Wanda J. Mahoney, Elysa Roberts, Kimberly Bryze, Judith A. Parker Kent; Occupational Engagement and Adults With Intellectual Disabilities. Am J Occup Ther 2015;70(1):7001350030. https://doi.org/10.5014/ajot.2016.016576
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© 2020 American Occupational Therapy Association
People with intellectual disabilities may be predisposed to occupational alienation as a result of an inherent need for ongoing support and limited understanding of how they express choice and engagement in occupation. In response to this risk of occupational injustice, this phenomenological study explored the occupational engagement of adults with intellectual disabilities in a community-based day program. Data were collected through interviews using visual supports and through observation of activity groups using the Volitional Questionnaire. Thematic analysis illustrated how participants demonstrated engagement in occupation through doing activity/initiating action, expressing positive affect, and showing focused attention. Findings can inform how occupational therapy practitioners describe and facilitate occupational engagement in adults with intellectual disabilities.
[The staff member] gave the maraca to Theresa and invited her to move beside her to play. Theresa got up and started shaking the maraca. The staff member told her that she could sit beside her, but Theresa remained standing. [After Theresa chose between two songs], the staff member started to play the [chosen] song and [other clients] joined in singing. Theresa shook the maraca and banged it against her opposite hand. She sang along with the song and kept going throughout the song.
Johnathan crossed his opposite leg and took his other shoe off and on. . . . He put his open palm against his face. He rocked his torso and rocked the chair. He looked down at the magazine and moved his sleeve up and down. He blew raspberries. . . . The staff member started to read a story from a magazine. Johnathan quiet[ed] and [didn’t] move or fidget for a few moments. He started moving around in his chair. Then he was quiet and not fidgeting for a moment.
A staff member asked, “Are you sure you don’t want to do the art project today? It’s a good one.” Timothy did not respond but put the old magazine back, picked up a different magazine, and walked back to his seat.
Megan moves her mouth, makes louder sounds, and seems to be crying. She continues to make louder sounds. The staff member comes to her and asks her if she is comfortable. Megan indicates “no.” The staff member repositions her slightly. . . and asks if she is better. Megan continues to cry[,] moving her jaw and making crying sounds. The staff member circles around the table spending a few minutes with each [client] talking and getting them to interact with the objects in front of them. [Megan did not have any objects in front of her.] Megan gets louder and has more frequent sounds with her crying.
[After Andrea answered the staff member’s question about needing to go to the bathroom], the staff member started to take her out toward the door. Andrea made noises and smiled. I commented how she was smiling. The staff member in the library said, “She doesn’t like library.”
When the staff member started the money skills, Theresa rubbed her face and chewed on her hair. . . . She momentarily looked at the [client] who first got the coins, then put her head back down toward her chest. Theresa had no reaction when the staff member asked coin questions [of] the [client] next to her. Theresa looked up when the staff member came in front of her from across the table, slid a coin in front of her, and asked what it was. Theresa leaned forward, pointed to the coin, and [said] “penny.” The staff member presented another coin, and Theresa said, “quarter.” When told to try again, she said, “dime”. . . . Theresa remained leaning forward during this activity and pointed to each coin presented.
Timothy stood up and moved his chair to get closer to the staff member with the flash cards. He tried to squeeze between 2 [clients] in wheelchairs across the table from the staff member. He reached for the table and leaned forward. He named the picture when the staff member asked, “You ready, Timothy?”
While cutting the potato [with hand-over-hand assistance], James alternates between looking up at me or something else in the room and looking at what he is doing. While still helping him cut the potato, the group leader asks another [client] if he’s ready to cut a potato. James says, “No, me.” The group leader finishes helping James cut up the potato.
This study can equip occupational therapy practitioners with insights to inform training for day center staff and other caregivers about how to recognize indicators of occupational engagement.
The study illustrates strategies related to providing social support to promote occupational engagement for people with intellectual disabilities.
Because occupational engagement is an individual phenomenon, it is important to identify each person’s expressions of meaning, choice, and motivation, and the VQ provides a useful structure for this task.
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