The COPM and ASD

In Practice

Making the interview part interesting and getting the child involved is crucial to the successful and valid completion of the COPM.

I find it easiest to begin by having some prior information about the children’s occupations. I get this information by using one of a number of tools, such as a daily log or the Paediatric Activity Card Sort (PACS) (Mandich, Polatajko, Miller, Baum, 2004) to identify potential activities that the child does or wants to do, and is having difficulty doing. Once I have an idea I begin the formal COPM. I sit down, usually on a mat on the floor, or at a table and talk about the activities he/she wants to, or needs to do, but finds tricky. Then we talk about the things he/she wants to get better at and how important these activities are to the child, how good is he/she at doing them and how happy is he/she with the way he/she does these activities.

I find that making the interview part interesting and getting the child involved is crucial to the successful and valid completion of the COPM. With younger children, especially, I find I have to spend time on making sure they understand the major concepts. So I talk with them about things that are important to them, (e.g., their mom, dad, playing with their favourite toy) and things that are not important to them (e.g., eating broccoli, keeping their room clean). Once I am sure they understand the concept “importance”, I explain the rating scale and ask them to circle on the paper. For example, I might say, “You said that playing with your favourite truck is really important to you, so we would give that a ten?” I usually explain the idea of “performance” by talking about “how good are you at doing something” and the idea of “satisfaction” is usually explained as “how happy are you with the way you do this activity”; again making sure to use extreme examples to be clear that they understand the concept and the rating scale. I try to make the scoring fun for the child by using pictures attached to the scales such as this one for example, for the “satisfaction” rating scale:

Example scale for children

Having the child actively participate is also very important. The younger children usually like to circle the number themselves, rather than having me do it. They also like to write the number on a chalkboard or a dry erase board instead of just talking about it.

Robert

Robert Engle is a 6-year-old boy diagnosed with ASD. He was referred by his mother. Mrs. Engel explained that Robert was having motor difficulties that affected his performance at school and at home. She had tried to access services from a community agency but was told the waiting list can take up to a year and half. Since Robert’s impairments were not considered urgent by the various public health care agencies, he was not a priority for community occupational therapists. Mrs. Engel felt that Robert would really benefit from OT, as she had observed an escalation in Robert’s frustration and stress level.

Mrs. Engel observed Robert having difficulties with tying his shoelaces, doing up zippers and buttons, playing soccer, riding his bicycle, socializing with his classmates, printing, and the noise level of his voice. Robert had also identified some of these things as tricky to do. He identified printing, socializing with his classmates and playing soccer, as his goals for OT. Robert had many hobbies including playing with Bionicles®, writing stories, drawing and writing comics, reading comics, and playing on the computer (with parent’s help due to high level of frustration). Robert also enjoyed playing soccer but at times had temper tantrums on the field. Robert’s father was very interested in Robert learning to ride his bicycle so the family could go on bicycle trips.

Robert identified activities that he could do well, activities he wanted to get better at doing and activities that he could not do at all. Robert identified that he participates in most self-care activities with a little assistance from his mom, except for getting dressed where he needs more assistance. Robert said he really enjoyed printing and would like to get better at it. Robert identified a limited repertoire of hobbies and social activities and commented, “sometimes I just get too frustrated.” When asked about sports, Robert explained that he would like to play sports but “when I play I am just no good.” After discussion Robert settled on the three goals (see below).

Once the goals were identified we began a treatment focused on using cognitive strategies to achieve Robert’s goals. As the data above show, Robert made great improvements in all areas. This improvement was corroborated by the mom. The success of this approach was, in part, attributable to identification of appropriate and meaningful goals, using the COPM.

This table illustrates the change in Performance and Satisfaction for each of the prioritized occupational performance problems. (you may need to scroll horizontally to view all the data)

Occupational Performance Problem Time 1 Time 2
Performance Satisfaction Performance Satisfaction
Printing 2 2 7 8
Making friends at school 3 2 9 10
Playing soccer 2 2 10 10
Total Scores: 7 6 26 28
Average Scores (Total Scores / number of problems): 2.3 2.0 8.7 9.3
Change Scores
(Time 2 – Time 1):
Performance Satisfaction
+ 6.4 + 7.3

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