Parts I and II of this series introduced the Cognitive Orientation to daily Occupational Performance (CO-OP), a new approach to intervention that is based on the premise that cognition plays an important role in the acquisition of occupational skills and the development of occupational competency. Developed for use with children who have occupational performance deficits, CO-OP is an individualized, client-centred approach focused on strategy-based skill acquisition. This third paper in this series presents a brief description of the actual CO-OP protocol including its objectives, prerequisites and key features.

Occupational therapists working within School Health Support Services are receiving increasing numbers of referrals, relative to past rates, for children who are experiencing motor problems and may have developmental coordination disorder. Based upon clinical experience, therapists indicate that these children are typically referred in the early school years and that most have handwriting difficulties; to date, however, there has been little empirical evidence to support these observations. In this paper, descriptive information is presented for 556 children who may be presumed to have developmental coordination disorder and who had been referred to school-based health services in two centres. Typical reasons for referral, co-morbidity information, and assessment practices are presented. Findings confirmed the presence of many occupational performance issues in this population, including handwriting difficulties, and challenge therapists to broaden the current scope of school health assessment and intervention practices.

Millions of dollars are spent each year on school-based therapy services, yet little is known about whether these services im-

SUMMARY The process‐oriented treatment (PORA) approach is a time‐limited programme aimed at increasing the kinaesthetic performance of children with mild motor problems in order to improve their motor performance. The approach was compared with a traditional or general motor approach and with no treatment in a randomized clinical trial of 75 children with developmental co‐ordination disorder. The children were assessed before and after treatment and after a six‐week follow‐up period. The results were mixed. The study provides evidence of the severity of so‐called “mild” motor problems of children referred to occupational therapy. The data suggest that these children do not improve spontaneously, and that their motor problems are very resistant to treatment. The data also suggest that an appropriate treatment strategy might be one that involves direct, repetitive training of a specific skill. RÉSUMÉ Essai clinique d'une approche par proce'de' de traitement oriente clwz les enfants avec trouble développemental de la coordination. L' approche par procédé de traitement oriente (PORx) est un programme limité dans le temps visant a accroître les performances kinesthésiques d'enfants présentant des problèmes moteurs modérés pour améliorer les performances motrices. Cettc approche a été compareée à une approche traditionnelle ou globale de rééducation motrice, et avec une absence dc traitement dans un essai clinique distribué au hasard, chez 75 enfants presentant un trouble de coordination. Une évaluation des enfants fut faite avant et après traitement. et après un suivi de six semaines. Les résultats furent miligés. l'étude démontre la gravité des problèmes moteurs des enfants adressés en ergothérapie, appelés à tort légers. Les données suggèrent que ces enfants nc progressent pas spontanément et que leurs problèmes moteurs résistent au traitement. Les données suggèrent également qu'une stratégic thérapeutique appropriée pourrait être cele qui implique un apprentissage direct, répétilif d'une tâche spécifique. ZUSAMMENFASSUNG Ein klinischer Versuch eines Prozeß‐orientierien‐Behandlungsansatzes bei Kindern mit Koordinationsstörungen Der Versuch einer Prozeß‐orientierten‐Behandlung (PORx) ist ein zeitlich begrenztes Programm mit dem Ziel die kinaesthetischen Fähigkeiten bei Kindern mit leichtcn motorisehen Problemen zu steigern und dadurch ihre motorisehen Fähigkeiten zu verbessern. Dieser Ansatz wurde in einer randoinisiertcn klinischen Studie an 75 Kindern mit Koordinationsstörungen mit einer traditionellen oder allgemeinen motorisehen Therapie, sowie ohne Behandlung verglichen. Die Kinder wurden vor und nach der Therapie und nach weiteren sechs Wochen untersucht. Die Ergebnisse waren gemischt. Durch die Studie wird der Schweregrad der sogenannten ‘leichten’ motorisehen Störungen bei Kindern deutlich, denen Beschäftigungstherapie verordnet wurde. Die Daten zeigen, daß sich diese Kinder nicht spontan bessern und daß ihre motorisehen Probleme sehr Therapie‐resistent sind. Außerdem lassen die Daten erkennen. Daß die richti...

This paper is the first in a series of three papers that present the systematic development and evaluation of Cognitive Orientation to daily Occupational Performance (CO-OP). CO-OP is a cognitively based, child-centred intervention that enables children to achieve their functional goals. In Part I, the breadth of literature that provides the theoretical underpinnings for the approach is reviewed. Parts II and III provide a description of the approach and present the evidence to support its use with children with developmental coordination disorder.