Restriction lift date: 2024-09-30
How do children and young people with intellectual and/or developmental disabilities experience the therapy process when engaging with occupational therapists, speech and language therapists, and physiotherapists?
Hynes, Patrick Joseph
University College Cork
Background: The UN Convention on the Rights of Persons with Disabilities (CRDP) was adopted by the United Nations General assembly in 2006 to protect, promote and ensure full equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities. The right of all children to be heard and taken seriously constitutes one of the fundamental values of the United Nations Convention on the Rights of the Child (UNCRC). For children with disabilities the UNCRC applies, confirming the child’s right to have a voice in all matters that affect them. Children with disabilities face barriers to participation and threats to enactment of their rights, including in healthcare settings such as those provided by the disciplines of occupational therapy, speech and language therapy, and physiotherapy. Children with disabilities frequently access these services. These disciplines purport to deliver client centred services in line with human rights. However, little is known about children’s experiences of these therapies as voiced by children themselves. Aim/Objectives: Through the completion of a systematic review of qualitative evidence, this study aimed to explore how children with intellectual and/or developmental disabilities experience the therapy process when engaging with occupational therapists, speech and language therapists, and physiotherapists. Methods: A systematic search of seven databases was undertaken, and included studies were synthesised following the stages of meta-ethnography described by Noblit and Hare (1988). Databases searched were Academic Search Complete, AMED, CINAHL complete, MEDLINE, APA PsycINFO, APA PsycARTICLES, and Social Sciences Full Text (H.W. Wilson). The Preferred Reporting Items for Systemic Reviews and Meta-Analysis Protocols (PRISMA-P) checklist was used to illustrate the research strategy procedures. Searches were limited to English language publications. No limits were applied to date of publication. The Critical Skills Appraisal Skills Programme (CASP) Qualitative Studies Checklist was used to critically appraise the quality of the included papers. Findings: Sixteen studies were included in the synthesis. Four interrelated themes were identified; “Interpersonal experience of therapy”, “Who is in the driving seat? – Children’s experiences of power in therapy”, “The nuts and bolts of therapy: experiencing therapy in the here and now”, and “Making sense of therapy”. Conclusions: The value of qualitative research can be seen in this review due to the rich data that was extracted from a range of qualitative papers. Children with intellectual and/or developmental disabilities described how they experienced therapy sessions. Common experiences included having fun (and a desire for therapy to be more fun) and conversely boredom, discomfort and pain were also commonly experienced. Children described their interpersonal experiences and relationship with the therapist during therapy including their experiences of engagement, communication and trust and their experiences of therapist attunement. Children described how they understood therapy and its purpose, including their experiences of making progress in therapy or achieving outcomes and how therapy related to their view of themselves and their views of ability and disability. Children reported on their experiences of power in therapy, with finding suggesting that therapists often hold power over decisions and goals for therapy, and less frequently children hold power, often regarding smaller decisions. Findings point to the need for occupational therapists, speech and language therapists, and physiotherapists who work with children with intellectual and/or developmental disabilities to further create opportunities for children to be part of the decision-making process and goal setting process. Through interrogation and reflection on their practice, therapists have the potential to be poised for action to utilise a model such as Lundy’s model of participation (Lundy, 2007) to ensure that children experience the full participation in therapy of having their voice heard in all matters that affect them.
Physiotherapy , Children's experience , Therapy , Children's rights , Goal setting , Decision making , Occupational therapy , Speech and language therapy
Hynes, P. J. 2022. How do children and young people with intellectual and/or developmental disabilities experience the therapy process when engaging with occupational therapists, speech and language therapists, and physiotherapists?. MSc Thesis, University College Cork.