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Dyspraxia refers to a condition characterized by difficulty with praxis that cannot be explained by a medical diagnosis or developmental disability and that occurs despite ordinary environmental opportunities for motor experiences (Parham & Mailloux, 2010:349).
Ayres defined the concept of praxis as "the ability to conceptualize, plan, and execute a non-habitual motor act" (Parham & Mailloux, 2010:349). Praxis is also described as an end product of sensory integration and has three basic processes namely ideation, motor planning and execution. Ideation is defined as "the ability to conceptualize what to do in a given situation" (Parham & Mailloux, 2010:332).
In early research done by Ayres, the correlation that exists between praxis, good tactile perception and the development of body scheme was already emphasized (Parham & Mailloux, 2010:349). Later on it became clear that praxis problems (dyspraxia) may be manifested in different forms, not all based in sensory integration functions.
Children who experience praxis difficulties often have problems with ideation. These children would find it difficult to generate ideas of what to do in an unstructured environment. Children with poor ideational abilities struggle with initiating activities that are not goal orientated. This is especially true when no specific instructions are given and they are simply told to play (Parham & Mailloux, 2010:351). Dyspraxia has a tremendous impact on the daily living of a child. All the occupational performance areas (OPA's) of the child are influenced, including personal independence, school, play and interpersonal relationships, as all of these areas are dependant to a lesser or greater degree on the ability of praxis.
Praxis abilities in terms of the execution part are well assessed in the sensory Integration and Praxis Test (SIPT) (Ayres, 1989). There was however no instrument available to assess ideation. Due to a lack of a measuring instrument to assess ideation, Theresa May-Benson developed the Test of Ideational Praxis (TIP). The test involves giving the child a piece of string and asking him to show you all the things he can do with it (May-Benson, 2005:4). This is an easy, affordable and effective way to test the child's ideational ability. However, the norms that have been established by Theresa May-Benson for use in the TIP are not necessarily applicable for the South African population.
As humans, our cognitive development is influenced by our physical environments (Evans, n.d.). Different cultural backgrounds and socio-economic statuses also influence children's development. According to Kheswa (2009:9, 11-12), there is a direct link between socio-economic status during childhood, the child's cognitive development and overall ability. Furthermore, cognitive ability and development are perceived to be central to an individual's capacity to learn, adapt and exploit the opportunities available within his/her environment (Kheswa, 2009:9, 11-12).
The aim of our research is to investigate ideation abilities with regards to the South African population, and specifically the 3-5 year old in middle to high socio-economic school-settings, in Bloemfontein, South Africa.
CHAPTER 2: PRAXIS
OVERVIEW REGARDING PRAXIS
The term sensory integration is of great significance for occupational therapists (OT's) worldwide. The theoretical principles, assessments, and intervention strategies concerning sensory integration was developed by Dr. A. Jean Ayres, an occupational therapist and psychologist whose lifelong research transformed occupational therapy practice with children (Bodison & Mailloux, 2006:1; Parham & Mailloux, 2010:325).
Ayres (1989) have defined sensory integration as "the neurological process that organises sensation from one's own body and from the environment and makes it possible to use the body effectively within the environment" (Kinnealey & Miller, 1993:2). The spatial and temporal aspects of inputs from different sensory modalities are interpreted, associated and unified. Sensory integration is information processing" (Kinnealey & Miller, 1993:2).
Sensory integration is directly linked to a child's everyday functioning and through Ayres's research it allows OT's to comprehend and interpret the emotional, developmental and learning problems that could arise in children (Parham & Mailloux, 2010:325).
Praxis forms an integral part of sensory integration, reflecting the quality of sensory integration (Williamson, Anzalone & Haft, 2010:164). Ayres (1995:91) defined praxis as "the ability to plan and carry out an unfamiliar action" and categorized praxis into three different components namely: (1) ideation, (2) motor planning, and (3) execution (May-Benson & Cermak, 2007:148):
Ideation - the ability to identify the goal (I want to jump down) and having an idea of how to achieve this (standing on the edge of the platform to jump).
Planning (motor) - the ability to plan and organize the sequence of movements necessary for the action, in response to the environment's demands.
Execution - the ability to accurately perform this action in order to achieve the goal.
Ideation is a fundamental step in praxis as it is during this time that a movement goal is identified in order to be able to execute a sought after action. In order to plan a desired action, cognitive knowledge is required - consisting of an objects actions and functions (May-Benson, 2004:25).
Motor planning entails taking your desired action from the ideation phase and plan, order and sequence how the desired action is going to be executed (May-Benson, 2004:26).
Motor execution requires timing and movement through space and consists of 4 types of relationships between the person involved and the environment: (1) Static client/static target; (2) Static client/moving target; (3) Moving target/static client; (4) Moving target/moving client (Gentile, 1987; Koomar & Bundy, 2002 and May-Benson, 2004).
The foundation of praxis is formed by the outcomes of the subcortical sensory processing functions of modulation and discrimination of specific inputs (May-Benson, 2004:24). Sensory modulation involves "the ability to assess sensory inputs for relevance and to respond appropriately" (May-Benson, 2004:24). Sensory discrimination involves identifying and integrating the salient qualities of sensory inputs for skill. This results it the development of body scheme and body awareness, postural abilities, and visual spatial skills necessary for motor performance (May-Benson, 2004:24-25).
Tactile and proprioception inputs are said to be of great importance for praxis, while visual and vestibular inputs are less vital, yet important. A functional level of arousal is needed in order to participate in activities and be aware of sensory input (May-Benson, 2004:24). Sequencing of proprioception and vestibular inputs are also important because it provides the basic foundation for timing, simple muscle contractions and internal rhythm of the body. Rhythmicity affects the level of sensory arousal for optimal modulation and discrimination to take place (May-Benson, 2004:25).
Feedback also plays an important role in praxis. Feedback is "the ability to recognize and respond to the motor act and its consequences" (May-Benson, 2004:25). Feedback relies on internal and external input and consists of the following 3 responses: (1) Production feedback from the body movements itself; (2) Production feedback from an adaptive response to the environment; (3) Outcome feedback based on observable effects of the action on the environment (Reeves & Cermak, 2002; May-Benson, 2004:26).
If a person struggles or has problems with praxis it is known as dyspraxia. "Dyspraxia is a generic term that refers to developmentally based disorders of praxis with a variety of etiologies" (Reeves & Cermark, 2002; Mylonadis, n.d: 2). Dyspraxia establishes in one of the following areas:
General dyspraxia: dysfunction in discrimination of somatosensory and vestibular inputs, with performance problems in motor planning and sequencing.
Somatodyspraxia: decreased tactile discrimination and motor planning problems. Praxis problems with regards to motor planning is manifested in difficulties with performing actions such as imitating gestures and performing various motor tasks (Reeves & Cermark, 2002; May-Benson, 2004).
People experiencing dyspraxia struggle to execute routine activities of daily living such as cooking, self-care, home management and driving. A combination of problems is usually present. A child with problems regarding praxis (developmental dyspraxia) tends to be slow and disorganized. These children may have normal intelligence levels and muscle functioning, but they struggle to link their intellect and muscles with one another (Ayres, 1995:91).
Children with praxis problems are usually clumsy and appear awkward, resulting from a poor body scheme. They can't identify where their bodies are in space and struggle to judge their relationship to objects and people. This causes them to stumble and bump into furniture. Shifting from one body position to another can be difficult. They struggle with sequencing (which may include language) and adapting to activities, therefore tend to prefer the familiar (Parham & Mailloux, 2010:350; Williamson, Anzalone & Haft, 2010:165). They're usually unable to precisely mimic others' actions. They also struggle with performing novel motor activities, often resulting in failure (Parham & Mailloux, 2010:350). Repeated failure causes feelings of frustration, which in turn leads to poor self-esteem. These children's language usage causes them to be viewed as being manipulative and controlling. Their use of language is in fact a mean of compensating for the dyspraxia, distracting and redirecting attention away from the motor disorder (Williamson et al., 2010:164-165).
Children can experience problems with any one or a combination of the three components of praxis (as described above). Children with poor ideational abilities struggle with the formulation of new goals fitting the specific situational demands (Williamson et al., 2010:165). They do not have an idea of what to do during novel situations and tend to be inactive or play in a limited and preservative manner, for example lining up toys (Parham & Mailloux, 2010:350; Williamson et al., 2010:165). If asked to merely play, not giving any instructions, these children are incapable of initiating activity. Any activity that is initiated will be limited, lack a goal and form part of a routine. Typical responses can include wandering, simple repetitive actions (ex. patting/pushing objects around), randomly piling up objects; or observing others (Parham & Mailloux, 2010:350).
From the above mentioned it is clear, that children with dyspraxia struggle with functioning in multiple areas of their occupation. The symptoms stated are just a guideline and not even the most severe cases of dyspraxia result in all of these symptoms being seen. Therefore, this emphasizes the importance of typical praxis abilities in children, in order for them to be fully functional in their daily lives.
CHAPTER 3: CHILD DEVELOPMENT: 3-5 YEARS
Intellectual development refers to the growth of children in such a way that their brain becomes more capable of understanding, analyzing and evaluating concepts to make sense out of the world around them. Intellectual development helps the child to understand their environment and gain knowledge.
According to May-Benson (2007:149), ideation and praxis are important aspects that need to develop in children for them to be considered typically developing. It may also be argued that both these aspects are important factors for establishing school readiness in a child by the age of six.
Ayres (1985:149) specified that the environment plays a vital role in the development of ideation. She stated that "praxis is expressed in a manner which is dependent upon the environmental invitation and demand" (May-Benson 2007:149). Ayres (In May-Benson 2007:148) further emphasized that "ideation or conceptualization is a cognitive function dependent in part on the integration of sensory inputs and resultant knowledge of possible body actions".
Motor planning abilities already start developing after the first six months of a child's development. The infant's manipulative skills start to develop, which enables him to experiment with different objects in various ways. This ability is not matured yet and is evident in the infant's poor tool handling skills - the infant is not able to use eating utensils skillfully at this age (Parham & Mailloux, 2010:331).
Praxis abilities become much more complex during the second year of life. The child has the ability to produce a variety of new ideas for actions and begins to plan actions in a systematic sequence. Motor planning develops alongside body scheme development. Ayres (In Parham & Mailloux, 2010:332) theorized that "as body scheme becomes more sophisticated, so does motor planning ability". A possible explanation being that the child uses his knowledge of his own body to perform unknown tasks (Parham & Mailloux, 2010:332).
By the end of the second year the toddler is able to sequence several pretend actions in play. Ideational praxis also starts to develop during this period which is evident in children's tendency to demonstrate that they have a plan - either verbally or by searching for a required object - before performing a series of actions (Parham & Mailloux, 2010:331-332). This development is made possible by the cognitive ability to use symbols (first through gestures and then vocally), which enables the child to participate in pretend actions and to imagine doing things, including actions that he's never done before.
The emergence of praxis abilities is essential to the development of self-concept. Maturation of sensorimotor abilities occurs during the third through seventh years of life - considered by Ayres as a critical period for sensory integration (Parham & Mailloux, 2010:332). Maturation of sensorimotor abilities is very important for child development, because it forms the groundwork for later, more complex intellectual abilities. Further development of praxis abilities is possible (until approximately 8 years of age) but is less notable (Parham & Mailloux, 2010:332).
Later on in life, as children start engaging in extra-curricular activities, especially sports, their adaptive responses improve. Challenges set by participation in these activities help the children's timing and sequencing abilities to develop even further. They have to conceptualize how to move their bodies successfully in relation to their changing environment (Parham & Mailloux, 2010:332,333).
Ideational abilities are very important for children to participate in everyday life seeing as it "underlines planning, sequencing, and organization of actions" (May-Benson, 2007:152). Ideational abilities influence the quality of children's participation in activities, especially when it comes to new environments or unstructured situations (May-Benson, 2007:152).
CHAPTER 4: SOCIO-ECONOMIC STATUS: MIDDLE TO HIGH
When doing a literature study of the ideational praxis abilities of children, socio-economic status is not one of the first concepts to come to mind. However, this aspect is crucial as it is a variable in this research project as literature suggests a direct relationship between socio-economic conditions and health. Higgs (2002:8) quotes Bollen saying "From a sociological perspective, social class and socio-economic status determine life chances".
Socio-economic status involves many dimensions, including family members' education, occupations and the household's access to goods and services (Angeles and Kolenikov, 2008:1). Hauser and Warren (1996:2) agrees with the above by stating that "socio-economic status is typically used as a shorthand expression for variables that characterize the placement of the persons, families, households, census tracts or other aggregates with the respect to the capacity to create or consume goods that are valued in our society". Therefore socio-economic status may be measured by educational attainment such as university degrees, occupation, income, wealth, or by tangible possessions such as houses, cars or boats (Hauser & Warren 1996:2).
MIDDLE OR HIGH SOCIO-ECONOMIC STATUS
There are no universal guidelines or boundaries which differentiate one socio-economic status from another. In other words there are no fixed rules classifying a person in a specific socio-economic category (based on one's income or possessions). For this reason it seems as though different studies define different parameters according to their own understanding and needs for the research.
The Human Science Research Council (HSRC) (2009:1) did a survey to determine how South Africans view their social class. The research was done on 3305 participants of ages 16 years and older, living in private households. They were asked the following question: "people sometimes describe themselves as belonging to the working class, the middle class, the upper or lower class. Would you describe yourself as belonging to theâ€¦?". Respondents were then offered five ordered response codes: 'lower class', 'working class', 'middle class', 'upper-middle class' and 'upper class' (HSRC 2009:1).
Their results are shown in Figure 1 under 'household income'. Participants with equal incomes viewed themselves as belonging to different social classes. In spite of this, it seems to be generally accepted that someone with a high socio-economic status will have a higher income, better education and live in a wealthier area than the rest of the participants in the research (HSRC 2009:1):
Figure 1: Social class identification by race, educational attainment and income (%)
DETERMINING SOCIO-ECONOMIC STATUS
There are many different ways of determining socio-economic status and research continues to develop new and better methods for measurement. In the United Kingdom the individual or household socio-economic status is traditionally measured using a sophisticated occupation coding regime developed by Meier and Moy (In Higgs 2002:3). In the United States the Census Bureau uses a scoring regime based on occupation, monthly household income and education. In other countries one's household durables are often included whilst there are other indications, namely geo-demographic, that are based in the area in which one lives (Higgs 2002:3).
In South Africa there has always been a high focus on the income and the expenditure of the population. In an attempt to find a broader segmentation basis, the South African Advertising Research Foundation (SAARF) did an extensive analysis of the All Media and Product study's (AMPs) data (Higgs 2002:3). They selected and scored questions on demographic information and shopping habits, finding that it represented a wealth continuum. The principal components analysis reflected that most of the demographic and shopping habits in South Africa are correlated with wealth (Higgs 2002:3).
When choosing a method to determine socio-economic status, it is essential to consider these important factors. The first concern is the level of aggregation issue. For example, is the data used specific with regards to the respondent, household, neighbourhood, suburb, etc? The second area of concern is the actual variables, as shown in the table below (Higgs 2002:13):
Personal shopping patterns
Personal financial holdings
Occupation of main wage earner
Availability of basic services
Availability of infrastructure
Size of community, health, schools
Proportion of students
Proportion of unemployed
Proportion of people under a certain age
Proportion of two-car households
Proportion of immigrants
Level of overcrowding
Type of tenure
Type of housing
Many of the above
GGP per head
Human development index
GDP per head
Table 1: Variables to consider when measuring socio-economic status (Higgs 2002:13).
The variables that are selected depend on the needs of the research. For example: a bank might like to look at the individual's income, occupation and education. In our study we may consider the geographical environment where the child has grown up, as well as the income of the parents. This may determine the availability of new toys, for example a child who grows up on a farm may need to make his own toys out of clay/wire - stimulating ideational praxis. It is important to note the type of toys the child plays with (bought or handmade) and the availability of new toys.
The Kuppuswami scale (Scribd 2005:1) is a widely used to measure socio-economic status of the individual. It was later adapted to be used for a household, by applying it to the family head and the capital income used. The scale is based on education, occupation and income.
Intermediate/Post high school diploma
Type of Occupation
Clerical, shop owner, farmer
Income (Rupees per month)
Less than 5
The most recent method used to determine the socio-economic status of children is to focus on only one adult (male/female) in the house - being the head of the house, or principal earner (Hauser 1994:1542). A socio-economic status is an expression of the person's ability to consume or create goods that are valued in our society. People are then classified into socio-economic categories (high/middle/low) according to their wealth, income and occupations.
As there are no universal parameters for the definition of a category, the research group will have to select or develop a classification tool for the participants, which will be done in collaboration with the Department of Biostatistics from the Faculty of Health Sciences at the University of the Free State.
CHAPTER 5: SOCIO- ECONOMIC STATUS AND CHILD DEVELOPMENT
It is important to look into the effect socio-economic status has on normal development with regards to praxis, as it is an important variable in this study. Socio-economic status is regarded to have a relatively strong influence on a child's normal development. According to Harvinghurst (1971: 110-124) the environment influences a person's development throughout his life cycle and socio-economic status can be a powerful predictor of different behaviors, education and IQ.
It is important to have knowledge regarding the meaning of socio-economic status. High socio-economic families often have more success in preparing their children for school, due to the access they have to a wide range of resources. They can provide their children with high quality child care, toys, books, and various learning activities in school and at home (Socio economic status, 1995: 1).
Occupational therapists recognize the possible influence socio-economic status could have on a person's functioning. They integrate the client's socio-economic background alongside other factors during planning of their intervention (Florey, 1989: 365-369).
Researchers from outside Occupational Therapy also recognized differences in children's cognitive abilities/skills, intelligence, motor planning and motor behavior with regards to socio-economic status. Differences in skill levels were noted among children from different socio-economic backgrounds. Children from upper or middle class backgrounds performed at a higher developmental level than children from lower socio-economic backgrounds. Differences were also found regarding motor behavior (Basavanna& Rani, 1984: 121-128; Golomb& McLean, 1984: 119-125).
A study in the United States was done on 22 children, aged 3-5 years from a lower socio-economic status and was compared with children from a higher (middle to high) socio-economic status on the basis of race, sex, hand dominance, age, height and weight. This study revealed major differences on the Praxis on Verbal Command subtest of the SIPT of those children from higher socio-economic background than those from lower socio-economic backgrounds. The results suggested that children from higher socio-economic backgrounds may function at a higher developmental level than children of lower socioeconomic backgrounds (Bowman & Wallace, 1990: 610-621).The differences found could possibly be ascribed to differences in praxis abilities between the two social backgrounds as well as differences in language which is related to praxis (Heilman, 1973: 861-867).
Bardouille-Crema, Black, and Feldhusen (1986: 841-844) reported that children from higher socio-economic background managed to achieve more mature and abstract levels of reasoning sooner. The high correlation suggests that praxis shares a cognitive element with intelligence and achievement. Ayres (1985: 148) conceptualized praxis as a "kind of intelligence" of action that contributes to human competence.
According to Ayres, Mailloux and Wendler (1987: 93-110) Praxis on Verbal Command subtest is dependent on language skills, comprehension, memory and somatopractic function abilities. Taking this into consideration, they reported strong correlations between praxis and language skills. They acknowledged the fact that children from middle to high socio-economic backgrounds might have had a greater chance to experience a broader spectrum of ideation and tactile stimuli. With further inquiry in the study it was revealed that the children from middle to high socio-economic backgrounds participated in extra-curricular activities such as gymnastics, swimming and ballet on a daily to weekly basis. This could have been the reason for the difference.
Thus, the children from the middle to high socio-economic background might possibly perform significantly higher in creating new ideas of motor actions. These children's language skills and comprehension will help in the verbalization of actions.
Taking the above mentioned literature and research into consideration the researchers is thus curious to investigate the ideation abilities of 3-5 year old children from middle to higher socio- economic settings.
CHAPTER 6: OCCUPATIONAL THERAPY AND CHILD ASSESSMENT
Occupational Therapy is focused on enabling the client to participate in occupations and fulfill their different life roles (Baum, Dunn & Law, 2005:339). During evaluation assesses the client's occupational performance needs are assessed and obstacles that hinder optimal participation are also identified (Baum, Dunn, & Law, 2005:339). Information gathered in assessments can be used for different purposes, including: identifying specific problems and strengths; determining if further assessment is necessary; planning intervention; measuring progress; evaluating efficiency of intervention; establishing a therapeutic relationship; and for further research purposes (Asher, 2007:12 & Baum, Dunn & Law, 2005:341).
There are different methods of assessment. These methods may be used separately or in combination. As it is difficult to assess the preschool child, it is recommended to use more than one assessment method (Parham, 1987:35). These methods include: (Asher, 2007:13-14; Baum, Dunn & Law, 2005:346; Stewart, 2010:194,197 and Richardson, 2010:216):
Record review: the history of the client is studied through gathering data from files or collateral information from caregivers, family and multi-disciplinary team members,
Interviews or questionnaire: Information is collected from the individual through written or verbal questioning,
Observation: Professional knowledge and expertise is used to observe behaviors and construct hypotheses about the outcomes of behavior,
Informal measures: Tools that were designed for specific use e.g. checklist,
Screenings: Tests that determine if further evaluation is needed. There are various standardized and non-standardized screenings available,
Standardized tests: These tests have uniform procedures for administration and scoring. A standardized test usually has a detailed test manual, exists of a set amount of items and has rigid guidelines for administration and scoring (Richardson, 2010:221). There are two types of standardized tests: norm-referenced and criterion-referenced (Richardson, 2010:221).
There are certain important factors that the occupational therapist should take in consideration when choosing assessment methods (Baum, Dunn & Law, 2005:341).
Clinical effectiveness - including cost, availability, scoring, time, equipment, training (Baum, Dunn & Law, 2005:341).
Reliability - consistency of scores obtained by an individual (Richardson, 2010:229).
Validity - the extent to which the test measures what it claims to measure (Richardson, 2010:232).
Standardized tests have been developed with the factors mentioned above well described and researched and therefore have various advantages, giving the assessment process more credibility (Richardson, 2010:239). It is important that all examiners using standardized tests are conscious of the advantages, disadvantages and implications that these tests can have on results. Advantages of standardized tests include objectivity, (Asher, 2007:14) quantification and are performed according to uniform procedures (Richardson, 2010:239). Since standardized tests that are norm-referenced according to age, children with developmental delays can be identified and improvement can be compared with expected developmental progress of normative sample (Richardson, 2010:239). Standardized tests must however be used in conjunction with other forms of assessment to provide meaning and ensure that the numerical scores obtained by standardized assessments represent the aspect assessed (Richardson, 2010:239).
Assessing sensory integration and praxis requires the therapist to use a combination of quantitative and qualitative procedures as described above (Kinnealey & Miller, 1993:477). One of the most important ways of assessing praxis is through observation of the child during participation in unfamiliar activities - both gross and fine motor tasks which provide unexpected, flexible and novel situations, challenging his problem solving abilities. Observation is focused on how the child plans and sequences tasks (Williamson et al., 2010:164).
A small number of standardized instruments are available to screen and assess sensory integration and praxis. Observation and clinical judgment are the most important ways of deciding whether praxis contributes to a performance deficit.
The Miller Assessment of Preschoolers is a norm-referenced test which can be used to screen a child's praxis abilities (Williamson et al., 2010:166).
Praxis is best evaluated by the Sensory Integration and Praxis Tests (SIPT), developed by Dr. A. Jean Ayres (Parham & Mailloux, 2010:350). The SIPT, published in the 1990's, was standardized on 1997 children in the United States and Canada. The test evaluates sensory processing and praxis abilities of children ages 4 to 9 (Bodison & Mailloux, 2006:1; Kinnealey & Miller, 1993:477). The SIPT consists of a battery of 17 tests, which assess visual perception, somatosensory processing, vestibular processing and various types of praxis (Stewart, 2010:215).
The SIPT is individually administered in approximately 90 to 120 minutes and results are computer-scored by the publisher. In order to administer the SIPT, therapists must be qualified and have completed various courses (Kinnealey & Miller, 1993:477). These tests however don't include subtests or specific criteria to measure ideational praxis in children. Due to this lack of objective information, Teresa A. May Benson (2007:148) developed the Test of Ideational Praxis (TIP) - an individually administered test that assesses ideational praxis in children 5-8 years of age (May-Benson & Cermak, 2007:148-149; May-Benson, 2005:2). The test was developed by means of three main steps: (1) recognizing the necessity for a method to assess ideational praxis, (2) defining ideation and it's functioning, and (3) the preliminary formation and pilot testing of a formal test of ideation (May-Benson & Cermak, 2007:148-49).
Studies found the TIP to be "a reliable objective assessment" (May-Benson & Cermak, 2007:152). The test consists of one item, a string, which is scored based on the child's ability to demonstrate various affordances identified for the object. The test focuses on a child's ability to produce as many ideas possible in which an object can be used. Emphasis is not on creativity, but rather on the child's ability to identify the object's various qualities. When scoring a child's performance, credit is given mainly for the child's ability to identify the basic affordances of an object and not for the use of creativity or imagination. The test requires that the child demonstrates his or her ideas, therefore it is important that any verbalizations are avoided as far as possible (May-Benson, 2005:2-3,5).
Administration and scoring is done while completing the test and takes approximately 5-10 minutes. In order to administer the TIP, the examiner must be thoroughly familiar with all aspects of test administration presented in the examiner's manual, along with scoring criteria and scoring procedures (May-Benson, 2005:2-3).
Interpretations of scores are done by using scoring tables given in the examiner's manual. (May-Benson, 2005:7). The average mean score and standard deviation for typically functioning children of each age group (ages 5-8 years) are given in the scoring tables. If a child's score falls below the standard deviation for the typical group of his or her age, it may be an indication that the child experiences problems with ideation (May-Benson, 2005:7).
The following strategies will ensure optimal performance during testing:
Examiner competency: Each occupational therapist must be thoroughly familiar with the test before administering (Richardson, 2010:235). Observing an experienced examiner and practicing the administration of the test can improve the examiner's skill in administration of the test (Richardson, 2010:235).
Structuring of the test room: The test room must meet specifications of the test manual (Richardson, 2010:236). No objects or materials, other than the shoelace may be used during test and all materials must be removed out of the testing room. If a child uses other materials no points will be awarded for the action, even if it was an original idea (May-Benson, 2005:3). The test room must be free of distractions. Screens or room dividers can be used to partition off a room, if there is limited space available (Richardson, 2010:236).
Condition of test materials: All the test materials should be available and in a working condition (May-Benson, 2005:4).
Test administration: The TIP has definite guidelines regarding the instructions to give the child performing the test. Suggestions from the examiner that uses a verb, adjective or adverb, such as "How else could you twirl the string?" would invalidate the test and should be avoided (May-Benson, 2005:4). The skilled examiner can help the child perform better on the test, by giving child appropriate prompts such as encouraging the child to demonstrate ideas, as verbalized ideas alone do not score any points on the TIP (May-Benson, 2005:3).
Familiarity with the administration of the test allows the examiner to manipulate the pace of test, take full advantage of the brief examination time and prevents mistakes which could invalidate test results (Richardson, 2010:237).
Handling of the child: The assessment process can be daunting but by explaining the test in clear, simple language and by being organized, the examiner can reduce the anxiety of the child (Stewart, 2010:204). It is also important to use positive reinforcement throughout the whole assessment to acknowledge the child's ideas and motivate the child to keep participating (Stewart, 2010:204).
Cultural bias: Tests are often developed on a specific cultural or income status group and these tests may not be valid, when used on other diverse populations (Richardson, 2010:238). According to (Richardson, 2010:239), several studies have found that performance of children from different countries on standardized tests, developed in the United States of America, differ from the population on which the test was developed on. Factors such as the child's familiarity with test situation, decreased motivation to complete tasks due to irrelevance of activities, previous experience with test materials and language barriers can affect the child's performance (Richardson, 2010:239). Examiners that are aware of these factors can take the necessary steps to minimize possible difficulties. Steps that can be taken include the use of an interpreter to cross the language barrier, including the caregiver in the assessment process to make the process less intimidating and developing norms that reflects performance of the cultural group tested (Richardson, 2010:239).
From the above information of the TIP, it is clear that at this stage the test has only been standardized on 3-5 year old children in the US. This research would however want to study the ideational praxis abilities of 3-5 year old children from middle to high socio-economic settings.
The literature study has revealed that ideational praxis abilities are already evident in 2 year old children. Looking at the importance of ideational praxis in daily functioning the researchers has decided to study the ideational praxis abilities of 3-5 years old in middle to high socio-economic settings as a pilot study, which could lead to further studies to standardize the TIP on the South African population.
This study will complement a similar study done on 3-5 year old children from low socio-economic settings.