The Change in Executive Functioning of Grade Four Learners Attending an Occupational Therapy Intervention at a Learners-with-Special-Education-Needs School

Abstract

Introduction: Executive functioning refers to the higher-level cognitive abilities required to plan, organise and direct thoughts and behaviour to achieve chosen goals. As executive functioning underpins the individual’s participation in meaningful occupations including education, it is an important treatment focus in paediatric occupational therapy. This is particularly true for children with Attention Deficit and Hyperactivity Disorder (ADHD), learning disorders, Autism Spectrum Disorder (ASD) and more. Various studies have considered the effectiveness of different intervention types to improve executive functioning, but there is still insufficient research in the occupational therapy field. Methods: A retrospective quasi-experimental research design was used to evaluate an occupational therapy intervention programme by determining the change in executive functioning in sixteen Grade 4 learners. The learners were attending a Learners with Special Educational Needs (LSEN) school in Gauteng, South Africa and had various diagnoses such as Cerebral Palsy, Specific Learning Disabilities, Autism Spectrum Disorder and physical disabilities. The Mediated Learning Experience approach was used as the basis for developing the intervention programme. Grade 4 learners attended the intervention group once weekly. The Delis Rating Scale of Executive Functioning (D-REF) assessment was used to determine the change in executive functioning of each Grade 4 learner, as well as for different diagnostic groups. The learners’ academic results were used to determine the association between the change in executive functioning and change in academic outcomes. Results: There were no significant changes in executive functioning scores or academic performance scores from Term 1 to 4. The intervention seems to have addressed severe executive functioning impairments more effectively than only slight executive functioning impairments, with better outcomes in the clinical indices of activity level and impulse control and abstract thought and problem solving. Only slight individual improvement in attention and working memory was indicated. There was no significant change in academic marks of the learners. Learners with an ADHD diagnosis in v conjunction with ASD diagnosis, seemed to have benefitted the most from the intervention. Conclusion: While some improvement was found in individual clinical indices for Grade 4 learners who attended the weekly interventions, scores varied. An individualised approach to addressing executive functioning deficits may be indicated.