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An occupational therapy delineation model of practice is presented, whichguides a multidimensional understanding of the psychopathology of attentiondeficit hyperactivity disorder (ADHD) and its management. Previous researchhas established that occupational therapists lack detailed training or theory inthis field. he delineation model of practice is based on a literature review,clinical e!perience and a consensus study carried out with occupationaltherapists to determine their priorities for the evaluation of, and interventionwith, children with ADHD.

Part " of this article presents the model and e!amines its implications forevaluation and intervention at the levels of child, task and environment. A family#centred assessment and treatment package, based on the delineation model, isdescribed. Part $ of this article will report the results of a multicentre study,which was designed to evaluate the effectiveness of this package.

%ccupational herapy for &hildrenwith Attention Deficit HyperactivityDisorder (ADHD), Part "' a Delineation

odel of Practice

Sidney Chu 1 and Frances Reynolds 2

ntroduction

In the United Kingdom (UK), occupational therapy forchildren with attention deficit hyperactivity disorder (ADHD)is a small field of practice (Chu !!"a), even though #$ ofschool%aged children in the population are affected &y thecondition (American 'sychiatric Association A'A *++ )-.ccupational therapists have much to offer children with

ADHD in facilitating engagement in meaningful tas/s andsuccessful participation in different occupations, &ut lac/holistic models of evaluation and intervention-

In part * of a two%part article, an occupational therapydelineation model of practice is presented, in order toprovide guidelines for understanding the specificpsychopathology and management of this disorder from amultidimensional perspective- 0he model is &ased on an

11aling 'rimary Care 0rust- 2 2runel University, U3&ridge, 4iddlese3-

Corresponding author: Dr 5idney Chu, ' aediatric .ccupational 0herapy 5ervice

4anager, 1aling 'rimary Care 0rust, 6indmill 7odge (1aling Hospital 5ite),

U3&ridge 8oad, 5outhall, 4iddlese3 U2* "1U- 1mail9 sidney-chu:nhs-net

Submitted: # 4ay !!;- Accepted: *" ( !!=) .ccupational therapy for children

with attention deficit hyperactivity disorder (ADHD), part *9 a delineation

model of practice- British ournal of !ccupational "herapy# $%&'(# "= %"?"-

e3tensive literature review, the first author@s clinical

e3perience and the data gathered from occupationaltherapists a&out their priorities for assessment andtreatment (Chu !!#)- 4any strategies are suggestedfor assessing, understanding and addressing theneeds of children with ADHD- 0he application of thismodel is discussed &y descri&ing specific occupationaltherapy evaluation and intervention procedures that aresuita&le for a family%centred assessment and treatmentpac/age- 5ome validation for this model is achievedthrough a multicentre evaluation, which will &e reportedin part of this article-

*ackground information

ADHD is a specific neuropsychiatric disorder (A'A*++ )- Children diagnosed with ADHD appearimpulsive, overactive andBor inattentive to an e3tentthat is unwarranted for their developmental age and isa significant hindrance to their social and educationalsuccess@ (2ritish 'sychological 5ociety *++;, p?)-0here have &een few pu&lished studies descri&ing therole of occupational therapy for children with ADHD

(Chu !!"&), apart from those addressing a sensoryintegrative approach (.etter *+?;a, *+?;&, Cerma/*+??a, *+??&) or a specific treatment method('eterson *++", 6oodrum *++", 5haffer et al !!*)-

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In 1urope and orth America, clinical guidelines have&een pu&lished on ADHD and hyper/inetic disorder formedical, psychological and other health care practitioners(2ritish 'sychological 5ociety *++;, American Academy ofChild and Adolescent 'sychiatry *++=a, *++=&, 0aylor et al*++?, .vermeyer and 0aylor *+++, ational Institutes ofHealth !!!, American Academy of 'ediatrics !!!, !!*,0aylor et al !! )- Although these guidelines are primarily

medically and psychologically &ased, certain assessmentand treatment components are useful for occupationaltherapy practice for e3ample, &ehavioural assessmentprocedures, psychoeducational programmes for parents andthe &ehavioural management of the child- In order tointegrate the use of these components with specificoccupational therapy evaluation and intervention proceduresfor children with ADHD, occupational therapists need tosynthesise relevant information and frame them within anoccupational therapy model of practice- 0he development ofa model of practice for children with ADHD will guidetherapists in the process of evaluation and intervention, andesta&lish the specific role of occupational therapy within amultidisciplinary team-

hat is a delineation modelof practice/

A delineation model identifies evaluation and interventionprinciples for specific groups of clients and can &econceptualised within a &roader professional model thatemphasises the concept of occupation for health

(Kortman *++ )- It &uilds on and integratesinterdisciplinary /nowledge and is applica&le in aparticular field of practice (Kielhofner *++ )- It presentsand organises a num&er of theoretical concepts used &ytherapists in their wor/ (>eaver and Cree/ *++")- A gooddelineation model gives clear guidelines a&out what toassess and how to assess it, and states the goals oftreatment with clear intervention strategies- 0hus, a

delineation model has the dual tas/ of e3plaining a groupof phenomena and guiding practice related to thosephenomena for a specific client group (Dunn !!!)-

heoretical concepts of anoccupational therapydelineation model of practicefor children with ADHD

0heoretical concepts relating to order, disorder andtherapeutic intervention are the primary theoretical coreof occupational therapy- 0hey provide logic, coherenceand rationale for the clinical applications of the model(Kielhofner *++ )- 0he occupational therapy delineationmodel of practice for children with ADHD is &ased on thetheoretical concepts relating to the child, the environment,the tas/, the interaction among these /ey factors and thechild@s participation in different occupations-

>ig- * illustrates the interaction of these factors withinthe proposed model- It helps the understanding of achild@s pro&lems at different levels of dysfunction the

Fig) 1) An occupational therapy delineation model of practice for children with attention deficit hyperacti*ity disorder &A+,+()


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effect of different environmental factors the demandsof the tas/ selected and the child@s level ofparticipation in different occupations, which arepurposeful and meaningful within different situationsand with different levels of family support-

he child with ADHD0he model presented in >ig- * highlights the interaction

&etween the child and his or her environment and tas/s atdifferent levels of functions (that is, neurological,psychological and &ehavioural) &y synthesising differentresearch evidence (as reviewed &y Chu !!"&)-

0heories a&out the neurological &asis of ADHD haveidentified the roles of the frontal%&asal ganglia and dopaminepathways, with impaired functioning resulting in pro&lems ofattention control and &ehavioural inhi&ition (7ou *++;,Castellanos *++=)- 0he &rain functions as a whole9 highercortical processes reEuire the sensory processing functionthat occurs at lower su&cortical levels, and lower su&corticallevels depend on cortical functions for interpreting sensoryinformation (2undy et al !! )- Foeller ( !!*) &roadened theproposed neurological &asis of ADHD to include prefrontal%su&cortical circuits- 0he frontal lo&e, &asal ganglia andthalamus may form a system or loop, which activates andinactivates ascendingBarousal and descendingBinhi&itingpathways (Cummings *++")- 0his conceptualisation lin/s thethree levels of functionsBdysfunctions as interrelatedcomponents in e3plaining the aetiological factors of ADHD-

0his model suggests that we need assessment tools toevaluate the primary &ehavioural features pertaining to

ADHD and also tools to identify the different neurologicaland psychological correlates for the presenting &ehaviouralpatterns- In terms of management, the model emphasisesthat a child with ADHD needs neurological, psychologicaland &ehavioural intervention strategies to supportperformance and promote participation in differentoccupations-

he environment1nvironments are the conte3ts in which children engage indifferent tas/s or occupations, and include the physical andsocial settings (Case%5mith !!*)- Different environmentshave inherent features that can ena&le or disa&le a child@sperformance- Children with ADHD typically have differentsymptoms at different times and in different situations- >ore3ample, some children with ADHD may e3hi&it considera&ly&etter self%control, appropriate &ehaviour and improvedperformance with a teacher who maintains a relatively calmatmosphere, with structured tas/s, well%defined e3pectationsand positive reinforcement for appropriate &ehaviour(Du'aul and 5toner !!")-

5chools that offer relatively effective programmesfor children with ADHD are also strong on organisational

and environmental factors, which include positive attitudestowards and understanding of ADHD, support at authoritylevel, and provision of coordinated intervention throughteams of professional wor/ers (2urcham et al

*++")- 0herefore, it is important to assess differentenvironmental factors that may contri&ute to thepresentation of different &ehavioural patterns inchildren with ADHD- 0he assessment provides a&asis for effective intervention &y addressing thoseenvironmental factors that induce or e3aggerate the&ehavioural patterns of a child with ADHD-

he task demands0as/s are defined as seEuences of actions in whichpersons engage to satisfy either e3ternal societalreEuirements or internal motives@ (Kielhofner *++#, p*!*)-.ccupational therapists classify these tas/s into self%care, schoolBwor/, play and leisure, and socialparticipation (6atson and 7lorens *++=)- 0as/s arerelated to occupations, at particular ages and in specificenvironments (Case%5mith !!*)- 6hen considering thedimension of tas/ demands, varia&les such as the goal,novelty, appropriateness, the level of challenge and theimportance of the tas/, and also the motivation of thechild, are salient- 0he goal of a tas/ is the central /eyfactor- It is critical to identify what the child wants orneeds to do when planning interventions- All this supportsthe need to assess the child@s neurological andpsychological functions, &ehavioural regulation,perceptual%motor functions and other environmentalfactors that may contri&ute to the child@s presentingpro&lems in different tas/s- It also provides the &asis fordifferent management strategies-

0amily supportIt is important to consider the impact of family supportand parental involvement on the child@s &ehaviours(Humphry !! )- 8ecent research has demonstrated thatthe more parents hold informed &eliefs a&out ADHD, theless li/ely they are to use ineffective discipline (reeman !! )- 0his highlights the importance ofappropriate education or information sharing with parentsso that they can interact with and support the child in anappropriate manner, achieving &etter long%term outcomes(Harrison and 5ofronoff !! , HinoGosa et al !! )-

&hild#environment#task balance0he child%environment%tas/ &alance determines thesuccess of occupational performance and participation indifferent occupations- .ccupational performance is aprocess of interacting with the environment according tothe child@s goals or intentions- It refers to the match&etween the s/ills and a&ilities of the child the demandsof the tas/ and the characteristics of the physical, socialand cultural environments (7aw et al *++;)- >or e3ample,if a child with ADHD is as/ed to engage in a tas/ thatover%challenges his or her attention control, this willcontri&ute to an unsuccessful occupational outcome-

Alternatively, if the environment is highly distracting, itwill &e difficult for the child to sustain sufficient attentioncontrol to complete the tas/, even though the tas/ itselfis at an appropriate level for the child-

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0amily#centred care approach

.ccupational therapists recognise that the ultimateoutcome of a child@s development is highly influenced&y the caregiving environment (HinoGosa et al !! )-0hey strive for a colla&orative relationship with parentsand appreciate that the child with ADHD is part of aninteractive family system- .ccupational therapists

wor/ing with children with special needs are part of theformal social support system and are in a position toencourage the family@s efforts to networ/ among friends,family mem&ers and parent groups-

A family%centred approach is demonstrated when thetherapist ena&les parents to &ecome eEual team mem&ers(2rown et al *++=)- A family%centred service recognises thateach family is uniEue that the family is the constant in thechild@s life and that parents are the e3perts on the child@sa&ilities and needs- 0he strengths and needs of all familymem&ers are considered- 0herapists wor/ colla&orativelywith parents to ma/e informed decisions a&out the servicesand supports availa&le, and to empower and ena&le them inthe whole intervention process- 6hen applying theseprinciples to the management of children with ADHD, all theevaluation and intervention procedures adopted should &eframed within a family%centred care approach, as advocated&y 8osen&aum et al (*++?) and Humphry and Case%5mith( !!*)-

2ecause of the comple3ity of the condition, amultidimensional evaluation approach and a multifacetedintervention framewor/ are adopted in the clinical applicationof the model- Different evaluation and intervention

procedures from different treatment approaches (fore3ample, &ehavioural, sensory integrative andpsychoeducational approaches) are integrated into thisdelineation model for children with ADHD- 0he followingsections descri&e the range of evaluation and interventionprocedures and their application, &ased on the principles ofthe family%centred care approach advocated in the model-

ultidimensional evaluation of children with ADHD

1ach child with ADHD has a uniEue constellation ofpro&lems and multiple domains of functioning may &eaffected (6halen and Hen/er *++;)- 0herefore, it isimportant to adopt a multidimensional evaluationapproach (Chu !!"c) in order to determine whether ornot ADHD is present and how it affects the child@sdevelopment and performance in different areas ofoccupation- .ver half of children with ADHD areinfluenced &y one or more of the associated comor&iditiesthat cause additional psychiatric, neurological andlearning pro&lems (0annoc/ *++?, 2rown !!!)- 0hereare also many different conditions that mimic the clinicalfeatures of ADHD (Hill and Cameron *+++)- 0herefore, itis important to ma/e a differential diagnosis and toidentify comor&idity when evaluating children with ADHD-

>ig- illustrates the application of some of theseevaluation procedures within the model and suggests anum&er of relevant standardised scales- Although each of

Fig) 2) Application of the model in the multidimensional e*aluation of children with attention deficit hyperacti*ity disorder &A+,+()


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reatment through education andtraining for parents and teacher

After the completion of the multidimensional evaluation, afeed&ac/ session should &e conducted with &oth parentsand teachers so that they &oth hear the same information- Itis important to set common goals and o&Gectives withparents, teachers and the child- >rom the family%centredcare perspective, sharing information a&out the child@s

condition with the main caregivers is an important aspect ofwor/- 0he research studies reviewed suggested that &ettertreatment outcomes can &e achieved &y improving parents@and teachers@ understanding of the condition (2urcham et al*++", Cor/um et al *+++, Ho a et al !!!, reeman !! ) and &ehavioural management strategies(Co/er and 0hyer *++!, Hinshaw and 4elnic/ *++ , 2ar/ley*++?)- 0he sharing of information can &e achieved &y usinginformation pac/s, seminars and direct consultation withparents and teacher-

reatment through environmentaladaptationDifferent environmental factors may contri&ute to thepresentation of different &ehavioural patterns in childrenwith ADHD and suita&le modification will help to facilitatethe child@s participation in different occupations- Clinicale3perience indicates that for children with ADHD, acalming environment with less stimulation is desira&le tomaintain their attention control and promote self%regulation, such as a classroom with a clear layout and aneutral colour scheme- 0he adaptation of the sensoryand physical environments is considered to &e an

important area of intervention in paediatric occupationaltherapy practice (4c1wen *++!)- 0he therapist needs tohelp parents and teacher to appreciate the e3tent towhich naturally occurring activities and interactionswithin the environment provide the sensory inputreEuired to regulate, or disrupt regulation of, arousallevel, attention control and activity level (6illiamson and

An alone !!*)-It is important to note that reasona&ly consistent,

predicta&le and structured daily routines help children toself%regulate- 0he therapist should introduce the use of avisual timeta&le within the home and classroomenvironments- A visual timeta&le is a visual presentationof a daily schedule on a large piece of paper (Dowdy et al*++?)- It provides a predictive schedule and helps thechild to /now what is a&out to happen- 2eing a&le toanticipate events ena&les the child to move from areactive mode to a purposeful, self%initiated mode of&ehaviour, which, in turn, helps the child to cope moresuccessfully with changes in the environment-

0he therapist should also chec/ otherenvironmental factors in relation to the child@sassociated pro&lems, such as the appropriate

dimensions of chair and ta&le to address poor posturalcontrol, the selection of seating position to addresspotential ocular%motor deficits and the provision of aspecial device to aid efficient handwriting performance-

reatment of the child at theneurological level

As discussed, recent research studies have providedevidence of the association &etween dysfunction insensory modulation and ADHD (4angeot et al !!*,Dunn and 2ennett !! )- 5ensory techniEues may &eeffective in addressing many of the pro&lem &ehaviourscharacteristic of children with ADHD, including inattention,

disorganisation and hyperactivity (2hatara et al *+=?,Kantner and 0acco *+?!, 2hatara et al *+?*)- 0heultimate goal of sensory integrative intervention is tofacilitate a child@s development, self%actualisation andoccupational performance (2undy et al !! )-

In order to address the child@s sensory needs, thetherapist needs to consider how the child@s sensory dietvaries throughout the day (6illiams and 5hellen&erger*++ )- 0he concept of sensory diet@ is &ased on theidea that each individual reEuires a certain amount ofsensory stimulation to &e in his or her most alert,adapta&le and s/ilful state (6il&arger *++#)- 0his ismuch li/e a person@s nutritional reEuirement- >ore3ample, for a child with sensory see/ing &ehaviour,the teacher can assign the child to distri&ute learningmaterials within the classroom so that the child can getthe necessary movement stimulation-

>or therapists who have completed postgraduate trainingin certain specific sensory%&ased techniEues, the Alert'rogramme for 5elf%8egulation (6illiams and 5hellen&erger*++ , *++ ), the 4.819 Integrating the 4outh with 5ensoryand 'ostural >unction (.etter et al *++#) and the0herapeutic 7istening 'rogramme (>ric/ and Hac/er !!!)

can provide effective techniEues in regulating the child@s&ehaviour- 0here are also different sensory modulationtechniEues, which could &e scheduled into the child@ssensory diet programme- 0hese include giving the child deeppressure touch (Krauss *+?=) using late3%free ru&&er tu&ingas a chewy@ (5cheerer *++ ) using a weighted vest(Fanden2erg !!*) and allowing the child to sit on a therapy&all chair while doing his or her schoolwor/ (5chilling et al

!!")- 0he therapist should integrate the use of a visualtimeta&le with a sensory diet programme-

reatment of the child at thepsychological level'sychologically%&ased treatment is usually the roleof a clinical psychologist within the multidisciplinaryteam- 5ome children with ADHD will &enefit fromspecific training in attention and impulse control,and also the treatment of e3ecutive dysfunctions(2ar/ley *++=, Dawson and Juare !! )-

reatment of the child at the behaviourallevelDifferent systematic reviews confirm that &ehavioural

management is an effective treatment for children with ADHD (>iore et al *++", 'elham and Jnagy *+++)- 2ar/ley(*++#) identified *! guiding principles for raising a child with

ADHD- 0hese *! principles highlight the specific

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needs of children with ADHD for e3ample, they needimmediate, freEuent and powerful conseEuences to esta&lish

and maintain desira&le &ehaviour- 0hese guide parents topause &efore reacting to the present misconduct of the child,

use the delay to reflect on the principles and choose a responseto the child that is consistent with these principles-

ADHD places children at serious educational ris/(2ar/ley *++?)- 0herapists can apply the principles of

&ehavioural management and sensory modulation indeveloping a programme of classroom management andenvironmental adaptation- As noted a&ove, the visualtimeta&le with sensory diet activities can &e integratedinto the schedule- 0he teacher can also set up &asicrules of classroom &ehaviour for all children- .thersuggestions include changes in the lesson schedule, theclassroom layout and the seating position of the child-0he guide to classroom interventions accompanying the57I provides e3amples of appropriate interventions forspecific &ehaviours identified in the 57I (Dowdy et al*++?)- 5ome children may also &enefit from a structuredsocial s/ill training programme integrated into the real%lifeenvironment (Juevremont *++", 5heridan et al *++;)-

reatment through appropriate taskselection and remediation ofdevelopmental and functional problemsIn terms of tas/ demands and selection, Lentall (*++")advocated an increase in active participation, the use of a ver&al as opposed to a written response, a focus onthe novelty of tas/s and self%pacing, and also areduction in the amount of seat wor/@ in order to

ma3imise the tas/ performance of children with ADHD- As identified &y 6hitmont and Clar/ (*++;), 2ar/ley

(*++?) and 'ie/ et al (*+++), children with ADHD presenta range of perceptual, language, motor and functionalpro&lems- 0hese pro&lems have a strong impact on thechild@s performance in different tas/s and affect thechild@s successful participation in different occupations-0he presence of these pro&lems could &e part of the

ADHD features or related to comor&id conditions, suchas DCD- 0he therapist should identify the pro&lems andprovide intervention accordingly-

he development ofassessment and treatmentpackages based on the model

0he model suggests a num&er of different evaluation andintervention procedures, a smaller array of which may &eselected to formulate a specific assessment and treatmentpac/age, managea&le within limited resources- 0hepac/age should &e afforda&le, in terms of time and

resources fle3i&le, so as to meet an individual family@s andchild@s needs servicea&le, with clinical procedures appliedin some very concrete ways and practical, so that therapistsdo not need to go through e3tensive training-

0he first author has developed a &asic pac/age &yta/ing into consideration the cost, time, resources andtraining involved- 0he pac/age reEuires the use ofassessment tools that are ine3pensive or readily availa&lein most paediatric occupational therapy departments- 0he&asic rationale is that the assessment tools selected canprovide sufficient information to identify the child@sunderlying dysfunctions and to plan an intervention

programme that is child and family centred-0he pac/age consists of a clinical pathway of *

wee/ly contacts, with a com&ination of clinicappointments and school visits- 0he duration of the

pathway is afforda&le &ecause it is consistent withmost of the pac/ages of care for different caregroups (for e3ample, children with DCD) provided&y paediatric occupational therapy servicesthroughout the countries in the UK (see >ig- )-

0he processes of evaluation and interventionare &ased on the principles of the family%centredcare approach- In the multidimensional evaluationprocess, it is recommended that the therapist usesthe following assessment procedures9*- For the neurological basis of A+,+ , the 5ensory

'rofile (Dunn *+++) and clinical o&servation- For the beha*ioural patterns of A+,+ and the child.s

psychosocial s/ills , semi%structured interview,o&servational assessment and the ADHD 8ating 5cale IF, Home and 5chool Fersions (Du'aul et al *++?)

"- For the en*ironmental factors , semi%structured interview,classroom o&servation and the 5trengths and 7imitationsInventory9 5chool Fersion (Dowdy et al *++?)

- For the child.s tas/ performance# perceptual0motorand functional s/ills , the DCD uestionnaire forparents (6ilson et al !!!) and other perceptual%motor tests

#- nformation from other professionals (for e3ample,child psychiatrist, psychologist and family therapist) isincorporated into the whole evaluation process-

In the multifaceted intervention programme, thefollowing components are advocated9*- ducation of parents and teachers about A+,+

through a feed&ac/ session and also the provision of

information pac/s (


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Fig) 4) Clinical pathway of the assessment and treatment pac/age) &onclusion

4'.C (King et al *++#, *++?) ADHD 8ating 5cale (Du'aul et al *++?)-

- "reatment at the beha*ioural le*el &y integrating appropriate educational management strategies(Dowdy et al *++?), &ehavioural managementstrategies (2ar/ley *++#, *++?) and sensorymodulation techniEues to regulate the child@s&ehaviour, in order to promote his or herengagement in different tas/s at home and school-

#- nhancement of tas/ performance &y remediatingany developmental and functional difficultiesidentified through child%appropriate treatmentstrategies or approaches, such as perceptual%motor s/ills, handwriting s/ills and self%care s/ills-

6ithin the UK, occupationaltherapy for children with

ADHD is a small field of practiceeven though considera&le

num&ers of children are affected-In part * of this two%part article,the authors have com&inedtheoretical information &ased on

data gathered from previousresearch studies, a literaturereview and clinical e3perience,and organised it into anoccupational therapydelineation model of practicefor children with ADHD-

0he model emphasises theinteraction &etween the child, thetas/ to &e carried out &y thechild, and the environment in

which the child carries outthe tas/- In order to achievesuccessful participation indifferent occupations, agoodness%of%fit amongst allthree factors needs to &eachieved- 0he model alsohighlights a new understanding

of ADHD as comple3,multifaceted clusters ofimpairments in the neurological,psychological and &ehaviouraldomains- Jiven the multipledysfunctions involved, amultidimensional evaluationand multifaceted intervention isproposed- A selective family%centred assessment andtreatment pac/age &ased on themodel, yet feasi&le within limitedresources, is descri&ed-

0his model of practice remainsto &e validated- Any assessmentand treatment pac/age developedneeds to &e field%tested in

clinical practice and evaluated- 'art of this article willreport the results of a multicentre research study, whichevaluated the effectiveness of a family%centred assessmentand treatment pac/age &ased on the model outlined a&oveas well as assessing its accepta&ility to parents-

Acknowledgements0he first author would li/e to than/ the College of .ccupational

0herapists in awarding the 2yers 4emorial >und and also the

Hospital 5aving Association in awarding the 'hD 5cholarship

Award !!* for his doctoral study at the 5chool of Health

5ciences and 5ocial Care, 2runel University-


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8eferences American Academy of Child and Adolescent 'sychiatry (*++=a) 5ummary of

the practice parameters for the assessment and treatment of children,

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Child and Adolescent 5sychiatry# -6&'(# *"**%*=-

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parameters for the assessment and treatment of children,

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American 'sychiatric Association (*++ ) +iagnostic and statistical

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hyperacti*ity disorder) ew Mor/9 Kluwer AcademicB'lenum 'ress-

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diagnosis and treatment) nd ed- ew Mor/9 Juilford 'ress, ch- ?-

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a clinical wor/shop) nd ed- ew Mor/, M9 Juilford 'ress-

2eery K1, 2eery A ( !! ) "he Beery0Bu/tenica +e*elopmental "est of

isual0;otor ntegration) #th ed- 4inneapolis, 4 9 C5 'earson-2hatara F, Clar/ D7, Arnold 71 (*+=?) 2ehavioural and nystagmus

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American ournal of !ccupational "herapy# -2# "**%*;-

2hatara F, Clar/ D7, Arnold 71, Junsett 8, 5melt er D

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