Individuals with fetal alcohol spectrum disorder: Predictive factors for successful occupational performance

INDIVIDUALS WITH FETAL ALCOHOL SPECTRUM DISORDER (FASD): PREDICTIVE FACTORS FOR SUCCESSFUL OCCUPATIONAL PERFORMANCE By Mary Culshaw, MSc, BScOT A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University Virginia Commonwealth University 2015 Dissertation Chair: Shelly Lane, PhD, OTR/L, FAOTA Professor Emeritus, Department of Occupational Therapy As awareness and diagnoses of FASD grow in Canada, there is increased need to support these individuals across their lifespan. One study suggested the prevalence of FASD may be as high as 10 per 1000 births (May & Gossage, 2001). The impact to society is growing as well, since this population requires support across their lifespan due to cognitive and sometimes physical impairments. It was estimated that the annual cost to Canadians was $53 billion (in 2007 dollar value) to support individuals aged 0-53 years (Stade et al., 2009). There is mounting evidence identifying the cognitive and physical impairments that these individuals have, particularly in children. Studies have also described the adaptive functioning of children with FASD, and their ability to cope in daily life. There is little information on youth and adults regarding their daily lives, and the factors that contribute to success in daily life. The purpose of this study was to identify predictive factors that contribute to success in occupational performance in youth and adults with FASD. Using the Canadian Model of Occupational Performance and Engagement (CMOP-E), the study explored variables reflecting the person, environment, and activity that promoted engagement and participation. The study also investigated the value of using selfreport or performance-based assessment with the FASD youth and adult population. Due to memory, cognitive, and executive functioning deficits, the individual with FASD may not be able to accurately self-report. Results from the study suggest an individual’s living situation, involvement with foster care, and family involvement play a role in successful occupational performance. Formal assessments of cognitive, academic and memory abilities did not appear to play a role in the individual’s school completion and daily life. Interestingly, the characteristics of this FASD sample depicted a group of youth and adults, who, in general, lived with family, had completed some schooling at the grade 10-12 level, had limited employment, were not involved with the judicial system, and were just as likely to be Caucasian as Aboriginal. The concept of occupational performance proved complex, and future study on the factors contributing to occupational performance would benefit from additional variables related to environment and activity than were available in the current data set. 1 Chapter 1: Introduction Awareness of Fetal Alcohol Spectrum Disorder (FASD) in North America is increasing. With this comes growing identification of children and adults whose functioning is affected by prenatal exposure to alcohol. Research has ascertained cognitive functioning is consistently compromised in children, adolescents, and adults with FASD (Murthy, Kudlur, George & Mathew, 2009). Sensory processing, the ability to appropriately react to sensation from the environment, is impaired as well (AbeleWebster, Magill-Evans & Pei, 2012). It is also known that individuals with FASD have great difficulty in adaptive functioning and participating effectively in daily activities (Whaley, O’Connor & Gunderson, 2001). Little is known of the factors that predict outcomes in daily functioning in the FASD population. Exploring daily functioning of individuals with FASD through the lens of occupational performance can give a more complete picture of the many factors that can impact an individual’s functioning. This is essential in order to provide efficient and effective support throughout the lifespan. Occupational performance considers not just the person, but also the environment and occupation, which contribute to successful participation in daily life (McColl, Law, Stewart, Doubt, Pollock & Krupa, 2003). In this dissertation, the use of the term “individual” includes the wide age range within the youth and adult since the study sample included youth and adults. This also allows for