyms Charlie and Thomas with AS aged 10 and 12 years diagnosed by paediatricians according DSM IV TR and with Asperger’s Disorder Quotient greater than 80 on the Gilliam Asperger’s Disorder Scale (GADS) (Gilliam 2001), participated in 10 sessions of CO-OP intervention. The Canadian Occupational Performance Measure and the Social Skills Rating Scale were used to determine goal achievement pre-intervention and post-intervention. Two randomly chosen 5 minute segments from each of the 10 sessions were coded by dividing these  into 15-s intervals. At the end of each 15-s interval, the coder recorded the occurrence of the Global and Domain Specific Strategies used.

Results:  

For Charlie, the COPM showed a clinically significant increase in performance and satisfaction scores across all goals. With respect to the SSRS, according to his teacher, Charlie’s social skills remained the same post-intervention. His mother’s social skills rating indicated an improvement from ‘fewer than expected’ to ‘average social skills’. Charlie’s self-report indicated an improvement in social skills post-intervention. According to the COPM, Thomas’s performance in three out of his five goals (managing anger, getting to sleep and making his bed) improved post-intervention. Thomas’s teacher’s pre-intervention and post-intervention rating scores on the SSRS remained the same post-intervention. Thomas’s mother’s post-intervention SSRS scores showed that she perceived that Thomas’s social skills improved; however, his score remained in the range of having fewer social skills than children his age. Thomas consistently rated himself higher than his teacher and mother.

Coding of the videotaped CO-OP sessions suggested that both children utilized all the Global strategies, particularly “understanding the context” and “plan,  and  used six common DSS, namely transitional supports, affective supports, attending, task-specification, task modification, and supplementing task knowledge, with task-specification being most prominent.

Conclusions:  

Both boys improved in social and organisational skills. Modifications to CO-OP for children with AS, study limitations and recommendations for future research are discussed.