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Globally physical inactivity is a leading, independent, and significant risk factor for disease and mortality. Exercise scientists and clinical exercise physiologists have a key role in supporting client participation in physical activity. However, with the rates of physical activity continuing to be low, we argue for a paradigm shift in the way practitioners engage with clients. Attachment theory, a theory which focuses on social relationships and bonds, has received increased attention within physical activity and broader health literature. Awareness of attachment theory provides insight into individual health-related responses and physical activity motivation and guides key professional practices and processes relevant to both exercise scientists and clinical exercise physiologists. However, there remains no research specific to the application of attachment theory by these 2 professions. This narrative review provides an overview of the literature on attachment theory applicable to exercise science and exercise physiology and highlights the potential for attachment theory to inform future practice, education, and research, concluding with 3 recommendations for future research priorities.

Sensory over-responsiveness, identified through self-report and quantitative sensory testing, has been associated with compression garment non-adherence in a burn-injured cohort. This study sought expert consensus on the usefulness of, and recommendations for, sensory modulation strategies to improve compression garment adherence in sensory over-responsive adults after burn.Experts in the field of sensory modulation were invited to participate in a mixed-methods, three-round electronic Delphi study.Experts (N = 18) agreed that sensory modulation therapy may be a useful clinical tool to improve compression garment adherence. Twenty-two items reached consensus as essential to assessment, treatment, or therapist training.With adequate therapist training and individualized assessment and treatment, sensory modulation strategies may be a useful clinical approach to improving compression garment adherence in those who are sensory over-responsive after burn. Further research is needed to gather perceptions from burns therapists, and to implement and evaluate the effectiveness in clinical practice.

Purpose: To examine associations between post-stroke participation and personal factors, including demographic characteristics, self- and threat appraisals, and personality variables. Methods: An exploratory cross-sectional study with purpose-designed survey was completed online or via mail. The survey was comprised of demographic and health-related questions and multiple questionnaires, including the Stroke Impact Scale Version 3.0 (SISv3) (participation/perceived recovery), Community Integration Questionnaire (CIQ) (participation), Head Injury Semantic Differential III (pre- vs post-stroke self-concept/self-discrepancy), Appraisal of Threat and Avoidance Questionnaire (threat appraisal), Life Orientation Test – Revised (optimism) and Relationships Questionnaire (adult attachment style) that measured variables of interest. Sixty-two participants, aged 24–96 years who had experienced a stroke (one or multiple events) and had returned to community living, completed the survey. Associations were examined using correlations, and univariate and multiple linear regression analyses. Results: Regression analysis showed that greater participation, measured using the CIQ, was associated with younger age, female gender, lower self-discrepancy and higher perceived recovery, explaining 69% of the variability in CIQ participation. Further, greater participation on the SISv3 was associated with lower self-discrepancy and higher perceived recovery, explaining 64% of the variability in SISv3 participation. Conclusions: Results indicate that personal factors, particularly self-appraisals like self-concept/self-discrepancy, in combination with perceived recovery may be important in explaining a large portion of variance in post-stroke participation. Specifically, findings highlight the interrelatedness of self-concept change, perceived recovery and post-stroke participation. Further longitudinal research is needed to clarify the directionality of these associations throughout the hospital-to-home transition.

Introduction: Incorporation of animal-assisted services is an emerging field of occupational therapy practice. While the owner–dog relationship is an important component supporting positive outcomes, pets also represent an added responsibility, with pet care a little-understood role for occupational therapists. The present study drew on attachment theory to investigate associations between owner attachment pattern, care of the dog, relationship with and closeness to the dog and perceptions of the dog’s personality. Method: Participants ( N = 97) completed an online survey using standardised measures. Results: Quality of the relationship with the pet dog was associated with the level of care provided to the dog, with stronger relationships associated with higher levels of care. While owner attachment pattern was not directly linked with the care provided to the dog, it was related to distress at being separated from the dog and perceptions of the dog’s personality. Conclusion: The present study supports existing findings that an attachment bond is present between owner and dog, and that this bond is linked with the care provided to the dog. Occupational therapists may facilitate the developing relationships between dog owners and their dogs, as well as supporting care of the dog, to optimise outcomes for both.

Objective There is emerging evidence that individual levels of sensory sensitivity may impact treatment outcomes for people recovering from burn injuries. For example, individuals with higher levels of sensory sensitivity were less adherent with compression garment wear, often used for scar management. The purpose of this study was to characterise sensory patterns for a sample of burn-injured patients as a cohort, using normative data as the reference. As different patterns of sensory processing can have implications clinically, understanding this at the cohort level may provide valuable insight for therapy. Method This was a secondary analysis of data collected during a cross-sectional study. Adults (N=117) attending the Professor Stuart Pegg Adult Burns Unit outpatient clinic completed the Adolescent/Adult Sensory Profile and the following quantitative sensory tests: two-point discrimination; mechanical detection threshold; and pressure pain threshold. Results Compared to matched normative data, burn-injured patients reported higher levels of sensory sensitive and avoiding patterns, and experienced lower detection thresholds for touch and pain. Conclusions Higher reports of sensory sensitivity and sensory avoiding, and lower thresholds for touch and pain, have been correlated with tactile defensiveness. Tactile defensiveness has been associated with social withdrawal and isolation, all of which could contribute to decreased engagement in therapy. The ways in which these sensory characteristics impact on burn-related treatments, such as compression garment adherence, warrant further investigation.

Australian guidelines and policies recommend the use of sensory approaches in mental health care. Nevertheless, many Australian psychiatric units report difficulty sustaining these approaches. To inform efforts to close the gap between recommendations and practice, the aim of this study was to understand the patterns of use of sensory approaches and what demographic and clinical factors influence their use, across one health region in Queensland, Australia.Using a cross-sectional survey design, a custom-designed questionnaire was distributed via email and in paper form to health professionals and peer support workers working in acute, secure, and community care psychiatric units across one health region. Information on demographics and the use of various sensory interventions was gathered utilising both open-ended and Likert scale questions.Useable questionnaires were collected from 183 participants from various disciplines (77% nursing). The majority reported using sensory approaches with a limited number of consumers, and almost 9% never used the approach. Activity-based sensory interventions and sensory equipment were most often used, whereas sensory assessments, sensory plans, and sensory groups were least used. Sensory interventions were mainly used to reduce consumer anxiety and agitation and to assist with emotional regulation. Factors positively correlated with frequency of use for all interventions were discipline (occupational therapy); working in an acute inpatient unit; and training in sensory approaches. Age was negatively correlated with frequency of use only for weighted modalities.This study revealed that sensory approaches were used by most staff though with a limited proportion of consumers in psychiatric units in one large metropolitan health service. It provides insights into the factors influencing frequency of use, highlighting the importance of training in sensory approaches and access to occupational therapists. With this knowledge, we can work towards closing the gap between recommendations and the practice of sensory approaches.

Introduction A core tenet of occupational therapy is that engagement in meaningful activities is integral for a person’s health and wellbeing. Childhood adversity can have lifelong impacts on physical and mental health; however, the effects of childhood experiences are dependent on the presence of susceptibility factors, including sensory processing sensitivity. To date, the effects of childhood adversity and sensory processing sensitivity have not been investigated for meaningful activity engagement. This study seeks to determine whether childhood adversity is related to engagement in meaningful activities in adulthood and whether this relationship is moderated by sensory processing sensitivity. Method Using convenience snowball sampling, a cross-sectional online survey was conducted with 328 adults. Participants completed a battery of questionnaires, including the Risky Families Questionnaire, Highly Sensitive Person Scale and Engagement in Meaningful Activities Scale. Results Correlational analyses found that childhood adversity was related to significantly less meaningful activity engagement in adulthood, but this relationship was not moderated by sensory processing sensitivity. Conclusion This study showed, for the first time, that a history of childhood adversity is linked to less engagement in meaningful activities in adulthood. While further research is needed, supporting meaningful activity engagement may be necessary for adults who experienced childhood adversity.

Introduction Autonomic nervous system functioning is theorised to underpin individual differences in sensory processing, with a small amount of supporting evidence. Despite recognition of the need to measure the balance between sympathetic and parasympathetic activity, most studies have measured only one of these systems. This study investigated whether sensory processing patterns are related to autonomic balance for young adults at rest and in response to a sensory-based stressor. Method In this cross-sectional laboratory study, 100 young adults completed the adolescent/adult sensory profile. Heart rate variability and pre-ejection period were recorded before, during and after a coldpressor task. Results Relationships between sensory processing patterns and autonomic balance varied by gender. In males, low sensory thresholds were generally related to a state of reciprocal sympathetic activation. In females, low thresholds were associated with greater autonomic reactivity in response to the coldpressor. Conclusion This study showed, for the first time in young adults, that sensory processing patterns may be linked to patterns of autonomic balance. Therapists should be aware that young men with low sensory thresholds may be more likely than others to exhibit a resting state of sympathetic hyperarousal and further research should investigate whether this impacts their daily functioning and wellbeing.

Young adulthood is a period of rapid occupational role development. While the impact of a cancer diagnosis at this time is likely to be substantial, little research has addressed this topic. The aims of this study were to gain insights into the impact of cancer on occupational roles throughout the cancer disease trajectory, from diagnosis to the palliative stage, for one young person.A longitudinal case study design was used. Five semi-structured interviews, layered with photo elicitation, were conducted over 3 years. Qualitative data were analysed thematically.Three themes emerged: the adjusted plan, establishing rules, and damage control and self-preservation. Challenges impacting participation in, and meaning of, and the occupational roles themselves shifted over time.Findings provide knowledge of occupational adaptation, and the reconstruction of occupational role identity and participation, of the young adult living with cancer along the disease trajectory.

Rationale, aims and objectives Generalists manage a broad range of biomedical and biographical knowledge as part of each clinical encounter, often in multiple encounters over time. The sophistication of this broad integrative work is often misunderstood by those schooled in reductionist or constructivist approaches to evidence. There is a need to describe the practical and philosophically robust ways that understanding about the whole person is formed. In this paper we describe first principles of generalist approaches to knowledge formation in clinical practice. We name the Craft of Generalism. Methods The newly described methodology of Transdisciplinary Generalism is examined by skilled generalist clinicians and translated into skills and attitudes useful for everyday generalist person-centred practice and research. Results The Craft of Generalism defines the required scope, process, priorities, and knowledge management skills of all generalists seeking to care for the whole person. These principles are Whole Person Scope, Relational Process, Healing Orientation, and Integrative Wisdom. These skills and attitudes are required for whole person care. If any element of these first principles is left out, the resultant knowledge is incomplete and philosophically incoherent. Conclusions Naming the Craft of Generalism defines the generalist gaze and protects generalism from the colonization of a narrowed medical gaze that excludes all but reductionist evidence or constructivist experience. Defining the Craft of Generalism enables clear teaching of the sophisticated skills and attitudes of the generalist clinician. These philosophically robust principles encourage and defend the use of generalist approaches to knowledge in settings across the community - including health policy, education, and research.

Background Substance use disorders (SUD) and trauma histories in adults have been linked with sensory processing patterns that are significantly different from the general population. Nevertheless, no studies have investigated sensory patterns, or the variables with which they are related, in youth with SUD. This study aimed to compare sensory patterns of this sample with normative data and consider associations between sensory patterns and: substance use, trauma, quality-of-life, mental and physical health. Methods A cross-sectional quantitative research design was employed with a sample of 87 young people (mean age = 20.8 years) with SUD voluntarily attending a specialist youth outpatient alcohol and other drug (AOD) service. For participants, the Adolescent Adult Sensory Profile was added to measures routinely collected at the service. Results Participants’ sensory processing patterns for low registration, sensory sensitivity, and sensation avoiding were significantly higher than the normative population, while sensation seeking was both lower and higher. Ninety-one percent reported atypical scores on one or more sensory patterns. High rates of probable Post-Traumatic-Stress-Disorder (PTSD), psychological distress, and low quality-of-life were also reported, which were meaningfully related with sensory patterns. Conclusion Young people reported complex combinations of sensory processing patterns, with comorbid probable PTSD, psychological distress, and low quality-of-life. Findings reflect studies with adult AOD, trauma, and other clinical conditions, and highlight the potential value of screening for sensory patterns and applying transdiagnostic approaches which simultaneously address substance use, mental health, trauma and sensory needs to optimize outcomes for young people with SUD.

The ability of parents to read children’s cues and respond sensitively underpins the effectiveness of early interventions. Allied health practitioners, however, typically spend little time focussin...

Introduction: Sex has been recognised as an activity of daily living, and sexuality as an important part of our identity, with implications for our self-esteem and quality of life. Although this brings sex and sexuality within the scope of occupational therapy practice, empirical and anecdotal information suggests that neither are routinely included in therapy. The aim of this study was to investigate the experiences of therapists who are comfortable addressing sex and sexuality in practice, with a view to influencing future research and practice. The research question posed was as follows: “What can we learn from occupational therapists who successfully address the area of sexuality in everyday practice?”. Methods: Interpretative Phenomenological Analysis (IPA) was used to explore the research question. Semi-structured interviews were conducted with 11 Australian occupational therapists who were purposively recruited. Interviews were audio-recorded, transcribed verbatim, and analysed following the guidelines for IPA data analysis. Results: Four master themes and five sub-themes emerged from the analysis and are discussed under the following headings: sexuality matters; know your boundaries; just do it; and seek support and mentoring. The themes provide insight into how occupational therapists successfully integrate sexuality into everyday practice. Conclusion: According to the participants in this study, addressing sex and sexuality during therapy is part of providing holistic client-centred care. With clear personal and professional boundaries, occupational therapists can address sexuality within routine practice utilising core occupational therapy skills, such as communication, collaborative problem solving, pacing, positioning, and adaptive equipment. Furthermore, participants demonstrated that this can be done within a range of settings. It starts with a commitment and the motivation to find a way.

Maternal–fetal attachment (MFA) describes the thoughts, feelings, and behaviors of a pregnant woman toward her unborn baby. With MFA increasingly seen as an important predecessor of future outcomes, understanding the factors associated with MFA may reveal targets for treatment, potentially optimizing outcomes for mothers and infants. The primary aim of this research was to examine associations between MFA and maternal sensory and attachment patterns, when controlling for psychological distress. The secondary aim was to compare MFA and distress for women with and without previous perinatal loss. Pregnant women (N = 108) were recruited from two antenatal clinics at an Australian maternity hospital. During pregnancy, participants completed the Maternal Antenatal Attachment Scale, Adolescent/Adult Sensory Profile, Mental Health Inventory-38, and Attachment Style Questionnaire. Hierarchical linear regression models, controlling for psychological distress as the second step, were performed. Final models revealed that more favorable quality of MFA was associated with lower sensory sensitivity and higher sensory seeking. More time spent in MFA was associated with younger maternal age and higher levels of maternal sensory seeking. Women with previous perinatal loss had more distress but similar levels of MFA compared to women without loss. We provide the first evidence of links between MFA and maternal sensory patterns, and further elucidate links between adult attachment and mental health in women with and without previous perinatal loss. Consideration of maternal sensory patterns, adult attachment, and mental health status antenatally may inform new directions for services seeking to facilitate the relationship between a mother and her unborn baby.

Although adolescents experiencing mental illness lack trust in others, potentially influencing their help-seeking behaviors, no broad review of trust in adolescents living with mental illness exists. This scoping review examines what can be learned about interpersonal trust from adolescents living with mental illness. More specifically, the aim of this study was to investigate reports from adolescents with mental illness regarding: (1) factors they perceive influence their trust, (2) factors statistically associated with trust, and (3) interventions that support trust. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Articles were identified through database and hand searches, with 89 of the 2010 identified articles included. Frequency counts and content analysis revealed several factors which fostered trust e.g., worker reliability. Trust was associated with protective factors such as quality of communication, and negatively with mental illness. Thirteen articles reported on trust outcomes of interventions, with most reporting positive outcomes. This review revealed adolescents’ perceptions of factors associated with trust, which may assist carers/professionals to build trust with them. Research is needed into links between trust and the quality of adolescents’ communication, and interventions targeting trust in adolescents with mental illness.

Introduction Whilst it is recognised that cancer may present numerous challenges for the adolescent or young adult during treatment, experiences after this stage as the young person transitions to life without cancer have received little attention. The purpose of this study is to understand the implications of having survived cancer for the young person’s choice of, and participation in, meaningful occupational roles. Method In this qualitative descriptive study, four participants were interviewed on two occasions using semi-structured interviews, with the subsequent interview supplemented with photo elicitation. Participants were male and female, aged 19 and 24 years, and medically cleared of (living beyond) cancer. Thematic analysis was used. Results Three main themes emerged: changes in relationships; moving beyond; and future perspectives. Adolescents and young adults identified the impact of the cancer experience on interpersonal relationships and related occupational roles (for example parenthood), and described how cancer affected their participation in, and the meaning of, occupational roles, and altered present and future occupational priorities. Conclusion Having cancer as an adolescent or young adult has lasting impacts on occupational roles. Understanding the opportunities and challenges this population may face when living beyond cancer can assist in providing enhanced age-aware occupational therapy, potentially optimising outcomes for young people.

Background: Adolescence and young adulthood are periods of increased substance use, with insecurely attached individuals at greater risk of abusing substances. With recent evidence linking insecure...

Decreased participation and life satisfaction are common post-stroke. Exploratory studies have indicated associations between these outcomes and personal factors. Information remains limited and experiences of people with stroke are not well-represented or understood. The aim of this study was to explore how personal factors influence experiences of participation and life satisfaction for people with stroke living in the community. Qualitative in-depth semi-structured interviews were conducted with eight participants living in the community post-stroke, chosen purposively based on participation and life satisfaction levels. Data were interrogated using interpretative phenomenological analysis. Three themes were identified: (1) What does participation mean to me? (2) Looking forward or looking back, and (3) Appraisals, avoidance, and “getting on with it”. The first acknowledged the multifaceted nature of participation, although it was typically viewed as incorporating active involvement and social interaction. The additional two themes explored impacts of pre/post-stroke self-discrepancies and threat appraisals on participation and life satisfaction outcomes. Relationships between participation and personal factors seem to be bidirectional. Life satisfaction appeared to be influenced by rumination on negative self-discrepancies based on difference in pre/post-stroke participation. Findings suggest there may be value in examining the influence of personal factor-related interventions on post-stroke outcomes.

Identification of prenatal characteristics that predict later infant development may afford opportunities for early intervention, potentially optimizing childhood development outcomes. The aim of the present study was to examine the effects of selected prenatal factors (maternal–fetal attachment, maternal adult attachment, maternal well-being, and previous perinatal loss) on later infant development. Pregnant women were recruited from two antenatal clinics at one tertiary hospital and asked to complete self-report questionnaires. The Bayley’s Scales of Infant and Toddler Development were then completed one to two years after their baby’s birth. Independent samples t-tests, correlational analyses, and multivariate linear regression models were conducted. Results from 40 dyads revealed that more favorable maternal–fetal attachment, more secure/less anxious maternal attachment, and higher maternal well-being predicted maternal reports of infant adaptive behavior regardless of previous perinatal loss. Infants of women without perinatal loss scored higher in external observer-rated cognitive development compared to infants of women with previous perinatal loss. While further research is required, findings indicate that a mother’s well-being and her relationship with her baby during pregnancy contributes to positive perceptions of her infant’s daily living skills. Supporting the parenting of women with perinatal loss is required to, in turn, promote optimal cognitive development in infants.

Palliative Care Australia suggests current needs (emotional wellbeing, understanding of cancers impact on relationships, everyday activities, and life milestones) for adolescent and young adults in palliative care are unmet due to a lack of age-specific palliative care facilities in Australia. This includes the provision of occupational therapy that can impact these unmet needs. Although the occupational therapy role in palliative care has been documented, little is known about existing occupational therapy services or occupational needs for young people with palliative care needs. The aims of this study were to obtain occupational therapists insights of working with this population in Australia regarding (1) gaps in palliative care services for this population; (2) facilitators and challenges to providing occupational therapy for this group; and (3) perceived occupational needs of young people living with a life-limiting cancer diagnosis.Using snowball sampling, an online survey was distributed to occupational therapists with experience working in palliative cancer care with adolescents and young adults. Available for 6 weeks, the survey included demographic, work history, and service delivery questions. Forced-choice questions were summarised descriptively, and content analysis was used to analyse free-text data.Eleven completed surveys were returned. Overall, therapists perceived current palliative care services for this population within Australia to be lacking. Two gaps emerged: age-appropriate facilities and gaps in provision of psycho-social and occupational therapy services. Funding, lack of knowledge of the occupational therapy role, and professional confidence were highlighted as challenges to practice. Main occupational needs related to maintenance of as "normal" a life as possible: maintaining occupational role engagement, continuing connection with others, and being heard regarding their occupational needs.Findings suggest a need for service changes, including custom-designed facilities, improved funding, training and mentoring, to support age-appropriate and occupation-focussed care for the young person in cancer-specific palliative care.

Effective parent functioning is a key predictor of functional outcomes for children with persistent pain. It is therefore important to identify factors that support or limit functioning in parents of these children. Child and parent attachment and child sensory processing patterns have been identified as risk-factors for parent functioning in healthy samples. Our study extends current research by examining whether parent and child attachment patterns and child sensory processing patterns are related to parent functioning in families of children with persistent pain. Using a cross-sectional design, data was collected at a tertiary pain management clinic from 98 parent-child dyads (i.e., a child or adolescent with persistent pain and one parent). Standardized questionnaires were used to assess parent and child attachment patterns, child sensory processing patterns, child pain intensity, and eight domains of parent functioning. Regression analyses revealed that parent attachment avoidance was significantly related to poorer overall parent functioning and three functioning domains: depression, partner relationship, and leisure. Child attachment avoidance was related to higher parental strain and the use of fewer protective parenting behaviors. Parent and child attachment anxiety and child sensory processing patterns were not significantly related to parent functioning. Findings suggest that parent and child attachment avoidance warrant further consideration with regards to parent functioning in clinical settings where children present with persistent pain. This may aid in identifying parents who are at-risk of poorer functioning and could guide the use of attachment-informed interventions for families of children with persistent pain.

Accumulating evidence linking pain with both attachment and sensory processing variables introduces the possibility that attachment- and sensory-informed strategies may modify pain experiences. The aim of this study was to investigate this proposition using an experimentally induced pain procedure. Pain perceptions of individuals using either a sensory-informed (weighted modality) or an attachment-informed (secure base priming) coping strategy were compared with those of individuals using no designated coping strategy. An independent measures experimental study design was used with a convenience sample of 272 pain-free adults. Experimental participants (n = 156) were randomly allocated to either an attachment (n = 75) or a sensory (n = 81) intervention group. Data from these participants were compared to those of 116 participants involved in an earlier cold pressor study in which no coping strategy was used. All participants completed the same sensory, attachment, and distress questionnaires and participated in the same cold pressor pain test. ANCOVAs revealed that participants in the sensory- and attachment-informed intervention groups reported significantly higher pain thresholds than the control group. Participants allocated to the sensory group also reported higher pain intensity scores than the control group. There were no significant differences in pain tolerance between the three groups after controlling for covariates. While further research is required, findings encourage further consideration of sensory- and attachment-informed strategies for people anticipating a painful experience.

While mental health care needs have increased during the global pandemic, access to care has been reduced. Easily accessible alternative interventions may supplement existing mental health services to meet the increased need of mental health care. Our review explored the evidence of two alternative interventions, religious/spiritual (R/S) singing and R/S movement (dynamic meditation and praise dance), in relation to mental health outcomes.After registering with PROSPERO (CRD42020189495), a systematic search of three major databases (CINAHL, MEDLINE, and PsycINFO) was undertaken using predetermined eligibility criteria. Reference lists of identified papers and additional sources such as Google Scholar were searched. Quality of studies was assessed using the Mixed Method Appraisal Tool (MMAT). Data was extracted, tabulated, and synthesised according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines.Seven of the 259 identified studies met inclusion criteria. Three studies considered R/S singing, while four considered R/S movement. In R/S movements, three studies considered dynamic meditation while one investigated praise dance. Although moderate to poor in quality, included studies indicated a positive trend for the effectiveness of R/S singing and movement in dealing with mental health concerns.While R/S singing and R/S movement (praise dance and dynamic meditation) may be of value as mental health strategies, findings of the review need to be considered with caution due to methodological constraints. The limited number and poor quality of included studies highlight the need for further quality research in these R/S practices in mental health.

Positive perceptions of pregnancy are associated with better postpartum outcomes, including stronger relationship with baby. Although better self-reported emotional availability (EA-SR) is associated with greater attachment security with infants, research has not yet explored the relationship between prenatal maternal factors and EA-SR. The aim of the study was to explore the associations between prenatal variables (adult attachment, shame, compassion) and EA-SR at 3- and 6-months postpartum. A cross-sectional survey design based on a convenience sample of pregnant Australian women completed the survey at three time points: pregnancy (3rd trimester, n = 133), and again at 3- (n = 65) and 6-months (n = 40) postpartum. Five, 5-step, hierarchical multiple regressions revealed the model (mean maternal age/prenatal attachment/shame/compassion/psychological adjustment) significantly explained 62% in self-reported maternal hostility, 53% in self-reported child involvement, and 52% in self-reported mutual attunement, at 6-months postpartum. Higher levels of prenatal internal shame were related to less self-reported child involvement (p = 0.04), and more self-reported maternal hostility (p = 0.03), at 3-months postpartum. More prenatal giving compassion was associated with better self-reported affect quality at 3- (p = 0.01) and 6-months postpartum (p = 0.01), and less self-reported hostility (p = 0.02) at 6-months postpartum. Greater understanding of the relationship between prenatal factors and EA-SR may help enhance prenatal care pathways to support women and families at risk of adverse postpartum outcomes.

Background. Increasingly, occupational therapists are working with women in the perinatal period, including supporting the developing mother-child relationship. Purpose. To examine prenatal predictors of maternal-infant attachment (maternal-fetal attachment, sensory patterns, adult attachment, perinatal loss, and mental health) that may provide possible avenues for assessment and intervention by occupational therapists. Method. Women (N = 60) were assessed during pregnancy and within one year postpartum in a cohort study. Independent t-tests, correlations, and multivariate regression models were conducted. Findings. Low threshold maternal sensory patterns, more insecure adult attachment, and poorer quality of maternal-fetal attachment were each correlated with less optimal maternal-infant attachment. Quality of prenatal attachment was the best predictor of overall postnatal attachment in multivariate regression models. Implications. Occupational therapists working in a range of clinical settings (e.g., mental health, substance use, and perinatal care) may work with women during pregnancy to promote their relationship with their developing baby in utero and after birth.

Transdisciplinary research and generalist practice both face the task of integrating and discerning the value of knowledge across disciplinary and sectoral knowledge cultures. Transdisciplinarity and generalism also both offer philosophical and practical insights into the epistemology, ontology, axiology, and logic of seeing the 'whole'. Although generalism is a skill that can be used in many settings from industry to education, the focus of this paper is the literature of the primary care setting (i.e., general practice or family medicine). Generalist philosophy and practice in the family medicine setting highly values whole person care that uses integrative and interpretive wisdom to include both biomedical and biographical forms of knowledge. Generalist researchers are often caught between reductionist (positivist) biomedical measures and social science (post-positivist) constructivist theories of knowing. Neither of these approaches, even when juxtaposed in mixed-methods research, approximate the complexity of the generalist clinical encounter. A theoretically robust research methodology is needed that acknowledges the complexity of interpreting these ways of knowing in research and clinical practice. A conceptual review of literature to define the alignment between (a) the philosophy and practice of generalism in primary care and (b) both the practical (Zurich) and philosophical or methodological (Nicolescuian) schools of transdisciplinarity. The alignment between generalism and transdisciplinarity included their broad scope, relational process, complex knowledge management, humble attitude to knowing, and real-world outcome focus. The concurrence between these approaches to knowing is offered here as Transdisciplinary Generalism - a coherent epistemology for both primary care researchers and generalist clinicians to understand, enact, and research their own sophisticated craft of managing diverse forms of knowledge.

Objective: The aim of this review was to explore the unique contribution of shame (negative evaluation of the self) and guilt (negative evaluation of behaviour) to postnatal psychological symptoms. Background: Although shame and guilt are related to psychological symptoms, the separate effect of each in postnatal psychological symptoms are not yet known. Methods: Seven electronic databases were systematically reviewed for articles on: (1) quantitative measures of shame, guilt, and psychological symptoms (2) in the postnatal period for infants under two years of age (3) published in English. Results: Of the 1,615 articles retrieved using PRISMA guidelines, five met criteria and were analysed independently by two reviewers using the STROBE criteria. In mothers, shame was significantly related to stress and postnatal depression. Shame significantly predicted postnatal depression. Guilt was significantly related to postnatal depression; however, the relationship was substantially reduced when included with shame. In fathers, shame, but not guilt, was significantly related to stress, anxiety, and depression. Conclusion: Shame and guilt are trans-diagnostic phenomena, negatively impacting on postnatal psychological health, and potentially the parent-child relationship. More research is needed to develop awareness of the unique effects of shame and guilt to optimise perinatal intervention.

Importance: Although attachment is associated with sensory modulation among children and adolescents and insecure attachment is associated with pain severity among adolescents, relationships among sensory modulation, attachment, and function have not previously been demonstrated in a clinical sample of children and adolescents with complex persistent pain. Objective: To investigate relationships among sensory modulation, attachment, function, and quality of life (QOL) in a pediatric population with persistent pain. Design: Cross-sectional quantitative design. From October 2015 to July 2017, all children, adolescents, and parents attending a clinic for assessment completed questionnaires and were provided information and consent forms. Those who consented completed sensory modulation and attachment questionnaires. Setting: Tertiary pain management clinic. Participants: Children (ages 8–12 yr) and adolescents (ages 13–18 yr) with persistent pain (pain of >3 mo duration or a specific pain disorder) and the capacity to answer questionnaires independently. Measures: Standardized sensory modulation, attachment, pain intensity, functional disability, and QOL questionnaires. Hypotheses were generated before data collection. Results: Of 152 children and adolescents, 114 children (30 girls, 9 boys) and adolescents (68 girls, 7 boys) met study criteria and consented to participate. Hierarchical multiple regression analyses revealed that sensory sensitivity predicted disability for children and adolescents, and attachment anxiety mediated the relationship between low registration and poorer school-related QOL. Conclusion and Relevance: Behaviors related to insecure attachment patterns provide a mediating pathway from sensory modulation to functional disability; addressing such behaviors clinically may facilitate engagement in daily activities for children and adolescents with persistent pain. What This Article Adds: Results support the need to consider the interactions between sensory modulation and attachment when addressing functional abilities with occupational therapy treatment.

Objective Compression garments are well accepted as routine practice for scar management after burn. In a recent systematic review, six main reasons for compression garment non-adherence were identified including sensory disturbances. To further understand the impact of sensory issues, the aim of the present study is to investigate associations between sensory variables and compression garment wear. Method Adults (N = 117) attending a quaternary adult burns outpatient clinic completed: The Adolescent/Adult Sensory Profile; a custom-designed compression garment wear questionnaire; and three quantitative sensory testing procedures (Two-Point Discrimination, Mechanical Detection Threshold and Pressure Pain Threshold). Results Patients who reported lower Pressure Pain Threshold or Mechanical Detection Threshold, higher acuity for Two Point Discrimination, and higher than average sensory avoiding and sensory sensitivity patterns were less adherent with garment wear. Conclusions Overall, sensory factors assessed using both self-report and quantitative sensory testing were associated with compression garment adherence. This knowledge suggests the value in developing and evaluating sensory-informed treatment strategies to improve compression garment wear.

Clinical guidelines and policies worldwide call for sensory modulation approaches to be incorporated into inpatient mental health care to assist in eliminating the use of restrictive practices. Although increasing evidence shows that these approaches reduce patient distress and the need for seclusion and restraint, sensory modulation approaches have been challenging to implement in many psychiatric units. Implementation strategies can effectively support inclusion of new approaches by addressing potential barriers to change and supporting likely enabling factors. This study aimed to gain a better understanding of the barriers and enablers influencing implementation of sensory modulation approaches in psychiatric inpatient units in one health region in Australia. A qualitative descriptive study design was used, with three focus groups and a total of 15 participants from nursing and allied health disciplines answering questions about the use of sensory modulation approaches. Framework analysis using the Theoretical Domains Framework and thematic analysis was used to analyse data. Overall, participants were positive about the use of sensory modulation approaches, particularly for reducing distress. Four domains (Social Influences; Belief about Consequences; Professional Role and Identify; and Environmental Context and Resources) were identified as the most salient. The key influencing factors were support from peers; beliefs about risks; belief it was part of their role; and availability of resources and materials. Numerous challenges and opportunities related to implementing sensory modulation approaches in mental health inpatient units, identified in this study, provide insights to support effective implementation of these approaches, underpinning more person-centred, trauma-informed, and recovery-orientated care.

IntroductionA growing body of evidence has demonstrated the importance of mentalization for adolescents' psychosocial functioning; however, further research is needed to understand links between mentalization and other socio-cognitive factors. The aim of this quantitative, cross-sectional study was to investigate the relationship between a teen's capacity to mentalize and three attachment-related factors: parent-teen trust, parent-teen communication, and parent-teen alienation.MethodsIn an online survey, 82 (mainly) Australian adolescents (57 female; 23 male; 2 non-binary; mean age 17.09 years) completed: i) The Children's Eyes Test, which measured mentalization; and ii) The Inventory of Parent and Peer Attachment-45, which measured trust, communication quality, and alienation.ResultsIn teens' relationships with both mothers and fathers, trust and communication quality were significantly positively correlated (p = .001) when controlling for age and gender. Both were significantly negatively correlated with alienation (p = .001) with control variables included. Capacity to mentalize did not correlate with trust, communication quality, or alienation in relationships with either mothers or fathers (p ≤ .05).ConclusionsPossible reasons are proposed for why no relationship was found between mentalization and trust, communication quality, or alienation. Implications for future research are discussed.

Socio-economic status (SES) and social supports have been strongly linked with both authoritarian and authoritative parenting styles among parents of children with Autism Spectrum Disorder (ASD) in Western countries. While Indonesia is one of the most heavily populated countries in the world, research focusing on factors associated with parenting style among Indonesian families with a child with ASD is largely absent from the literature. The aim of the present study was to investigate the relationships among SES, social supports and parenting styles among Indonesian parents of children with ASD. One hundred and one Indonesian parents of a child with ASD completed the survey. SES and social supports both emerged as unique predictors of parenting styles for these parents, although the direction of the association with SES was unexpected. For Indonesian parents of children with ASD, lower SES and more supports predicted more authoritative and less authoritarian parenting. This study supports existing evidence for associations among parenting style and social supports, but raises questions about the cultural meanings of these parenting styles for parents with a child with ASD in Indonesia.

Statement of contextRecent empirical evidence demonstrates both insecure attachment and atypical sensory modulation patterns are associated with impaired function for children/adolescents with pers...

Beyond expert suggestions as to the appropriate subject matter for chronic pain assessments, little is known about the actual content of multidisciplinary pain centre (MPC) clinical assessments. The International Classification of Functioning, Disability and Health Low Back Pain Core Set (ICF LBP-CS) provides a universal language to support the consistent description of LBP-related assessments across disciplines within multidisciplinary teams (MDTs). This study sought to map the content of MPC clinical assessments to the ICF to: (1) identify and compare the content of clinical MDT assessments using a cross-disciplinary framework and (2) examine the content validity of the LBP-CS. A qualitative examination of MPC team clinical assessments of chronic low back pain was undertaken. Multidisciplinary team (pain medicine, psychiatry, nursing, physiotherapy, occupational therapy, and psychology) assessments were audio-recorded and transcribed. Concepts were extracted from transcripts using a meaning condensation procedure and then linked to the ICF. Across 7 MDT assessments, comprised 42 discipline-specific assessments and 241,209 transcribed words, 8596 concepts were extracted. Contextual factors (ie, the person and environment), except for physiotherapy, accounted for almost half of each discipline's assessments (range: 49%-58%). Concepts spanned 113 second-level ICF categories, including 73/78 LBP-CS categories. Overall, the findings revealed novel insights into the content of MPC clinical assessments that can be used to improve health care delivery. International Classification of Functioning, Disability and Health-based assessment profiles demonstrated unique contributions from each discipline to chronic low back pain assessment. Finally, users of the LBP-CS can be confident that the tool exhibits sound content validity from the perceptive of MDT assessments of functioning, disability, and health.

This paper provides an introduction to epistemic trust for speech-language pathologists (SLPs). 'Epistemic trust' describes a specific form of trust that an individual places in others when learning about the world, particularly the social world. To date, the relevance of epistemic trust to SLP clinical practice has received little theoretical or empirical attention. The aim of this paper is to define epistemic trust and explain its relationship with parent-child attachment and mentalization which have, in turn, been linked with language development and use. Suggestions are made for ways in which SLPs may encourage epistemic trust in clients, emphasizing the need to establish strong therapeutic alliances. The authors conclude that epistemic trust is an important consideration for SLPs and that further research exploring the relationship between epistemic trust and language skills is needed to better understand the interplay of these variables and inform clinical practice.

Introduction Stress and burnout have been shown to be a concern among mental health professionals in several countries including Singapore, and can affect quality of care and staff turnover. The aim of this study was to examine the effectiveness of a mindfulness program in increasing mindfulness and compassion, and reducing stress and burnout, among mental health professionals in Singapore. Methods The study utilized data from a prospective pre–post study design with follow-up. A total of 37 mental health professionals participated in the program, which was conducted in three cohorts over nine months. The program consisted of six, two-hour sessions offered once a week over six weeks, and used a range of mindfulness techniques to teach participants to cultivate compassionate and non-judgemental attitudes toward their inner experiences. Data were collected at three stages: pre- and post-intervention, and three months follow-up. Assessments considered mindfulness (five facets mindfulness questionnaire), compassion (self-compassion scale-SF and compassion scale), stress (perceived stress scale-10), and burnout (Oldenburg Burnout inventory). Results Participants demonstrated significant improvement in four of the five mindfulness facets (observe, describe, non-judge, and non-react) and in compassion levels, and a significant reduction in stress, following intervention. The gains in mindfulness and self-compassion scores were maintained at three months follow-up. No change was observed for burnout variables. Conclusion Results suggest that mindfulness training was effective in reducing stress and improving mindfulness and compassion, but not decreasing burnout, for this group of mental health professionals in Singapore. Future experimental research with larger samples is warranted to validate the findings of the present study.

Background Emotionally available parent–child relationships are supportive of child health and development. When a child has cerebral palsy, a range of child and parent factors can potentially impact the parent–child relationship; however, little research has specifically addressed this question. The aim of this study is to investigate links between parent–child emotional availability and both child functional abilities and parent distress in a sample of parents and children with cerebral palsy. Methods Twenty-three mothers (mean age 37.3+/−5.7 years) and their children (mean age 4.9+/−3.3 years) with cerebral palsy completed a 20 min videoed parent–child interaction, scored using the Emotional Availability Scales. Parents also completed the Depression Anxiety Stress Scale, the Paediatric Evaluation of Disability Inventory, and the Strengths and Difficulties Questionnaire. Correlational analyses were conducted, and qualitative observations were made. Results Parent–child dyads in which the parent reported depressive symptoms scored poorer on all aspects of parent–child emotional availability. Where parents reported experiencing anxiety or stress, increased parent hostility and decreased child responsiveness was found. There was no relationship between child functional abilities and either parent distress or parent–child emotional availability. Parent sensitivity, structuring, and nonintrusiveness were negatively associated with child peer problems. Both child responsiveness and child involvement were negatively associated with hyperactivity/inattention. Observations of video footage suggested that parent implementation of therapy strategies impacted negatively on parent–child emotional availability for some dyads. Conclusion Findings from this study are consistent with the wider literature showing a link between parental depression and the parent–child relationship and extend this link to the cerebral palsy population. The importance of routine screening for parental mental health problems in early childhood intervention is highlighted by these findings. In addition, this study emphasizes the need to better understand how therapists support parents to implement therapeutic strategies to minimize negative impact on the developing parent–child relationship.

There is evidence for different styles of parenting in different cultures. Authoritative parenting style has been found to be associated with optimum child outcomes in Western countries, while authoritarian parenting is preferred by Asian cultures. However, literature concerning parenting style and parent–child relationships in Indonesia is largely absent, whether for parents of typically developing children or children with a disability. As in most countries in the world, the rate of diagnosis of autism spectrum disorder (ASD) in Indonesia is increasing. This study aims to compare parenting styles, the parent–child relationship and social support in Indonesian parents of children with and without ASD. Based on literature from other countries, it was hypothesized that Indonesian parents of children with ASD would: be more authoritarian, report less positive parent–child relationships and report less social support than comparison parents. Surveys were completed by 101 parents of children with ASD and 101 matched parents of typically developing children. In line with hypotheses, parents of children with ASD reported that they were more authoritarian than parents of typically developing children, who were more authoritative in their parenting. In addition, parents of children with ASD reported higher levels of power assertion and lower positive qualities in their parent–child relationship than parents of typically developing children. Parents of children with ASD also received less support than the comparison group. This study provides an initial picture of parenting, the parent–child relationship and perceptions of social support for parents of children with and without ASD in Indonesia.

This study examined executive function (EF) among preschoolers exposed to maltreatment, and tested whether caregiver practices related to emotion socialization (e.g., reactions to children's emotions; discussion of emotion) moderate the relationship between maltreatment and EF in this period. Participants were (n=107) children aged 4-5 years (M=4.75; SD=0.57; 39% female), with various levels of exposure to maltreatment. Using the Maltreatment Classification System, substantiated reports of maltreatment were coded to produce an index of the multiplicity of abuse subtypes to which children had been exposed. EF was indexed using a composite of scores on three performance-based tests (Happy-Sad Stroop Task; Tapping Test; Dimensional Change Card Sort). Caregivers reported on their use of emotion related socialization behaviors (ERSBs) with the Coping with Children's Negative Emotions Scale. Exposure to maltreatment and ERSBs were both found to account for unique variance in EF, independent of developmental-ecological factors including children's receptive language and maternal depression. Significant interactions between maltreatment and ERSBs were also found to suggest that nonsupportive ERSBs (e.g., punitive reactions to negative child emotion) may amplify the risk for poor EF associated with maltreatment, whereas supportive ERPBs (e.g., expressive encouragement) protect against it.

Evidence suggests that children with fetal alcohol spectrum disorder (FASD) experience challenges across many areas of their daily lives and often require interprofessional supports. Recent studies have emphasized the need for an integrated system of care for children with FASD, incorporating medical, allied health, and education services, to facilitate open communication and support for the complex needs that many children experience. To develop such a system of care, it is important to first understand the impact of FASD on children's functioning during daily activities in different environmental contexts. A critical review of existing research was conducted using a critical interpretive synthesis approach. Results revealed that while many studies discussed impacts at the body functions and structures level of children with FASD, they often did not consider the activity, participation, and environmental factors also contributing to the daily functioning of this population. Several studies discussed caregiver experiences and challenges raising a child with FASD; however, no studies investigated the lived experiences relating to impacts across activities and environments from children's perspectives. In addition, the focus on deficits overshadowed investigation into the strengths of children with FASD, leaving a gap in the picture of their daily lives. Further research is required to determine the strengths that children with FASD demonstrate and the challenges impacting their daily functioning within different environmental contexts. Insights gleaned from such research would support intervention practices to become more holistic and interprofessional.

Objective Up to 40% of adult burn-injured patients are non-adherent with prescribed compression garment wear. The aim of this paper is to systematically review the literature to understand barriers to adherence with compression garment wear. Method Papers were included if they: investigated adults who required compression garment wear for the management of burns scars; focussed on reasons for non-adherence to compression garment wear; and were available in English. The process of meta-ethnography was then followed to synthesise the findings. Results The factors impacting adherence to compression garment wear were grouped into six themes: sensory factors, psychological state, the impact of the garment on the patient’s function, the availability of social support, the degree of choice, and the education provided to patients by their therapists. A model of compression garment adherence was developed detailing how these factors fit within the continuum of treatment for a burn-injured patient. Conclusions Adherence to compression garment wear post-burn injury is a complex, dynamic phenomenon impacted by a range of factors. Findings from this review may inform approaches to support more consistent and/or extended garment wear, potentially improving scar outcomes and quality-of-life. Further research is recommended to investigate how each of the six identified themes impact adherence.